Detection of right ventricular dysfunction in acute pulmonary embolism by computed tomography or echocardiography: A systematic review and meta-analysis

Link to article at PubMed

J Thromb Haemost. 2021 Jul 10. doi: 10.1111/jth.15453. Online ahead of print.

ABSTRACT

BACKGROUND: Right ventricular (RV) dysfunction predicts worse outcomes in acute pulmonary embolism (PE). As computed tomography (CT) pulmonary angiography visualizes cardiac structures, it is a potential method for assessing RV function without the delays associated with inpatient echocardiography. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of CT scan findings for detecting RV dysfunction compared to echocardiography.

METHODS: We searched MEDLINE and EMBASE from inception to April 2020 for studies comparing RV dysfunction on CT scan to echocardiography standard. Study quality was assessed with the QUADAS-2 risk of bias tool. Meta-analysis was performed using a bivariate mixed effects regression framework.

RESULTS: After screening, 26 studies (3,508 patients) were included. In a pooled analysis, septal deviation (5 studies; 459 patients) had a sensitivity of 0.31 (95% CI=0.25 0.38; I2 = 0%), specificity of 0.98 (95% CI=0.90 - 1.00; I2 = 59.4%), and positive likelihood ratio of 13.6 (95% CI=3.1 - 60.4) for RV dysfunction compared to echocardiography. The pooled sensitivity of increased RV/LV ratio (21 studies; 3,111 patients) was 0.83 (95% CI=0.78 - 0.87; I2 = 81.8%) while the pooled specificity was 0.75 (95% CI=0.66- 0.82; I2 = 94.2%) and negative likelihood ratio was 0.23 (0.18-0.29).

CONCLUSIONS: Overall, RV dysfunction can be detected by CT imaging but the diagnostic accuracy when compared to echocardiography varies depending on specific findings. The presence of septal bowing appears to be highly specific for RV dysfunction. Our findings suggest that multiple CT findings of RV dysfunction may improve diagnostic accuracy and further studies are warranted.

PMID:34245115 | DOI:10.1111/jth.15453

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