Computed tomography‐assessed right ventricular dysfunction and risk stratification of patients with acute non‐massive pulmonary embolism: systematic review and meta‐analysis

Abstract

Summary. Background: The ability of computed tomography (CT)-assessed right ventricular dysfunction (RVD) to identify normotensive patients with acute pulmonary embolism (PE) at high risk of mortality or adverse outcome lacks clarity. Methods and Results: We performed a systematic review and a meta-analysis of studies in normotensive patients with acute PE to assess the prognostic value of CT-assessed RVD for death and a predefined composite outcome of PE-related complications. We conducted unrestricted searches of MEDLINE and EMBASE from 1980 to March 2013, and used the terms 'computed tomography', 'pulmonary embolism', and 'prognos*'. We used a random-effects model to pool study results, funnel-plot inspection to evaluate for publication bias, and I 2 testing to assess for heterogeneity. The analysis included data from 10 studies (2288 patients). Overall, 99 of 1268 patients with RVD assessed by CT died (7.8%; 95% confidence interval [CI] 6.3-9.3) as compared with 52 of 1020 without RVD (5.1%; 95% CI 3.7-6.4). CT-assessed RVD had significant associations with mortality (odds ratio [OR] 1.8; 95% CI 1.3-2.6), with death resulting from PE (OR 7.4; 95% CI 1.4-39.5), and with PE-related complications (OR 2.4; 95% CI 1.2-4.7). Pooled likelihood ratios (LRs) were not extreme (negative LR 0.71; 95% CI 0.57-0.89; and positive LR 1.27; 95% CI 1.12-1.43). Conclusions: Although RVD assessed by CT showed an association with an increased risk of mortality in patients with hemodynamically stable PE, it resulted in only small increases in the ability to classify risk.

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

“…More recently, a role has been identified for CT angiography in the assessment of right ventricle dilation and, if confirmed, could make risk stratification simpler and rapidly available in an urgent setting. A recently published meta-analysis showed an increased risk of death in patients with sub-massive pulmonary embolism [54]. By confirming this association in both the real ''short-term'' phase (up to 30 days) and up to 3 months for different CT measurement (transverse and 4-chamber images, and IVS bowing), and in a large population (almost 4000 patients), our study sets the stage for the role of CT angiography in risk stratification in patients with pulmonary embolism.…”

Correlation of clot distribution with morphometric measurements and pleuroparenchymal findings in acute pulmonary embolism: experience with 692 cases

“…and 30-day mortality (15,16,18), and one meta-analysis (17) states RV/LV to be related with 30-day and 3-month mortality rates. A meta-analysis (18) concluded central PE was associated with increased 30-day mortality.…”

“…(10)(11)(12)(13). The correlation between the severity of PE and pleuroparenchymal findings as well as risk stratification by means of thrombus characteristics, quantification, and indicators of right ventricular dysfunction have been reported in recent studies (14)(15)(16)(17)(18). …”

The efficacy of CT for detection of right ventricular dysfunction in acute pulmonary embolism, and comparison with cardiac biomarkers

“…Although echocardiography (ECHO) performed at bedside is the imaging modality of choice for demonstration of RVD, for unstable patients CTPA has recently replaced ECHO for this purpose, because of its high accuracy and 24-h availability in most healthcare centers [6]. CTPA enables heart chamber quantification and has thus been increasingly preferred for evaluation of right ventricular (RV) function in acute PE, and is an attractive alternative to ECHO [7].…”