Need for Transthoracic Echocardiogram in Patients with Low-Risk Pulmonary Thromboembolism: A Systematic Review and Meta-Analysis

Andrade, Isabel; García, Alba; Mercedes, Edwin; León, Francisco; Velasco, Diurbis; Rodrı́guez, Carmen; Pintado, Beatriz; Pérez, Andrea; Jiménez, David

doi:10.1016/j.arbr.2020.03.006

Cited by 6 publications

(9 citation statements)

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“…17 Another recent meta-analysis of 1,868 patients at low risk as identified by clinical scores demonstrated that RV dysfunction was associated with PErelated but not overall mortality compared with absence of RV dysfunction. 19 However, the absolute number of PE-specific deaths was very low, affecting 6/447 patients with and 2/1,421 patients without RV dysfunction. 19 The results from the two meta-analyses are partially driven by the results from a registry that reported 4 deaths among 145 low-risk patients (only 1 was PE-related).…”

Section: Discussionmentioning

confidence: 95%

“…19 However, the absolute number of PE-specific deaths was very low, affecting 6/447 patients with and 2/1,421 patients without RV dysfunction. 19 The results from the two meta-analyses are partially driven by the results from a registry that reported 4 deaths among 145 low-risk patients (only 1 was PE-related). 20 This relatively elevated mortality may be due to the high proportion of patients with cancer in this registry (31%), which was substantially higher than in our cohort (17%) and most other PE studies.…”

Section: Discussionmentioning

confidence: 95%

“…22 Moreover, the presence of RV dysfunction or elevated troponin did not predict adverse outcomes in patients with PE selected for home treatment. 23,24 17,19 whether a treatment upgrade (e.g., hospitalization or increased monitoring) improves patient safety remains to be investigated. In our analysis, the 2019 ESC risk stratification algorithm tended to have a lower discriminative power for short-term outcomes than the simpler 2014 ESC algorithm or the PESI.…”

Section: Discussionmentioning

confidence: 99%

“…To date, no prospective management studies have compared clinical risk assessment alone with a strategy combining clinical and systematic RV function assessment in low-risk PE patients. Although observational studies have shown an increased risk of short-term mortality in low-risk PE patients with compared with those without RV dysfunction,17,19 whether a treatment upgrade (e.g., hospitalization or increased monitoring) improves patient safety remains to be investigated.In our analysis, the 2019 ESC risk stratification algorithm tended to have a lower discriminative power for short-term outcomes than the simpler 2014 ESC algorithm or the PESI. Irrespective of RV function, no deaths occurred in low-risk categories of any of the three risk stratification modalities, indicating that additional risk stratification in low-risk patients based on a validated clinical score may be unnecessary.…”

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confidence: 99%

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Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

et al. 2021

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Background: The 2019 European Society of Cardiology (ESC) guidelines recommend evaluation for right ventricular dysfunction in all normotensive patients with acute pulmonary embolism (PE). We compared the predictive performance of the 2019 and 2014 ESC risk stratification algorithms and the Pulmonary Embolism Severity Index (PESI). Methods: We performed a post-hoc analysis of normotensive patients aged ≥65 years with acute PE from a prospective cohort. The primary outcome was overall mortality; secondary outcomes were PE-related mortality and adverse outcomes (PE-related death, cardiopulmonary resuscitation, intubation, catecholamine use, recurrent venous thromboembolism) at 30 days. We assessed outcomes in intermediate-high, intermediate-low, and low risk groups according to the 2019 and 2014 ESC algorithms and the PESI. Discriminative power was compared using the area under the receiver operating curve (AUC). Results: Among 419 patients, 14 (3.3%) died (7 from PE) and 16 (3.8%) had adverse outcomes within 30 days. The 2019 ESC algorithm classified more patients as intermediate-high risk (45%) than the 2014 ESC algorithm (24%) or PESI (37%), and only 19% as low risk (32% with 2014 ESC or PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC 63.6%), compared to the 2014 ESC algorithm (AUC 71.5%) or PESI (AUC 75.2%), although the difference did not reach statistical significance (p=0.063). Discrimination for PE-related mortality and adverse outcomes was similar. Conclusions: While categorizing more patients in higher-risk groups, the 2019 ESC algorithm for PE did not improve prediction of short-term outcomes compared to the 2014 ESC algorithm or the PESI.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

et al. 2021

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“…Pulmonary thromboembolism (PTE) is a disease caused by thrombosis from the venous system or the right heart that blocks the pulmonary artery or its branches. Pulmonary circulation and respiratory dysfunction are its main clinical and pathophysiological characteristics [ 4 ]. Pulmonary thromboembolism is the most common type of pulmonary embolism (PE), accounting for more than 90% of all PEs, and it is usually called PE or PTE.…”

Section: Related Workmentioning

confidence: 99%

Clinical Characteristics of Patients with Pulmonary Thromboembolism Based on Computer Statistical Analysis

Wang

Jia

Pang

2022

Journal of Healthcare Engineering

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In order to explore the reliable clinical characteristics of patients with pulmonary thromboembolism, this paper applies computer statistical analysis methods to the analysis of clinical characteristics of patients with pulmonary thromboembolism. Moreover, starting from the actual situation, this paper combines experiments to study the case, uses sample screening and sample processing to group samples freely, and conducts grouping reliability research through data statistics methods. After verifying the reliability of the grouping, this paper combines the samples to test the effectiveness of the computer statistical analysis method applied to the clinical characteristic analysis of patients with pulmonary thromboembolism and conducts numerical analysis in combination with the comparative analysis method. The results of the research show that the computer statistical method proposed in this paper has a good effect on the clinical characteristics of patients with pulmonary thromboembolism and meets the actual needs of clinical analysis.

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Can right ventricular assessments improve triaging of low risk pulmonary embolism?

Raper

Thomas

Lupez

et al. 2022

Academic Emergency Medicine

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Objectives Identifying right ventricle (RV) abnormalities is important to stratifying pulmonary embolism (PE) severity. Disposition decisions are influenced by concerns about early deterioration. Triaging strategies, like the Simplified Pulmonary Embolism Severity Index (sPESI), do not include RV assessments as predictors or early deterioration as outcome(s). We aimed to (1) determine if RV assessment variables add prognostic accuracy for 5‐day clinical deterioration in patients classified low risk by sPESI, and (2) determine the prognostic importance of RV assessments compared to other variables and to each other. Methods We identified low risk sPESI patients (sPESI = 0) from a prospective PE registry. From a large field of candidate variables, we developed, and compared prognostic accuracy of, full and reduced random forest models (with and without RV assessment variables, respectively) on a validation database. We reported variable importance plots from full random forest and provided odds ratios for statistical inference of importance from multivariable logistic regression. Outcomes were death, cardiac arrest, hypotension, dysrhythmia, or respiratory failure within 5 days of PE. Results Of 1736 patients, 610 (35.1%) were low risk by sPESI and 72 (11.8%) experienced early deterioration. Of the 610, RV abnormality was present in 157 (25.7%) by CT, 121 (19.8%) by echocardiography, 132 (21.6%) by natriuretic peptide, and 107 (17.5%) by troponin. For deterioration, the receiver operating characteristics for full and reduced random forest prognostic models were 0.80 (0.77–0.82) and 0.71 (0.68–0.73), respectively. RV assessments were the top four in the variable importance plot for the random forest model. Echocardiography and CT significantly increased predicted probability of 5‐day clinical deterioration by the multivariable logistic regression. Conclusions A PE triaging strategy with RV imaging assessments had superior prognostic performance at classifying low risk for 5‐day clinical deterioration versus one without.

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Need for Transthoracic Echocardiogram in Patients with Low-Risk Pulmonary Thromboembolism: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 30 publications

Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

Clinical Characteristics of Patients with Pulmonary Thromboembolism Based on Computer Statistical Analysis

Can right ventricular assessments improve triaging of low risk pulmonary embolism?

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