Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis

Abstract

BackgroundWe sought to determine the prognostic value of transthoracic echocardiography (TTE)-derived right ventricular dysfunction (RVD) in haemodynamically stable and intermediate-risk patients with acute pulmonary embolism (PE), evaluate continuous RVD parameters, and assess the literature quality.MethodsWe searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for studies assessing TTE-derived RVD in haemodynamically stable PE that reported in-hospital adverse events within 30 days. We determined pooled odds ratios (ORs) using a random-effects model, created funnel plots, evaluated the Newcastle–Ottawa scale and performed Grading of Recommendations, Assessment, Development and Evaluation.ResultsBased on 55 studies (17 090 patients, 37.8% RVD), RVD was associated with combined adverse events (AEs) (OR 3.29, 95% confidence interval (CI) 2.59–4.18), mortality (OR 2.00, CI 1.66–2.40) and PE-related mortality (OR 4.01, CI 2.79–5.78). In intermediate-risk patients, RVD was associated with AEs (OR 1.99, CI 1.17–3.37) and PE-related mortality (OR 6.16, CI 1.33–28.40), but not mortality (OR 1.63, CI 0.76–3.48). Continuous RVD parameters provide a greater spectrum of risk compared to categorical RVD. We identified publication bias, poor methodological quality in 34/55 studies and overall low certainty of evidence.ConclusionsRVD is frequent in PE and associated with adverse outcomes. However, data quality and publication bias are limitations of existing evidence.

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

“…The absence of significant association could be due to underpower for TAPSE, while it seems questionable for RV/LV ratio. In a recent meta-analysis, increasing RV/LV was a predictor of all-cause short-term death in haemodynamically stable patients (three studies, meta-analysis of continuous values) [ 81 ]. In our study, RV/LV was not a predictor of death in haemodynamically stable patients (six studies, meta-analysis of proportions).…”

Association between Hispanic or Latino ethnicity and pulmonary embolism severity, management, and in-hospital outcomes

“…Measurements of RV size and function were determined qualitatively, however, and future research should evaluate more granular and quantifiable signs of RV dysfunction such as tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (FAC). 38,39 On the surface, results of this study suggest that Hispanic patients have a lower likelihood of PE-specific intervention. This follows a study in Pennsylvania by Phillips et al which found that Black patients were less likely to receive PE-specific intervention than White patients.…”

“…Measurements of RV size and function were determined qualitatively, however, and future research should evaluate more granular and quantifiable signs of RV dysfunction such as tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (FAC). 38,39…”

Prevalence of long-term right ventricular dysfunction after acute pulmonary embolism: a systematic review and meta-analysis

“…Of note, it has been newly reported that the parameters were predictive for poor prognoses of acute PE than RVD alone in accuracy: for each unit increase in RV/LV ratio, the odds of all-cause mortality increased by over 2.5 fold, every 1 mm decrease in TAPSE increased the odds of combined adverse events by 1.3-fold, and for every 10 mmHg increase in PASP the odds of a combined adverse event increased by 1.5-fold. 3 However, dynamic changes of the parameters, the underlying mechanism, their relationship with long-term structural and functional changes of the right ventricle and outcomes were less discussed. Further investigation are warranted.…”

“… 1 Acute right ventricular dysfunction (RVD), defined as a rapidly progressive syndrome due to acute obstruction of pulmonary artery by thrombus resulting in impaired right ventricular filling and/or reduced right ventricular flow output, indicated by abnormal echocardiographic signs or elevated cardiac biomarkers has been shown as a critical determinant of short-term mortality in patients with PE, even in the absence of clinically evident haemodynamic compromise. 1 , 2 , 3 , 4 Acute RVD was reported an incidence of at least 34% at disease onset and is determined as one of the vital indicators for intermediate-risk PE. 5 , 6 , 7 …”