Details

Autor(en) / Beteiligte

• Andrade, Isabel
• Mehdipoor, Ghazaleh
• Le Mao, Raphael
• García-Sánchez, Aldara
• Pintado, Beatriz
• Pérez, Andrea
• Rodríguez, Carmen
• Velasco, Diurbis
• Bikdeli, Behnood
• Jiménez, David

Titel

Prognostic significance of computed tomography-assessed right ventricular enlargement in low-risk patients with pulmonary embolism: Systematic review and meta-analysis

Ist Teil von

• Thrombosis research, 2021-01, Vol.197, p.48-55

Ort / Verlag

United States: Elsevier Ltd

Erscheinungsjahr

2021

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• For patients with acute low-risk pulmonary embolism (PE), determined by a validated clinical prognostic score, the additive prognostic significance of computed tomography (CT)-assessed right ventricular (RV) enlargement is uncertain. We performed a systematic review and meta-analysis of studies that enrolled patients with acute low-risk PE to assess the prognostic value of concomitant CT-assessed RV enlargement for 30-day all-cause mortality and PE-related death. We conducted unrestricted searches of PubMed and Embase through December 2019. We used a random-effects model to pool study results; Begg rank correlation method to evaluate for publication bias; and I2 testing to assess for heterogeneity. Of the 7 cohorts with 2197 participants who had low-risk PE and provided results on the primary outcome, 743 (34%; 95% confidence interval [CI], 32–36%) patients had concomitant RV enlargement. Six of 743 (0.8%; 95% CI, 0.3–1.8%) patients with concomitant RV enlargement died 30-days after the diagnosis of PE compared with 3 of 1454 (0.2%, 95% CI, 0–0.6%) without RV enlargement. CT-assessed RV enlargement did not have a significant association with 30-day all-cause mortality (odds ratio [OR], 2.6; 95% CI, 0.7–9.4; I2 = 0%; P = 0.15) or PE-related mortality (OR, 2.8; 95% CI, 0.7–12.1; I2 = 0%; P = 0.16). CT-assessed RV enlargement occurs in a third of PE patients identified as low-risk by clinical scores. Mortality rate in these patients is low, and CT-assessed RV enlargement was not associated with a significantly increased risk of death within 30 days of PE diagnosis. •The 2019 European Society of Cardiology (ESC) guidelines suggest the routine assessment of the right ventricle (RV) by imaging methods in patients with low-risk pulmonary embolism (PE).•In this meta-analysis of patients with acute symptomatic low-risk PE, the presence of computed tomography-detectable RV enlargement did not show significantly increased risk of short-term death.•Additional studies are required to determine if routine monitoring of RV enlargement is helpful in select subgroups of patients with acute low-risk PE.