Pulmonary embolism: impact of right ventricular dysfunction.
OBJECTIVE
The appropriate treatment of patients with acute pulmonary embolism who present with right ventricular dysfunction but normal arterial blood pressure, and particularly the potential benefits of thrombolytic treatment in this setting, continue to be highly controversial. In the past year, several well designed studies improved our understanding of subclinical right ventricular dysfunction in pulmonary embolism, and emerging risk stratification algorithms now appear to identify high-risk patients reliably.


RESULTS
A meta-analysis confirmed that echocardiographically diagnosed right ventricular dysfunction is an independent predictor of early mortality in normotensive patients with pulmonary embolism. Retrospective studies suggest that similar information can also be obtained by multidetector-row chest computed tomography. Recent data indicate that biomarker (particularly troponin) testing followed by echocardiographic imaging of the right ventricle is an efficient and reliable strategy both for excluding (ruling out) and for predicting (ruling in) a poor outcome in patients with pulmonary embolism.


CONCLUSIONS
Novel risk stratification algorithms may help identify possible candidates for early thrombolytic treatment in pulmonary embolism and thus provide the background for a large international multicenter study that will hopefully resolve the 30-year-old debate on the benefits of thrombolysis in normotensive patients with pulmonary embolism and right ventricular dysfunction.
Konstantinides
Stavros
S
Department of Cardiology and Pulmonary Medicine, Georg August University of Goettingen, Germany. skonstan@med.uni-goettingen.de
D000465:Algorithms; D015415:Biomarkers / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D045265:Natriuretic Peptides / Q000032:analysis; D011379:Prognosis; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014336:Troponin / Q000032:analysis; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000175:diagnosis*
D015415:Biomarkers; D045265:Natriuretic Peptides; D014336:Troponin