title: Enlarged right ventricle without shock in acute pulmonary embolism: prognosis.
abstract: OBJECTIVE
  An unsettled issue is the use of thrombolytic agents in patients with acute pulmonary embolism (PE) who are hemodynamically stable but have right ventricular (RV) enlargement. We assessed the in-hospital mortality of hemodynamically stable patients with PE and RV enlargement.
  
  
  METHODS
  Patients were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis II. Exclusions included shock, critical illness, ventilatory support, or myocardial infarction within 1 month, and ventricular tachycardia or ventricular fibrillation within 24 hours. We evaluated the ratio of the RV minor axis to the left ventricular minor axis measured on transverse images during computed tomographic angiography.
  
  
  RESULTS
  Among 76 patients with RV enlargement treated with anticoagulants and/or inferior vena cava filters, in-hospital deaths from PE were 0 of 76 (0%) and all-cause mortality was 2 of 76 (2.6%). No septal motion abnormality was observed in 49 patients (64%), septal flattening was observed in 25 patients (33%), and septal deviation was observed in 2 patients (3%). No patients required ventilatory support, vasopressor therapy, rescue thrombolytic therapy, or catheter embolectomy. There were no in-hospital deaths caused by PE. There was no difference in all-cause mortality between patients with and without RV enlargement (relative risk=1.04).
  
  
  CONCLUSIONS
  In-hospital prognosis is good in patients with PE and RV enlargement if they are not in shock, acutely ill, or on ventilatory support, or had a recent myocardial infarction or life-threatening arrhythmia. RV enlargement alone in patients with PE, therefore, does not seem to indicate a poor prognosis or the need for thrombolytic therapy.
authors.affiliation: Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich 48341-5023, USA. steinp@trinity-health.org
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.forename: Afzal
authors.initials: A
authors.lastname: Beemath
authors.forename: Fadi
authors.initials: F
authors.lastname: Matta
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Goodman
authors.forename: John G
authors.initials: JG
authors.lastname: Weg
authors.forename: Charles A
authors.initials: CA
authors.lastname: Hales
authors.forename: Russell D
authors.initials: RD
authors.lastname: Hull
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Leeper
authors.forename: H Dirk
authors.initials: HD
authors.lastname: Sostman
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Woodard
mesh_terms: D000792:Angiography / Q000379:methods*; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic; D017128:Embolectomy / Q000379:methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D012769:Shock; D015912:Thrombolytic Therapy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016306:Vena Cava Filters; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents