Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review.
OBJECTIVE
To determine the prognostic value of right ventricular (RV) dysfunction assessed by echocardiography or spiral computed tomography (CT), or by increased levels of cardiac biomarkers [troponin, brain natriuretic peptide (BNP) and pro-BNP] in patients with haemodynamically stable pulmonary embolism (PE).


RESULTS
We included all studies published between January 1985 and October 2007 estimating the relationship between echocardiography, CT or cardiac biomarkers and the risk of death in patients with haemodynamically stable PE. Twelve of 722 potentially relevant studies met inclusion criteria. The unadjusted risk ratio of RV dysfunction as assessed by echocardiography (five studies) or by CT (two studies) for predicting death was 2.4 [95% confidence interval (CI) 1.3-4.4]. The unadjusted risk ratio for predicting death was 9.5 (95% CI 3.2-28.6) for BNP (five studies), 5.7 (95% CI 2.2-15.1) for pro-BNP (two studies) and 8.3 (95% CI 3.6-19.3) for cardiac troponin (three studies). Threshold values differed substantially between studies for all markers.


CONCLUSIONS
RV dysfunction assessed by CT, echocardiography, or by cardiac biomarkers are all associated with an increased risk of mortality in patients with haemodynamically stable PE. These findings should be interpreted with caution because of the clinical and methodological diversity of studies.
Sanchez
Olivier
O
Division of Respiratory and Intensive Care Medicine, Georges Pompidou European Hospital, 75015 Paris, France. olivier.sanchez@egp.aphp.fr
Trinquart
Ludovic
L
Colombet
Isabelle
I
Durieux
Pierre
P
Huisman
Menno V
MV
Chatellier
Gilles
G
Meyer
Guy
G
D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D004452:Echocardiography; D004812:Epidemiologic Methods; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011379:Prognosis; D011655:Pulmonary Embolism / Q000401:mortality*; D036542:Tomography, Spiral Computed; D014336:Troponin / Q000378:metabolism; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis*
D015415:Biomarkers; D014336:Troponin; D020097:Natriuretic Peptide, Brain