title: The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis.
abstract: BACKGROUND
  In pulmonary embolism (PE) without hemodynamic compromise, the prognostic value of right ventricular (RV) dysfunction as measured by echocardiography, computed tomography (CT) or biological (natriuretic peptides) markers has only been assessed in small studies.
  
  
  METHODS
  Databases were searched using the combined medical subject headings for right ventricular dysfunction or right ventricular dilatation with the exploded term acute pulmonary embolism. This retrieved 8 echocardiographic marker based studies (n = 1249), three CT marker based studies (n = 503) and 7 natriuretic peptide based studies (n = 582). A meta-analysis of these data was performed with the primary endpoint of mortality within three months after pulmonary embolism, and a secondary endpoint of overall mortality and morbidity by pulmonary embolism.
  
  
  RESULTS
  Patients with PE without hemodynamic compromise on admission and the presence of RV dysfunction determined by echocardiography and biological markers were associated with increased short-term mortality (odds ratio (OR) ECHO = 2.36; 95% confidence interval (CI): 1.3-43; OR BNP = 7.7; 95% CI: 2.9-20) while CT was not (ORCT = 1.54-95% CI: 0.7-3.4). However, corresponding pooled negative and positive likelihood ratios independent of death rates were unsatisfactory for clinical usefulness in risk stratification.
  
  
  CONCLUSIONS
  The presence of echocardiographic RV dysfunction or elevated natriuretic peptides is associated with short-term mortality in patients with pulmonary embolism without hemodynamic compromise. In contrast, the prognostic value of RV dilation on CT has yet to be validated in this population. As indicated both by positive and negative likelihood ratios the current prognostic value in clinical practice remains very limited.
authors: Cardiologie, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandy, France.
authors: Guillaume
authors: G
authors: Coutance
authors: Emmanuelle
authors: E
authors: Cauderlier
authors: Javed
authors: J
authors: Ehtisham
authors: Michèle
authors: M
authors: Hamon
authors: Martial
authors: M
authors: Hamon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D018570:Risk Assessment / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides