title: Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis.
abstract: BACKGROUND
  We investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE). Short-term mortality has been investigated only in small studies and the results have been controversial.
  
  
  METHODS
  A PubMed search was conducted using two keywords, "pulmonary embolism" and "echocardiogram", for articles published between January 1st 1998 and December 31st 2011. Out of 991 articles, after careful review, we found 12 articles that investigated the implications of RVD as assessed by echocardiogram in predicting short-term mortality for hemodynamically stable patients with acute PE. We conducted a meta-analysis of these data to identify whether the presence of RVD increased short-term mortality.
  
  
  RESULTS
  Among 3283 hemodynamically stable patients with acute PE, 1223 patients (37.3%) had RVD, as assessed by echocardiogram, while 2060 patients (62.7%) had normal right ventricular function. Short-term mortality was reported in 167 (13.7%) out of 1223 patients with RVD and in 134 (6.5%) out of 2060 patients without RVD. Hemodynamically stable patients with acute PE who had RVD as assessed by echocardiogram had a 2.29-fold increase in short-term mortality (odds ratio 2.29, 95% confidence interval 1.61-3.26) compared with patients without RVD.
  
  
  CONCLUSIONS
  In hemodynamically stable patients with acute PE, RVD as assessed by echocardiogram increases short-term mortality by 2.29 times. Consideration should be given to obtaining echocardiogram to identify high-risk patients even if they are hemodynamically stable.
authors.affiliation: Department of Hospital Medicine, Cleveland Clinic, OH, 9500 Euclid Avenue, M2-Annex, Cleveland, OH 44195, USA. choj2@ccf.org.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Cho
authors.forename: Gurusaravanan
authors.initials: G
authors.lastname: Kutti Sridharan
authors.forename: Seon Ha
authors.initials: SH
authors.lastname: Kim
authors.forename: Roop
authors.initials: R
authors.lastname: Kaw
authors.forename: Triveni
authors.initials: T
authors.lastname: Abburi
authors.forename: Affan
authors.initials: A
authors.lastname: Irfan
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Kocheril
mesh_terms: D000208:Acute Disease; D016009:Chi-Square Distribution; D006439:Hemodynamics; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016278:Ventricular Function, Right