title: Prognostic Significance of Right Heart Thrombi in Patients With Acute Symptomatic Pulmonary Embolism: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant right heart thrombi (RHT) lacks clarity.
  
  
  METHODS
  We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of echocardiography-detectable RHT for the primary outcome of short-term all-cause mortality and the secondary outcome of short-term PE-related mortality. Unrestricted searches were conducted of PubMed and Embase from 1980 through January 31, 2016, and used the terms "right heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was used to pool study results; Begg rank correlation method was used to evaluate for publication bias; and I2testing was used to assess for heterogeneity.
  
  
  RESULTS
  Six of 79 potentially relevant studies met the inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95% CI, 4.0-4.7]). RHT had a significant association with short-term all-cause mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I2= 20%) and with PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I2= 76%). Results were consistent for the prospective (two cohorts, 514 patients; OR, 4.8 [95% CI, 1.7-13.6]; I2= 56%) and the retrospective (four cohorts, 14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I2= 0%) studies.
  
  
  CONCLUSIONS
  In patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis.
  
  
  BACKGROUND
  PROSPERO registry; No.: CRD42016033960; URL: https://www.crd.york.ac.uk/prospero/.
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
authors.forename: Deisy
authors.initials: D
authors.lastname: Barrios
authors.affiliation: Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Rosa-Salazar
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Morillo
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Nieto
authors.affiliation: Cardiology Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Fernández
authors.affiliation: Cardiology Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona and Universidad Católica de Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
authors.affiliation: Department of Cardiovascular and Pulmonary Thromboembolic Diseases, European Health Centre, Otwock, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D002423:Cause of Death; D015897:Comorbidity; D004452:Echocardiography; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D009026:Mortality; D011379:Prognosis; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000401:mortality*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: meta-analysis; mortality; prognosis; pulmonary embolism; right heart thrombi