The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis

Autor: Javed Ehtisham, Emmanuelle Cauderlier, Michèle Hamon, Guillaume Coutance, Martial Hamon
Přispěvatelé: BMC, Ed., Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de Radiologie [CHU Caen], Epidémiologie des maladies chroniques : impact des interactions gène environnement sur la santé des populations, Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Male
MESH: Pulmonary Embolism
[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
Ventricular Dysfunction
Right
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
MESH: Risk Assessment
0302 clinical medicine
MESH: Aged
80 and over
Clinical endpoint
Natriuretic peptide
030212 general & internal medicine
MESH: Ventricular Dysfunction
Right
Aged
80 and over
MESH: Aged
education.field_of_study
MESH: Middle Aged
Mortality rate
Middle Aged
Prognosis
MESH: Predictive Value of Tests
3. Good health
Pulmonary embolism
Echocardiography
Predictive value of tests
Cardiology
Female
MESH: Tomography
X-Ray Computed
medicine.medical_specialty
medicine.drug_class
Population
Risk Assessment
MESH: Prognosis
03 medical and health sciences
Predictive Value of Tests
Internal medicine
medicine
[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO]
Humans
MESH: Natriuretic Peptides
education
Natriuretic Peptides
Aged
MESH: Humans
business.industry
Research
MESH: Biological Markers
Odds ratio
medicine.disease
Confidence interval
MESH: Male
MESH: Echocardiography
business
Pulmonary Embolism
Tomography
X-Ray Computed
MESH: Female
Biomarkers
Zdroj: Critical Care
Critical Care, BioMed Central, 2011, 15 (2), pp.R103. ⟨10.1186/cc10119⟩
ISSN: 1364-8535
1466-609X
DOI: 10.1186/cc10119⟩
Popis: International audience; INTRODUCTION: 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.
Databáze: OpenAIRE
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