Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: Systematic review and meta-analysis

J. Trujillo-Santos, P. L. den Exter, V. Gómez, H. del Castillo, C. Moreno, T. van der Hulle, M. V. Huisman, M. Monreal, R. D. Yusen, D. Jiménez

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Abstract

Background: The ability of computed tomography (CT)-assessed right ventricular dysfunction (RVD) to identify normotensive patients with acute pulmonary embolism (PE) at high risk of mortality or adverse outcome lacks clarity. Methods and Results: We performed a systematic review and a meta-analysis of studies in normotensive patients with acute PE to assess the prognostic value of CT-assessed RVD for death and a predefined composite outcome of PE-related complications. We conducted unrestricted searches of MEDLINE and EMBASE from 1980 to March 2013, and used the terms 'computed tomography', 'pulmonary embolism', and 'prognos*'. We used a random-effects model to pool study results, funnel-plot inspection to evaluate for publication bias, and I2 testing to assess for heterogeneity. The analysis included data from 10 studies (2288 patients). Overall, 99 of 1268 patients with RVD assessed by CT died (7.8%; 95% confidence interval [CI] 6.3-9.3) as compared with 52 of 1020 without RVD (5.1%; 95% CI 3.7-6.4). CT-assessed RVD had significant associations with mortality (odds ratio [OR] 1.8; 95% CI 1.3-2.6), with death resulting from PE (OR 7.4; 95% CI 1.4-39.5), and with PE-related complications (OR 2.4; 95% CI 1.2-4.7). Pooled likelihood ratios (LRs) were not extreme (negative LR 0.71; 95% CI 0.57-0.89; and positive LR 1.27; 95% CI 1.12-1.43). Conclusions: Although RVD assessed by CT showed an association with an increased risk of mortality in patients with hemodynamically stable PE, it resulted in only small increases in the ability to classify risk.

Original languageEnglish
Pages (from-to)1823-1832
Number of pages10
JournalJournal of Thrombosis and Haemostasis
Volume11
Issue number10
DOIs
StatePublished - Oct 2013

Keywords

  • Meta-analysis
  • Mortality
  • Multidetector computed tomography
  • Prognosis
  • Pulmonary embolism

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    Trujillo-Santos, J., den Exter, P. L., Gómez, V., del Castillo, H., Moreno, C., van der Hulle, T., Huisman, M. V., Monreal, M., Yusen, R. D., & Jiménez, D. (2013). Computed tomography-assessed right ventricular dysfunction and risk stratification of patients with acute non-massive pulmonary embolism: Systematic review and meta-analysis. Journal of Thrombosis and Haemostasis, 11(10), 1823-1832. https://doi.org/10.1111/jth.12393