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Open Access Highly Accessed Research

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

Guillaume Coutance1, Emmanuelle Cauderlier2, Javed Ehtisham1, Michèle Hamon2 and Martial Hamon13*

Author Affiliations

1 Cardiologie, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandy, France

2 Service de radiologie, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandy, France

3 Inserm 744, Institut Pasteur de Lille, 1 rue du Professeur Calmette, 59019 Lille cedex, France

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Critical Care 2011, 15:R103  doi:10.1186/cc10119

Published: 28 March 2011

Abstract

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.