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

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.
Type de document :
Article dans une revue
Critical Care, BioMed Central, 2011, 15 (2), pp.R103. 〈10.1186/cc10119〉
Liste complète des métadonnées

Littérature citée [19 références]  Voir  Masquer  Télécharger

http://www.hal.inserm.fr/inserm-00663666
Contributeur : Ed. Bmc <>
Soumis le : vendredi 27 janvier 2012 - 14:02:46
Dernière modification le : jeudi 26 avril 2018 - 01:05:24
Document(s) archivé(s) le : mercredi 14 décembre 2016 - 01:49:41

Fichiers

cc10119.pdf
Fichiers éditeurs autorisés sur une archive ouverte

Identifiants

Collections

Citation

Guillaume Coutance, Emmanuelle Cauderlier, Javed Ehtisham, Michèle Hamon, Martial Hamon. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis.. Critical Care, BioMed Central, 2011, 15 (2), pp.R103. 〈10.1186/cc10119〉. 〈inserm-00663666〉

Partager

Métriques

Consultations de la notice

185

Téléchargements de fichiers

165