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Open Access Highly Accessed Research article

Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis

Jae Hyung Cho1*, Gurusaravanan Kutti Sridharan2, Seon Ha Kim3, Roop Kaw4, Triveni Abburi2, Affan Irfan2 and Abraham G Kocheril5

Author Affiliations

1 Department of Hospital Medicine, Cleveland Clinic, OH, 9500 Euclid Avenue, M2-Annex, Cleveland, OH 44195, USA

2 Department of Internal Medicine, College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA

3 Department of Nursing, Dankook University, Cheonan, Republic of Korea

4 Departments of Hospital Medicine and Outcomes Research Anesthesiology, Cleveland Clinic, Cleveland, OH, USA

5 Department of Cardiology, College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA

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BMC Cardiovascular Disorders 2014, 14:64  doi:10.1186/1471-2261-14-64

Published: 6 May 2014

Abstract

Background

We investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE). Short-term mortality has been investigated only in small studies and the results have been controversial.

Methods

A PubMed search was conducted using two keywords, “pulmonary embolism” and “echocardiogram”, for articles published between January 1st 1998 and December 31st 2011. Out of 991 articles, after careful review, we found 12 articles that investigated the implications of RVD as assessed by echocardiogram in predicting short-term mortality for hemodynamically stable patients with acute PE. We conducted a meta-analysis of these data to identify whether the presence of RVD increased short-term mortality.

Results

Among 3283 hemodynamically stable patients with acute PE, 1223 patients (37.3%) had RVD, as assessed by echocardiogram, while 2060 patients (62.7%) had normal right ventricular function. Short-term mortality was reported in 167 (13.7%) out of 1223 patients with RVD and in 134 (6.5%) out of 2060 patients without RVD. Hemodynamically stable patients with acute PE who had RVD as assessed by echocardiogram had a 2.29-fold increase in short-term mortality (odds ratio 2.29, 95% confidence interval 1.61-3.26) compared with patients without RVD.

Conclusions

In hemodynamically stable patients with acute PE, RVD as assessed by echocardiogram increases short-term mortality by 2.29 times. Consideration should be given to obtaining echocardiogram to identify high-risk patients even if they are hemodynamically stable.

Keywords:
Echocardiography; Pulmonary embolism; Right ventricular dysfunction