Assessment of right ventricular function in acute pulmonary embolism
Background The optimal approach to assess right ventricular ( RV ) function in patients with acute symptomatic pulmonary embolism ( PE ) lacks clarity. Methods This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assesse...
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| Veröffentlicht in: | The American heart journal 2017-03, Vol.185, p.123-129 |
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| creator | Barrios, Deisy Morillo, Raquel Lobo, José Luis Nieto, Rosa Jaureguizar, Ana Portillo, Ana K Barbero, Esther Fernandez-Golfin, Covadonga Yusen, Roger D Jiménez, David |
| description | Background The optimal approach to assess right ventricular ( RV ) function in patients with acute symptomatic pulmonary embolism ( PE ) lacks clarity. Methods This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. Results Eight hundred and forty eight patients were enrolled. Computed tomography ( MDCT ) and echocardiography ( TTE ) agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index ( sPESI ) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had a sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred and twenty nine patients (15%) had a sPESI of >0 points, MDCT and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30 days, and 10 (7.7%) of them died. Conclusions Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, while it improved identification of those at intermediate-high risk for short-term complications. |
| doi_str_mv | 10.1016/j.ahj.2016.12.009 |
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Methods This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. Results Eight hundred and forty eight patients were enrolled. Computed tomography ( MDCT ) and echocardiography ( TTE ) agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index ( sPESI ) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had a sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred and twenty nine patients (15%) had a sPESI of >0 points, MDCT and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30 days, and 10 (7.7%) of them died. Conclusions Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, while it improved identification of those at intermediate-high risk for short-term complications.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2016.12.009</identifier><identifier>PMID: 28267465</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; Aged ; Aged, 80 and over ; Binomial distribution ; Cardiovascular ; Cause of Death ; Comorbidity ; Complications ; Computed tomography ; Echocardiography ; Embolism ; Embolisms ; Enlargement ; Female ; Health risk assessment ; Heart ; Heart Failure - epidemiology ; Humans ; Lungs ; Male ; Medical imaging ; Medical prognosis ; Middle Aged ; Mortality ; Multidetector Computed Tomography ; Patients ; Prognosis ; Prospective Studies ; Pulmonary arteries ; Pulmonary Disease, Chronic Obstructive - epidemiology ; Pulmonary Embolism - complications ; Pulmonary Embolism - epidemiology ; Pulmonary Embolism - physiopathology ; Pulmonary embolisms ; Risk Assessment ; Risk groups ; Severity of Illness Index ; Urban health care ; Ventricle ; Ventricular Dysfunction, Right - complications ; Ventricular Dysfunction, Right - diagnostic imaging ; Ventricular Dysfunction, Right - epidemiology ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Function, Right</subject><ispartof>The American heart journal, 2017-03, Vol.185, p.123-129</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c497t-8ce89fdd77493bf782abd9cc81bc41d6a1bc0d6d0a238a03f72daa1193eac7953</citedby><cites>FETCH-LOGICAL-c497t-8ce89fdd77493bf782abd9cc81bc41d6a1bc0d6d0a238a03f72daa1193eac7953</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1874436472?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28267465$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barrios, Deisy</creatorcontrib><creatorcontrib>Morillo, Raquel</creatorcontrib><creatorcontrib>Lobo, José Luis</creatorcontrib><creatorcontrib>Nieto, Rosa</creatorcontrib><creatorcontrib>Jaureguizar, Ana</creatorcontrib><creatorcontrib>Portillo, Ana K</creatorcontrib><creatorcontrib>Barbero, Esther</creatorcontrib><creatorcontrib>Fernandez-Golfin, Covadonga</creatorcontrib><creatorcontrib>Yusen, Roger D</creatorcontrib><creatorcontrib>Jiménez, David</creatorcontrib><creatorcontrib>PROTECT investigators</creatorcontrib><title>Assessment of right ventricular function in acute pulmonary embolism</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background The optimal approach to assess right ventricular ( RV ) function in patients with acute symptomatic pulmonary embolism ( PE ) lacks clarity. Methods This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. Results Eight hundred and forty eight patients were enrolled. Computed tomography ( MDCT ) and echocardiography ( TTE ) agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index ( sPESI ) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had a sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred and twenty nine patients (15%) had a sPESI of >0 points, MDCT and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30 days, and 10 (7.7%) of them died. Conclusions Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, while it improved identification of those at intermediate-high risk for short-term complications.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Binomial distribution</subject><subject>Cardiovascular</subject><subject>Cause of Death</subject><subject>Comorbidity</subject><subject>Complications</subject><subject>Computed tomography</subject><subject>Echocardiography</subject><subject>Embolism</subject><subject>Embolisms</subject><subject>Enlargement</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Heart</subject><subject>Heart Failure - epidemiology</subject><subject>Humans</subject><subject>Lungs</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multidetector Computed Tomography</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Pulmonary arteries</subject><subject>Pulmonary Disease, Chronic Obstructive - epidemiology</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - epidemiology</subject><subject>Pulmonary Embolism - physiopathology</subject><subject>Pulmonary embolisms</subject><subject>Risk Assessment</subject><subject>Risk groups</subject><subject>Severity of Illness Index</subject><subject>Urban health care</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Right - complications</subject><subject>Ventricular Dysfunction, Right - diagnostic imaging</subject><subject>Ventricular Dysfunction, Right - epidemiology</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><subject>Ventricular Function, Right</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkk1rFTEUhoMo9rb6A9zIgBs3M83XzQeCUGqrQsGFug6Z5IzNOJNck5lC_31zubVCF8XVyYHnfcM570HoDcEdwUScjp29Hjtanx2hHcb6GdoQrGUrJOfP0QZjTFslMTtCx6WMtRVUiZfoiCpaEbHdoE9npUApM8SlSUOTw6_rpbmpXQ5unWxuhjW6JaTYhNhYty7Q7NZpTtHm2wbmPk2hzK_Qi8FOBV7f1xP08_Lix_mX9urb56_nZ1et41ourXKg9OC9lFyzfpCK2t5r5xTpHSde2FqxFx5bypTFbJDUW0uIZmCd1Ft2gt4ffHc5_VmhLGYOxcE02QhpLYYoKRVngv4XuuUYy62s6LtH6JjWHOsgpq5WY660epKqXrz-yiWtFDlQLqdSMgxml8Ncd2UINvvMzGhqZntjYQg1NbOqeXvvvPYz-AfF35Aq8OEAQN3tTYBsigsQHfiQwS3Gp_Ck_cdHajeFGJydfsMtlH9TmFIF5vv-aPY3QwTDVGPG7gARobpr</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Barrios, Deisy</creator><creator>Morillo, Raquel</creator><creator>Lobo, José Luis</creator><creator>Nieto, Rosa</creator><creator>Jaureguizar, Ana</creator><creator>Portillo, Ana K</creator><creator>Barbero, Esther</creator><creator>Fernandez-Golfin, Covadonga</creator><creator>Yusen, Roger D</creator><creator>Jiménez, David</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20170301</creationdate><title>Assessment of right ventricular function in acute pulmonary embolism</title><author>Barrios, Deisy ; Morillo, Raquel ; Lobo, José Luis ; Nieto, Rosa ; Jaureguizar, Ana ; Portillo, Ana K ; Barbero, Esther ; Fernandez-Golfin, Covadonga ; Yusen, Roger D ; Jiménez, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c497t-8ce89fdd77493bf782abd9cc81bc41d6a1bc0d6d0a238a03f72daa1193eac7953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Binomial distribution</topic><topic>Cardiovascular</topic><topic>Cause of Death</topic><topic>Comorbidity</topic><topic>Complications</topic><topic>Computed tomography</topic><topic>Echocardiography</topic><topic>Embolism</topic><topic>Embolisms</topic><topic>Enlargement</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Heart Failure - epidemiology</topic><topic>Humans</topic><topic>Lungs</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multidetector Computed Tomography</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Pulmonary arteries</topic><topic>Pulmonary Disease, Chronic Obstructive - epidemiology</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - epidemiology</topic><topic>Pulmonary Embolism - physiopathology</topic><topic>Pulmonary embolisms</topic><topic>Risk Assessment</topic><topic>Risk groups</topic><topic>Severity of Illness Index</topic><topic>Urban health care</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Right - complications</topic><topic>Ventricular Dysfunction, Right - diagnostic imaging</topic><topic>Ventricular Dysfunction, Right - epidemiology</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><topic>Ventricular Function, Right</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barrios, Deisy</creatorcontrib><creatorcontrib>Morillo, Raquel</creatorcontrib><creatorcontrib>Lobo, José Luis</creatorcontrib><creatorcontrib>Nieto, Rosa</creatorcontrib><creatorcontrib>Jaureguizar, Ana</creatorcontrib><creatorcontrib>Portillo, Ana K</creatorcontrib><creatorcontrib>Barbero, Esther</creatorcontrib><creatorcontrib>Fernandez-Golfin, Covadonga</creatorcontrib><creatorcontrib>Yusen, Roger D</creatorcontrib><creatorcontrib>Jiménez, David</creatorcontrib><creatorcontrib>PROTECT investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barrios, Deisy</au><au>Morillo, Raquel</au><au>Lobo, José Luis</au><au>Nieto, Rosa</au><au>Jaureguizar, Ana</au><au>Portillo, Ana K</au><au>Barbero, Esther</au><au>Fernandez-Golfin, Covadonga</au><au>Yusen, Roger D</au><au>Jiménez, David</au><aucorp>PROTECT investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of right ventricular function in acute pulmonary embolism</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>185</volume><spage>123</spage><epage>129</epage><pages>123-129</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>Background The optimal approach to assess right ventricular ( RV ) function in patients with acute symptomatic pulmonary embolism ( PE ) lacks clarity. Methods This study aimed to evaluate the optimal approach to assess RV function in normotensive patients with acute symptomatic PE. Outcomes assessed through 30-days after the diagnosis of PE included all-cause mortality and complicated course. Results Eight hundred and forty eight patients were enrolled. Computed tomography ( MDCT ) and echocardiography ( TTE ) agreed on the presence or absence of RV overload in 449 (53%) patients. The combination of the simplified Pulmonary Embolism Severity Index ( sPESI ) and MDCT showed a negative predictive value for 30-day all-cause mortality of 100%. Of the 43% that had a sPESI of >0 points and MDCT RV enlargement, 41 (11.3%) experienced a complicated course that included 24 (6.6%) deaths. One hundred and twenty nine patients (15%) had a sPESI of >0 points, MDCT and echocardiographic RV overload. Of these, 21 (16.3%) experienced a complicated course within the first 30 days, and 10 (7.7%) of them died. Conclusions Incorporation of echocardiographic RV overload to the sPESI and MDCT did not improve identification of low-risk PE patients, while it improved identification of those at intermediate-high risk for short-term complications.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28267465</pmid><doi>10.1016/j.ahj.2016.12.009</doi><tpages>7</tpages></addata></record> |
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| subjects | Acute Disease Aged Aged, 80 and over Binomial distribution Cardiovascular Cause of Death Comorbidity Complications Computed tomography Echocardiography Embolism Embolisms Enlargement Female Health risk assessment Heart Heart Failure - epidemiology Humans Lungs Male Medical imaging Medical prognosis Middle Aged Mortality Multidetector Computed Tomography Patients Prognosis Prospective Studies Pulmonary arteries Pulmonary Disease, Chronic Obstructive - epidemiology Pulmonary Embolism - complications Pulmonary Embolism - epidemiology Pulmonary Embolism - physiopathology Pulmonary embolisms Risk Assessment Risk groups Severity of Illness Index Urban health care Ventricle Ventricular Dysfunction, Right - complications Ventricular Dysfunction, Right - diagnostic imaging Ventricular Dysfunction, Right - epidemiology Ventricular Dysfunction, Right - physiopathology Ventricular Function, Right |
| title | Assessment of right ventricular function in acute pulmonary embolism |
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