Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis

Abstract Aims Patients with acute pulmonary embolism (PE) classified as low risk by the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), or the Hestia criteria may be considered for early discharge. We investigated whether the presence of right ventricular (RV) dysfunction m...

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Veröffentlicht in:European heart journal 2019-03, Vol.40 (11), p.902-910
Hauptverfasser: Barco, Stefano, Mahmoudpour, Seyed Hamidreza, Planquette, Benjamin, Sanchez, Olivier, Konstantinides, Stavros V, Meyer, Guy
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container_end_page 910
container_issue 11
container_start_page 902
container_title European heart journal
container_volume 40
creator Barco, Stefano
Mahmoudpour, Seyed Hamidreza
Planquette, Benjamin
Sanchez, Olivier
Konstantinides, Stavros V
Meyer, Guy
description Abstract Aims Patients with acute pulmonary embolism (PE) classified as low risk by the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), or the Hestia criteria may be considered for early discharge. We investigated whether the presence of right ventricular (RV) dysfunction may aggravate the early prognosis of these patients. Methods and results We did a systematic review and meta-analysis of studies including low-risk patients with acute PE to investigate the prognostic value of RV dysfunction. Diagnosis of RV dysfunction was based on echocardiography or computed tomography pulmonary angiography. In addition, we investigated the prognostic value of elevated troponin or natriuretic peptide levels. The primary outcome was all-cause mortality at 30 days or during hospitalization. We included 22 studies (N = 3295 low-risk patients) in the systematic review: 21 were selected for quantitative analysis. Early all-cause mortality rates in patients with vs. without RV dysfunction on imaging were 1.8% [95% confidence interval (CI) 0.9–3.5%] vs. 0.2% (95% CI 0.03–1.7%), respectively, [odds ratio (OR) 4.19, 95% CI 1.39–12.58]. For troponins, rates were 3.8% (95% CI 2.1–6.8%) vs. 0.5% (95% CI 0.2–1.3%), (OR 6.25, 95% CI 1.95–20.05). For natriuretic peptides, only data on early PE-related mortality were available: rates were 1.7% (95% CI 0.4–6.9%) vs. 0.4% (95% CI 0.1–1.1%), (OR 3.71, 95% CI 0.81–17.02). Conclusions In low-risk patients with acute PE, the presence of RV dysfunction on admission was associated with early mortality. Our results may have implications for the management of patients who appear at low risk based on clinical criteria alone, but present with RV dysfunction as indicated by imaging findings or laboratory markers.
doi_str_mv 10.1093/eurheartj/ehy873
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We investigated whether the presence of right ventricular (RV) dysfunction may aggravate the early prognosis of these patients. Methods and results We did a systematic review and meta-analysis of studies including low-risk patients with acute PE to investigate the prognostic value of RV dysfunction. Diagnosis of RV dysfunction was based on echocardiography or computed tomography pulmonary angiography. In addition, we investigated the prognostic value of elevated troponin or natriuretic peptide levels. The primary outcome was all-cause mortality at 30 days or during hospitalization. We included 22 studies (N = 3295 low-risk patients) in the systematic review: 21 were selected for quantitative analysis. Early all-cause mortality rates in patients with vs. without RV dysfunction on imaging were 1.8% [95% confidence interval (CI) 0.9–3.5%] vs. 0.2% (95% CI 0.03–1.7%), respectively, [odds ratio (OR) 4.19, 95% CI 1.39–12.58]. For troponins, rates were 3.8% (95% CI 2.1–6.8%) vs. 0.5% (95% CI 0.2–1.3%), (OR 6.25, 95% CI 1.95–20.05). For natriuretic peptides, only data on early PE-related mortality were available: rates were 1.7% (95% CI 0.4–6.9%) vs. 0.4% (95% CI 0.1–1.1%), (OR 3.71, 95% CI 0.81–17.02). Conclusions In low-risk patients with acute PE, the presence of RV dysfunction on admission was associated with early mortality. Our results may have implications for the management of patients who appear at low risk based on clinical criteria alone, but present with RV dysfunction as indicated by imaging findings or laboratory markers.</description><identifier>ISSN: 0195-668X</identifier><identifier>ISSN: 1522-9645</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehy873</identifier><identifier>PMID: 30590531</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; Biomarkers - blood ; Computed Tomography Angiography - methods ; Echocardiography - methods ; Editor's Choice ; Fast Track Clinical Research ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Natriuretic Peptides - blood ; Prognosis ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - drug therapy ; Risk Assessment - methods ; Severity of Illness Index ; Troponin - blood ; Ventricular Dysfunction, Right - blood ; Ventricular Dysfunction, Right - complications ; Ventricular Dysfunction, Right - diagnostic imaging ; Ventricular Dysfunction, Right - physiopathology</subject><ispartof>European heart journal, 2019-03, Vol.40 (11), p.902-910</ispartof><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-2ff676a7af59977a093539431a0ad1c1592358ec675d3b7150cdfe4d1a7be6bf3</citedby><cites>FETCH-LOGICAL-c432t-2ff676a7af59977a093539431a0ad1c1592358ec675d3b7150cdfe4d1a7be6bf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,1579,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30590531$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barco, Stefano</creatorcontrib><creatorcontrib>Mahmoudpour, Seyed Hamidreza</creatorcontrib><creatorcontrib>Planquette, Benjamin</creatorcontrib><creatorcontrib>Sanchez, Olivier</creatorcontrib><creatorcontrib>Konstantinides, Stavros V</creatorcontrib><creatorcontrib>Meyer, Guy</creatorcontrib><title>Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Abstract Aims Patients with acute pulmonary embolism (PE) classified as low risk by the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), or the Hestia criteria may be considered for early discharge. We investigated whether the presence of right ventricular (RV) dysfunction may aggravate the early prognosis of these patients. Methods and results We did a systematic review and meta-analysis of studies including low-risk patients with acute PE to investigate the prognostic value of RV dysfunction. Diagnosis of RV dysfunction was based on echocardiography or computed tomography pulmonary angiography. In addition, we investigated the prognostic value of elevated troponin or natriuretic peptide levels. The primary outcome was all-cause mortality at 30 days or during hospitalization. We included 22 studies (N = 3295 low-risk patients) in the systematic review: 21 were selected for quantitative analysis. Early all-cause mortality rates in patients with vs. without RV dysfunction on imaging were 1.8% [95% confidence interval (CI) 0.9–3.5%] vs. 0.2% (95% CI 0.03–1.7%), respectively, [odds ratio (OR) 4.19, 95% CI 1.39–12.58]. For troponins, rates were 3.8% (95% CI 2.1–6.8%) vs. 0.5% (95% CI 0.2–1.3%), (OR 6.25, 95% CI 1.95–20.05). For natriuretic peptides, only data on early PE-related mortality were available: rates were 1.7% (95% CI 0.4–6.9%) vs. 0.4% (95% CI 0.1–1.1%), (OR 3.71, 95% CI 0.81–17.02). Conclusions In low-risk patients with acute PE, the presence of RV dysfunction on admission was associated with early mortality. Our results may have implications for the management of patients who appear at low risk based on clinical criteria alone, but present with RV dysfunction as indicated by imaging findings or laboratory markers.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - therapeutic use</subject><subject>Biomarkers - blood</subject><subject>Computed Tomography Angiography - methods</subject><subject>Echocardiography - methods</subject><subject>Editor's Choice</subject><subject>Fast Track Clinical Research</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Natriuretic Peptides - blood</subject><subject>Prognosis</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - drug therapy</subject><subject>Risk Assessment - methods</subject><subject>Severity of Illness Index</subject><subject>Troponin - blood</subject><subject>Ventricular Dysfunction, Right - blood</subject><subject>Ventricular Dysfunction, Right - complications</subject><subject>Ventricular Dysfunction, Right - diagnostic imaging</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><issn>0195-668X</issn><issn>1522-9645</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqFUcFu1DAUjBCIbgt3TshHJBRqx7Gz4YBUVVCQKsEBJG7Wi_OycevYwXayyv_woWTZsoITp3d4M_PmzWTZC0bfMFrzS5xCjxDS3SX2y7bij7INE0WR17IUj7MNZbXIpdx-P8vOY7yjlG4lk0-zM05FTQVnm-znl-B3zsdkNJnBTkh8R4LZ9YnM6FIwerIQSLvEbnI6Ge-IDwQtzpCwJRpCa0CTxvgBwj2GSIwjIySzkiPZm9QT6_d5MPGejJMdvIOwEBwab00c3hIgcYkJBzgYCDgb3BNwLRkwQQ4O7BJNfJY96cBGfP4wL7JvH95_vf6Y336--XR9dZvrkhcpL7pOVhIq6ERdVxWsCQlel5wBhZZpJuqCiy1qWYmWNxUTVLcdli2DqkHZdPwie3fUHadmwFYfAgCrxmDW5xblwah_N870audnJUsmBeerwKsHgeB_TBiTGkzUaC049FNUBZOsooz9htIjVAcfY8DudIZRdShXncpVx3JXysu_7Z0If9pcAa-PAD-N_5f7Bfm5ucc</recordid><startdate>20190314</startdate><enddate>20190314</enddate><creator>Barco, Stefano</creator><creator>Mahmoudpour, Seyed Hamidreza</creator><creator>Planquette, Benjamin</creator><creator>Sanchez, Olivier</creator><creator>Konstantinides, Stavros V</creator><creator>Meyer, Guy</creator><general>Oxford University Press</general><scope>TOX</scope><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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190314</creationdate><title>Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis</title><author>Barco, Stefano ; Mahmoudpour, Seyed Hamidreza ; Planquette, Benjamin ; Sanchez, Olivier ; Konstantinides, Stavros V ; Meyer, Guy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-2ff676a7af59977a093539431a0ad1c1592358ec675d3b7150cdfe4d1a7be6bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - therapeutic use</topic><topic>Biomarkers - blood</topic><topic>Computed Tomography Angiography - methods</topic><topic>Echocardiography - methods</topic><topic>Editor's Choice</topic><topic>Fast Track Clinical Research</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Natriuretic Peptides - blood</topic><topic>Prognosis</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - drug therapy</topic><topic>Risk Assessment - methods</topic><topic>Severity of Illness Index</topic><topic>Troponin - blood</topic><topic>Ventricular Dysfunction, Right - blood</topic><topic>Ventricular Dysfunction, Right - complications</topic><topic>Ventricular Dysfunction, Right - diagnostic imaging</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barco, Stefano</creatorcontrib><creatorcontrib>Mahmoudpour, Seyed Hamidreza</creatorcontrib><creatorcontrib>Planquette, Benjamin</creatorcontrib><creatorcontrib>Sanchez, Olivier</creatorcontrib><creatorcontrib>Konstantinides, Stavros V</creatorcontrib><creatorcontrib>Meyer, Guy</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barco, Stefano</au><au>Mahmoudpour, Seyed Hamidreza</au><au>Planquette, Benjamin</au><au>Sanchez, Olivier</au><au>Konstantinides, Stavros V</au><au>Meyer, Guy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2019-03-14</date><risdate>2019</risdate><volume>40</volume><issue>11</issue><spage>902</spage><epage>910</epage><pages>902-910</pages><issn>0195-668X</issn><issn>1522-9645</issn><eissn>1522-9645</eissn><abstract>Abstract Aims Patients with acute pulmonary embolism (PE) classified as low risk by the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), or the Hestia criteria may be considered for early discharge. We investigated whether the presence of right ventricular (RV) dysfunction may aggravate the early prognosis of these patients. Methods and results We did a systematic review and meta-analysis of studies including low-risk patients with acute PE to investigate the prognostic value of RV dysfunction. Diagnosis of RV dysfunction was based on echocardiography or computed tomography pulmonary angiography. In addition, we investigated the prognostic value of elevated troponin or natriuretic peptide levels. The primary outcome was all-cause mortality at 30 days or during hospitalization. We included 22 studies (N = 3295 low-risk patients) in the systematic review: 21 were selected for quantitative analysis. Early all-cause mortality rates in patients with vs. without RV dysfunction on imaging were 1.8% [95% confidence interval (CI) 0.9–3.5%] vs. 0.2% (95% CI 0.03–1.7%), respectively, [odds ratio (OR) 4.19, 95% CI 1.39–12.58]. For troponins, rates were 3.8% (95% CI 2.1–6.8%) vs. 0.5% (95% CI 0.2–1.3%), (OR 6.25, 95% CI 1.95–20.05). For natriuretic peptides, only data on early PE-related mortality were available: rates were 1.7% (95% CI 0.4–6.9%) vs. 0.4% (95% CI 0.1–1.1%), (OR 3.71, 95% CI 0.81–17.02). Conclusions In low-risk patients with acute PE, the presence of RV dysfunction on admission was associated with early mortality. Our results may have implications for the management of patients who appear at low risk based on clinical criteria alone, but present with RV dysfunction as indicated by imaging findings or laboratory markers.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30590531</pmid><doi>10.1093/eurheartj/ehy873</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection
subjects Acute Disease
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Biomarkers - blood
Computed Tomography Angiography - methods
Echocardiography - methods
Editor's Choice
Fast Track Clinical Research
Female
Hospital Mortality
Humans
Male
Middle Aged
Natriuretic Peptides - blood
Prognosis
Pulmonary Embolism - diagnosis
Pulmonary Embolism - drug therapy
Risk Assessment - methods
Severity of Illness Index
Troponin - blood
Ventricular Dysfunction, Right - blood
Ventricular Dysfunction, Right - complications
Ventricular Dysfunction, Right - diagnostic imaging
Ventricular Dysfunction, Right - physiopathology
title Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis
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