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Right Ventricle Assessment in Patients With Pulmonary Embolism
Quick Takes
- Absence of RV dysfunction on imaging and/or laboratory markers may help identify patients who are at very low risk of mortality within 3 months after an acute pulmonary embolism (PE).
- These findings are hypothesis generating and need to be validated before routine workup for RV dysfunction can be recommended in patients with low-risk acute PE.
- Future work should focus on validation and integration of RV dysfunction within PESI, sPESI, or Hestia criterion.
Study Questions:
Does right ventricle dysfunction (RVD) on imaging or laboratory markers predict short-term mortality in patients with acute pulmonary embolism (PE) who are otherwise deemed low-risk by currently used clinical models?
Methods:
The authors report a pooled analysis of patient-level data from 18 studies in literature assessing the relationship between RVD and short-term mortality in patients with low-risk acute PE. Low-risk PE is identified using Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), or Hestia criterion.
Results:
Overall, this analysis included 5,010 patients. Mean age was 55 years and 48% were male. Short-term mortality was 0.7% (95% confidence interval [CI], 0.4–1.3) in the entire cohort. RVD noted on imaging or elevated B-type natriuretic peptide (BNP)/N-terminal–proBNP (NT-proBNP) was associated with increased risk for all-cause mortality within 3 months (1.6 vs. 0.4%; odds ratio [OR], 4.03; 95% CI, 2.01–8.08), as well as PE-related death (1.1 vs. 0.04%; OR, 22.9; 95% CI, 2.89–181). Similarly, an elevated troponin on presentation was also associated with increased risk of death within 3 months (OR, 3.68; 95% CI, 1.75–7.74).
Conclusions:
RVD assessed by echocardiography, computed tomography, or elevated BNP/NT-proBNP levels and increased troponin are associated with short-term death in acute PE patients otherwise deemed low risk by clinical models. RV assessment may be considered even in low-risk acute PE patients to improve risk stratification.
Perspective:
Absence of RVD on imaging and/or laboratory markers may help identify those who are at very low risk of short-term mortality after an acute PE. While these results may suggest worse prognosis with RVD in low-risk acute PE, in the absence of further validation, we cannot justify inpatient admission and management of low-risk PE patients otherwise deemed suitable for outpatient management based on these data.
Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Vascular Medicine, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound
Keywords: Anticoagulants, Biomarkers, Diagnostic Imaging, Echocardiography, Echocardiography, Doppler, Heart Failure, Inpatients, Natriuretic Peptide, Brain, Natriuretic Peptides, Outpatients, Peptide Fragments, Pulmonary Embolism, Risk Assessment, Secondary Prevention, Tomography, Troponin, Vascular Diseases
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