European Heart Journal Advance Access originally published online on September 9, 2008
European Heart Journal 2008 29(21):2696-2697; doi:10.1093/eurheartj/ehn401
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Right ventricular dysfunction for prognosis in haemodynamically stable patients with acute symptomatic pulmonary embolism
Respiratory and Medicine Department
Ramón y Cajal Hospital and Alcalá de
Henares University
Madrid
Spain
We read with interest an article in a recent issue of the European Heart Journal, in which Sanchez et al.1 performed a systematic review to determine the prognostic value of right ventricular (RV) dysfunction in haemodynamically stable patients with acute pulmonary embolism (PE). In this study the authors found that RV dysfunction assessed by echocardiography was associated with an increased risk of mortality when including five studies with 475 patients with haemodynamically stable PE [relative risk (RR) 2.53; 95% confidence interval (CI) 1.17–5.50].
The authors did not include a study in which the prognostic value of echocardiography in 214 consecutive patients with acute symptomatic PE was evaluated.2 This study met all eligibility criteria for inclusion in the systematic review: (i) it was published in September 2007; (ii) consecutive patients with an objective diagnosis of acute symptomatic PE were enrolled; (iii) all patients were haemodynamically stable; and (iv) all-cause 30-day mortality was reported. In this study, which enrolled a larger number of patients than any of the studies included in the systematic review, RV dysfunction assessed by echocardiography was not associated with an increased risk of 30-day mortality (RR 1.98; 95% CI 0.46–8.65).
After adding this study to the systematic review, the pooled unadjusted RR for mortality is shown in Figure 1. Analysis was carried out with STATA v8.0.
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In conclusion, RV dysfunction assessed by echocardiography is associated with an increased risk of mortality in patients with haemodynamically stable PE.
References
- Sanchez O, Trinquart L, Colombet I, Duriex P, Huisman MV, Chatellier G, Meyer G. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J (2008) 29:1569–1577.
[Abstract/Free Full Text] - Jiménez D, Escobar C, Martí D, Díaz G, Vidal R, Taboada D, Ortega J, Moya JL, Barrios V, Sueiro A. Prognostic value of transthoracic echocardiography in hemodynamically stable patients with acute symptomatic pulmonary embolism. Arch Bronconeumol (2007) 43:490–494.[Web of Science][Medline]
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