Prognostic role of different findings at echocardiography in acute pulmonary embolism. A critical review and meta-analysis

Background Right ventricle dysfunction (RVD) at echocardiography predicts mortality in patients with acute pulmonary embolism (PE), but heterogenous definitions of RVD have been used. We performed a meta-analysis to assess the role of different definitions of RVD and of individual parameters of RVD as predictors of death.

Methods A systematic search for studies including patients with confirmed PE reporting on RV assessment at echocardiography and death in the acute phase was performed. The primary study outcome was death in-hospital or at 30 days.

Results RVD at echocardiography, regardless of its definition, was associated with increased risk of death (RR 1.49, 95%CI 1.24–1.79, I²=64%) and PE-related death (RR 3.77, 95% CI 1.61–8.80, I²=0%) in all-comers with PE, and with death in hemodynamically stable patients (RR 1.52, 95%CI 1.15–2.00, I²=73%). The association with death was confirmed for RVD defined as the presence of at least one criterion or at least two criteria for RV overload. In all-comers with PE, increased RV/LV ratio (RR 1.61, 95% CI 1.90–2.39) and abnormal TAPSE (RR 2.29 CI 1.45–3.59) but not increased RV diameter were associated with death; in hemodynamically stable patients, neither RV/LV ratio (RR 1.11 CI 95% 0.91–1.35) nor TAPSE (RR 2.29, 95% CI 0.97–5.44) were significantly associated with death.

Conclusion Echocardiography showing RVD is a useful tool for risk stratification in all-comers with acute PE and in hemodynamically stable patients. The prognostic value of individual parameters of RVD in hemodynamically stable patients remains controversial.