Right ventricle assessment in patients with pulmonary embolismat low risk for death based on clinicalmodels: an individual patient datameta-analysis

被引：64

作者：

Becattini, Cecilia ^{[1
]}

Maraziti, Giorgio ^{[1
]}

Vinson, David R. ^{[2
,3
]}

Ng, Austin C. C. ^{[4
]}

den Exter, Paul L. ^{[5
]}

Cote, Benoit ^{[6
]}

Vanni, Simone ^{[7
]}

Doukky, Rami ^{[8
]}

Khemasuwan, Danai ^{[9
]}

Weekes, Anthony J. ^{[10
]}

Soares, Thiago Horta ^{[11
]}

Ozsu, Savas ^{[12
]}

Friz, Hernan Polo ^{[13
]}

Erol, Serhat ^{[14
]}

Agnelli, Giancarlo ^{[1
]}

Jimenez, David ^{[15
,16
,17
]}

机构：

[1] Univ Perugia, Internal & Cardiovasc Med Stroke Unit, Osped Santa Maria della Misericordia, Via G Dottori 1, I-06129 Perugia, Italy

[2] Permanente Med Grp Inc, Dept Emergency Med, Oakland, CA USA

[3] Kaiser Permanente Div Res, Oakland, CA USA

[4] Univ Sydney, Concord Hosp, Cardiol Dept, Concord, NSW, Australia

[5] Leiden Univ, Dept Thrombosis & Hemostasis, Med Ctr, Leiden, Netherlands

[6] Univ Laval, Dept Med Interne, Hop Enfant Jesus, CHU Quebec, Quebec City, PQ, Canada

[7] Azienda Usl Toscana Ctr, Emergency Med Unit, Empoli, Italy

[8] Cook Cty Hlth, Div Cardiol, Chicago, IL USA

[9] Virginia Commonwealth Univ, Div Pulm & Crit Care Med, Richmond, VA USA

[10] Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28203 USA

[11] Rede Mater Saude, Internal Med Div, Belo Horizonte, MG, Brazil

[12] Karadeniz Tech Univ, Sch Med, Dept Pulm Med, Trabzon, Turkey

[13] Vimercate Hosp, Med Dept, Internal Med Div, Vimercate, Italy

[14] Univ Ankara, Pulm Dis Dept, Sch Med, Ankara, Turkey

[15] Ramon & Cajal Hosp, Resp Dept, Madrid, Spain

[16] Univ Alcala IRYCIS, Madrid, Spain

[17] Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain

来源：

EUROPEAN HEART JOURNAL | 2021年 / 42卷 / 33期

基金：

美国医疗保健研究与质量局;

关键词：

Pulmonary embolism; Home treatment; Low risk; Mortality; Outpatient; Right ventricular dysfunction; EMERGENCY-DEPARTMENT PATIENTS; OF-CARE ULTRASOUND; SEVERITY INDEX; PROGNOSTIC VALUE; OUTPATIENT TREATMENT; CARDIAC TROPONIN; NORMOTENSIVE PATIENTS; COMPUTED-TOMOGRAPHY; EUROPEAN-SOCIETY; STRATIFICATION;

D O I：

10.1093/eurheartj/ehab329

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Patients with acute pulmonary embolism (PE) at low risk for short-term death are candidates for home treatment or short-hospital stay. We aimed at determining whether the assessment of right ventricle dysfunction (RVD) or elevated troponin improves identification of low-risk patients over clinical models alone Methods and results Individual patient data meta-analysis of studies assessing the relationship between RVD or elevated troponin and shortterm mortality in patients with acute PE at low risk for death based on clinical models (Pulmonary Embolism Severity Index, simplified Pulmonary Embolism Severity Index or Hestia). The primary study outcome was short-term death defined as death occurring in hospital or within 30 days. Individual data of 5010 low-risk patients from 18 studies were pooled. Short-term mortality was 0.7% [95% confidence interval (CI) 0.4-1.3]. RVD at echocardiography, computed tomography or B-type natriuretic peptide (BNP)/N-terminal pro BNP (NT-proBNP) was associated with increased risk for short-term death (1.5 vs. 0.3%; OR 4.81, 95% CI 1.98-11.68), death within 3 months (1.6 vs. 0.4%; OR 4.03, 95% CI 2.01-8.08), and PE-related death (1.1 vs. 0.04%; OR 22.9, 95% CI 2.89-181). Elevated troponin was associated with short-term death (OR 2.78, 95% CI 1.06-7.26) and death within 3 months (OR 3.68, 95% CI 1.75-7.74) Conclusion RVD assessed by echocardiography, computed tomography, or elevated BNP/NT-proBNP levels and increased troponin are associated with short-term death in patients with acute PE at low risk based on clinical models. RVD assessment, mainly by BNP/NT-proBNP or echocardiography, should be considered to improve identification of low-risk patients that may be candidates for outpatient management or short hospital stay.

引用

页码：3190 / 3199

页数：10

共 61 条

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