Faculty Collaboration Database

Enlarged right ventricle without shock in acute pulmonary embolism: prognosis. Am J Med 2008 Jan;121(1):34-42

Date

01/12/2008

Pubmed ID

18187071

Pubmed Central ID

PMC2219923

DOI

10.1016/j.amjmed.2007.06.032

Scopus ID

2-s2.0-37649008466 (requires institutional sign-in at Scopus site)   77 Citations

Abstract

OBJECTIVE: An unsettled issue is the use of thrombolytic agents in patients with acute pulmonary embolism (PE) who are hemodynamically stable but have right ventricular (RV) enlargement. We assessed the in-hospital mortality of hemodynamically stable patients with PE and RV enlargement.

METHODS: Patients were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis II. Exclusions included shock, critical illness, ventilatory support, or myocardial infarction within 1 month, and ventricular tachycardia or ventricular fibrillation within 24 hours. We evaluated the ratio of the RV minor axis to the left ventricular minor axis measured on transverse images during computed tomographic angiography.

RESULTS: Among 76 patients with RV enlargement treated with anticoagulants and/or inferior vena cava filters, in-hospital deaths from PE were 0 of 76 (0%) and all-cause mortality was 2 of 76 (2.6%). No septal motion abnormality was observed in 49 patients (64%), septal flattening was observed in 25 patients (33%), and septal deviation was observed in 2 patients (3%). No patients required ventilatory support, vasopressor therapy, rescue thrombolytic therapy, or catheter embolectomy. There were no in-hospital deaths caused by PE. There was no difference in all-cause mortality between patients with and without RV enlargement (relative risk=1.04).

CONCLUSION: In-hospital prognosis is good in patients with PE and RV enlargement if they are not in shock, acutely ill, or on ventilatory support, or had a recent myocardial infarction or life-threatening arrhythmia. RV enlargement alone in patients with PE, therefore, does not seem to indicate a poor prognosis or the need for thrombolytic therapy.

Author List

Stein PD, Beemath A, Matta F, Goodman LR, Weg JG, Hales CA, Hull RD, Leeper KV Jr, Sostman HD, Woodard PK

MESH terms used to index this publication - Major topics in bold

Angiography
Diagnosis, Differential
Dilatation, Pathologic
Embolectomy
Fibrinolytic Agents
Follow-Up Studies
Heart Ventricles
Hospital Mortality
Humans
Prognosis
Prospective Studies
Pulmonary Embolism
Shock
Thrombolytic Therapy
Tomography, X-Ray Computed
Vena Cava Filters
Ventricular Dysfunction, Right