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

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.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.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.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.