PT  - JOURNAL ARTICLE
AU  - Graeme Prosperi-Porta
AU  - Paul Ronksley
AU  - Omid Kiamanesh
AU  - Kevin Solverson
AU  - Pouya Motazedian
AU  - Jason Weatherald
TI  - Prognostic value of echocardiography-derived right ventricular dysfunction in haemodynamically stable pulmonary embolism: a systematic review and meta-analysis
AID  - 10.1183/16000617.0120-2022
DP  - 2022 Dec 31
TA  - European Respiratory Review
PG  - 220120
VI  - 31
IP  - 166
4099  - http://err.ersjournals.com/content/31/166/220120.short
4100  - http://err.ersjournals.com/content/31/166/220120.full
SO  - EUROPEAN RESPIRATORY REVIEW2022 Dec 31; 31
AB  - Background We sought to determine the prognostic value of transthoracic echocardiography (TTE)-derived right ventricular dysfunction (RVD) in haemodynamically stable and intermediate-risk patients with acute pulmonary embolism (PE), evaluate continuous RVD parameters, and assess the literature quality.Methods We searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for studies assessing TTE-derived RVD in haemodynamically stable PE that reported in-hospital adverse events within 30 days. We determined pooled odds ratios (ORs) using a random-effects model, created funnel plots, evaluated the Newcastle–Ottawa scale and performed Grading of Recommendations, Assessment, Development and Evaluation.Results Based on 55 studies (17 090 patients, 37.8% RVD), RVD was associated with combined adverse events (AEs) (OR 3.29, 95% confidence interval (CI) 2.59–4.18), mortality (OR 2.00, CI 1.66–2.40) and PE-related mortality (OR 4.01, CI 2.79–5.78). In intermediate-risk patients, RVD was associated with AEs (OR 1.99, CI 1.17–3.37) and PE-related mortality (OR 6.16, CI 1.33–28.40), but not mortality (OR 1.63, CI 0.76–3.48). Continuous RVD parameters provide a greater spectrum of risk compared to categorical RVD. We identified publication bias, poor methodological quality in 34/55 studies and overall low certainty of evidence.Conclusions RVD is frequent in PE and associated with adverse outcomes. However, data quality and publication bias are limitations of existing evidence.Right ventricular dysfunction on echocardiogram is a frequent finding in pulmonary embolism and associated with adverse events. Publication bias and methodological limitations of existing studies highlight the need for well-designed prospective studies. https://bit.ly/3SNd4bE