Clinical research studyEnlarged Right Ventricle Without Shock in Acute Pulmonary Embolism: Prognosis
Section snippets
Materials and Methods
Data are from the PIOPED II, which was a multicenter national collaborative investigation of the accuracy of multidetector computed tomographic (CT) angiography alone with venous phase imaging of the veins of the pelvis and thigh for the diagnosis of acute PE.6 The data allow a retrospective cohort comparison of outcome between those with and those without RV enlargement. In PIOPED II, 181 patients had a reference test diagnosis of PE and a CT angiogram that was of adequate quality for
Results
Among 160 patients with PE, by the reference standard in PIOPED II who had a CT angiogram adequate for interpretation of whether PE was present and whose images were available for review for this study, 157 (98%) showed the left and right ventricles with adequate clarity for evaluation of the diastolic dimensions (Figure 3). Two of these received thrombolytic therapy. One of these patients was normotensive but was treated with thrombolytic therapy because of the perceived high risk of RV
Discussion
The data do not support the hypothesis that an enlarged right ventricle in stable patients with acute PE may lead to a higher in-hospital mortality or higher rate of life-threatening adverse events. There was no difference in the rate of death from PE or all-cause mortality between patients with RV enlargement and patients without RV enlargement. In the patients with no prior cardiopulmonary disease, those with possible prior RV enlargement were excluded. None of the patients with RV
Conclusions
In-hospital prognosis is good in patients with PE and RV enlargement, providing they are not in shock, acutely ill, or receiving ventilatory support, or had a recent myocardial infarction or life-threatening arrhythmia. In patients with PE, RV enlargement alone does not seem to adversely affect prognosis or be an indication for thrombolytic therapy.
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2017, Thrombosis ResearchCitation Excerpt :The diagnosis of acute PE was confirmed in all patients with CT angiography in which a partial intraluminal defect surrounded by contrast medium or complete occlusion of a pulmonary artery in two consecutive CT sections was shown. RV end-diastolic diameter (RVEDD), leftward shifting of IVS and RV/LV dimension ratios were assessed on the transverse sections of the diagnostic CT angiography [22,23]. The thrombus burden of patients was evaluated according to the index suggested by Qanadli et al.
This study was supported by Grants HL63899, HL63928, HL63931, HL63940, HL63981, HL63982, and HL67453 from the U.S. Department of Health and Human Services, Public Health Services, National Heart, Lung, and Blood Institute, Bethesda, Md.