Deisy Barrios1, Vladimir Rosa-Salazar2, Raquel Morillo1, Rosa Nieto1, Sara Fernández3, José Luis Zamorano3, Manuel Monreal4, Adam Torbicki5, Roger D Yusen6, David Jiménez7. 1. Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain. 2. Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain. 3. Cardiology Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain. 4. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona and Universidad Católica de Murcia, Spain. 5. Department of Cardiovascular and Pulmonary Thromboembolic Diseases, European Health Centre, Otwock, Poland. 6. Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO. 7. Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
Abstract
BACKGROUND: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant right heart thrombi (RHT) lacks clarity. METHODS: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of echocardiography-detectable RHT for the primary outcome of short-term all-cause mortality and the secondary outcome of short-term PE-related mortality. Unrestricted searches were conducted of PubMed and Embase from 1980 through January 31, 2016, and used the terms "right heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was used to pool study results; Begg rank correlation method was used to evaluate for publication bias; and I2 testing was used to assess for heterogeneity. RESULTS: Six of 79 potentially relevant studies met the inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95% CI, 4.0-4.7]). RHT had a significant association with short-term all-cause mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I2 = 20%) and with PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I2 = 76%). Results were consistent for the prospective (two cohorts, 514 patients; OR, 4.8 [95% CI, 1.7-13.6]; I2 = 56%) and the retrospective (four cohorts, 14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I2 = 0%) studies. CONCLUSIONS: In patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis. TRIAL REGISTRY: PROSPERO registry; No.: CRD42016033960; URL: https://www.crd.york.ac.uk/prospero/.
BACKGROUND: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant right heart thrombi (RHT) lacks clarity. METHODS: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of echocardiography-detectable RHT for the primary outcome of short-term all-cause mortality and the secondary outcome of short-term PE-related mortality. Unrestricted searches were conducted of PubMed and Embase from 1980 through January 31, 2016, and used the terms "right heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was used to pool study results; Begg rank correlation method was used to evaluate for publication bias; and I2 testing was used to assess for heterogeneity. RESULTS: Six of 79 potentially relevant studies met the inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95% CI, 4.0-4.7]). RHT had a significant association with short-term all-cause mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I2 = 20%) and with PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I2 = 76%). Results were consistent for the prospective (two cohorts, 514 patients; OR, 4.8 [95% CI, 1.7-13.6]; I2 = 56%) and the retrospective (four cohorts, 14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I2 = 0%) studies. CONCLUSIONS: In patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis. TRIAL REGISTRY: PROSPERO registry; No.: CRD42016033960; URL: https://www.crd.york.ac.uk/prospero/.
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