the prognostic value of markers of right ventricular dysfunction in pulmonary embolism a meta-analysis右心室功能障碍的预后标志物的价值在肺栓塞荟萃分析.pdfVIP

Coutance et al. Critical Care 2011, 15:R103 /content/15/2/R103 RESEARCH Open Access The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis 1 2 1 2 1,3* Guillaume Coutance , Emmanuelle Cauderlier , Javed Ehtisham , Michèle Hamon and Martial Hamon Abstract Introduction: In pulmonary embolism (PE) without hemodynamic compromise, the prognostic value of right ventricular (RV) dysfunction as measured by echocardiography, computed tomography (CT) or biological (natriuretic peptides) markers has only been assessed in small studies. Methods: Databases were searched using the combined medical subject headings for right ventricular dysfunction or right ventricular dilatation with the exploded term acute pulmonary embolism. This retrieved 8 echocardiographic marker based studies (n = 1249), three CT marker based studies (n = 503) and 7 natriuretic peptide based studies (n = 582). A meta-analysis of these data was performed with the primary endpoint of mortality within three months after pulmonary embolism, and a secondary endpoint of overall mortality and morbidity by pulmonary embolism. Results: Patients with PE without hemodynamic compromise on admission and the presence of RV dysfunction determined by echocardiography and biological markers were associated with increased short-term mortality (odds ratio (OR) ECHO = 2.36; 95% confidence interval (CI): 1.3-43; OR BNP = 7.7; 95% CI: 2.9-20) while CT was not (ORCT = 1.54-95% CI: 0.7-3.4). However, corresponding pooled negative and positive likelihood ratios independent of death rates were unsatisfactory for clinical usefulness in risk stratification. Conclusions: The presence