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Original Research |

Prognostic Significance of Right Heart Thrombi in Patients with Acute Symptomatic Pulmonary Embolism: Systematic Review and Meta-Analysis

Deisy Barrios, MD; Vladimir Rosa-Salazar, PhD; Raquel Morillo, MD; Rosa Nieto, MD; Sara Fernández, MD; José Luis Zamorano, PhD; Manuel Monreal, PhD; Adam Torbicki, PhD; Roger D. Yusen, MD; David Jiménez, PhD
Author and Funding Information

Source of funding: None.

Financial disclosures: None reported.

Trial registration: PROSPERO CRD42016033960.

1Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain

2Department of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain

3Cardiology Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain

4Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona and Universidad Católica de Murcia, Spain

5Department of Cardiovascular and Pulmonary Thromboembolic Diseases, European Health Centre, Otwock, Poland

6Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA

Correspondence and reprints: David Jiménez Respiratory Department and Medicine Department Ramón y Cajal Hospital, Universidad de Alcala IRYCIS 28034 Madrid, SPAIN.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.09.038
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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. We conducted unrestricted searches of Pubmed and Embase from 1980 through January 31, 2016 and used the terms “right heart thrombi”, “pulmonary embolism”, and “prognos*”. We used a random-effects model to pool study results; Begg rank correlation method to evaluate for publication bias; and I2 testing to assess for heterogeneity.

Results  Six of 79 potentially relevant studies met inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7%; 95% CI, 13.8% to 19.9%) compared with 639 of 14,627 without RHT (4.4%; 95% CI, 4.0% to 4.7%). RHT had a significant association with short-term all-cause mortality in all patients (odds ratio [OR], 3.0; 95% CI, 2.2 to 4.1; I2 = 20%), and with PE-related death (3 cohorts, 12,955 patients; OR, 4.8; 95% CI, 2.0 to 11.3; I2 = 76%). Results were consistent for prospective (2 cohorts, 514 patients; OR, 4.8; 95% CI, 1.7 to 13.6; I2 = 56%) or retrospective studies (4 cohorts, 14,706 patients; OR, 2.8; 95% CI, 2.1 to 3.8; I2 = 0%).

Conclusions  In patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis.


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