| Enlarged right ventricle without shock in acute pulmonary embolism: prognosis. | |
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MedLine Citation:
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PMID: 18187071 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: An unsettled issue is the use of thrombolytic agents in patients with acute pulmonary embolism (PE) who are hemodynamically stable but have right ventricular (RV) enlargement. We assessed the in-hospital mortality of hemodynamically stable patients with PE and RV enlargement. METHODS: Patients were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis II. Exclusions included shock, critical illness, ventilatory support, or myocardial infarction within 1 month, and ventricular tachycardia or ventricular fibrillation within 24 hours. We evaluated the ratio of the RV minor axis to the left ventricular minor axis measured on transverse images during computed tomographic angiography. RESULTS: Among 76 patients with RV enlargement treated with anticoagulants and/or inferior vena cava filters, in-hospital deaths from PE were 0 of 76 (0%) and all-cause mortality was 2 of 76 (2.6%). No septal motion abnormality was observed in 49 patients (64%), septal flattening was observed in 25 patients (33%), and septal deviation was observed in 2 patients (3%). No patients required ventilatory support, vasopressor therapy, rescue thrombolytic therapy, or catheter embolectomy. There were no in-hospital deaths caused by PE. There was no difference in all-cause mortality between patients with and without RV enlargement (relative risk=1.04). CONCLUSION: In-hospital prognosis is good in patients with PE and RV enlargement if they are not in shock, acutely ill, or on ventilatory support, or had a recent myocardial infarction or life-threatening arrhythmia. RV enlargement alone in patients with PE, therefore, does not seem to indicate a poor prognosis or the need for thrombolytic therapy. |
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Authors:
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Paul D Stein; Afzal Beemath; Fadi Matta; Lawrence R Goodman; John G Weg; Charles A Hales; Russell D Hull; Kenneth V Leeper; H Dirk Sostman; Pamela K Woodard |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: The American journal of medicine Volume: 121 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2008-01-11 Completed Date: 2008-01-24 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 34-42 Citation Subset: AIM; IM |
Affiliation:
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Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich 48341-5023, USA. steinp@trinity-health.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angiography
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methods* Diagnosis, Differential Dilatation, Pathologic Embolectomy / methods Fibrinolytic Agents / therapeutic use Follow-Up Studies Heart Ventricles / radiography* Hospital Mortality / trends Humans Prognosis Prospective Studies Pulmonary Embolism / complications*, radiography, therapy Shock Thrombolytic Therapy / methods Tomography, X-Ray Computed / methods* Vena Cava Filters Ventricular Dysfunction, Right / etiology*, radiography, therapy |
| Grant Support | |
ID/Acronym/Agency:
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HL63899/HL/NHLBI NIH HHS; HL63928/HL/NHLBI NIH HHS; HL63931/HL/NHLBI NIH HHS; HL63940/HL/NHLBI NIH HHS; HL63981/HL/NHLBI NIH HHS; HL63982/HL/NHLBI NIH HHS; HL67453/HL/NHLBI NIH HHS; U01 HL063899-04/HL/NHLBI NIH HHS; U01 HL063928-04/HL/NHLBI NIH HHS; U01 HL063931-04/HL/NHLBI NIH HHS; U01 HL063940-04/HL/NHLBI NIH HHS; U01 HL063981-04/HL/NHLBI NIH HHS; U01 HL063982-04/HL/NHLBI NIH HHS; U01 HL067453-04/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents |
| Comments/Corrections | |
Comment In:
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Am J Med. 2008 Aug;121(8):e15; author reply e17
[PMID:
18691463
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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