The American Journal of Medicine
Volume 121, Issue 1 , Pages 34-42, January 2008

Enlarged Right Ventricle Without Shock in Acute Pulmonary Embolism: Prognosis

  • Paul D. Stein, MD

      Affiliations

    • Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich
    • Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
    • Corresponding Author InformationRequests for reprints should be addressed to Paul D. Stein, MD, St Joseph Mercy Oakland, 44405 Woodward Ave, Pontiac, MI 48341-5023.
    • ,
  • Afzal Beemath, MD

      Affiliations

    • Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich
    • ,
  • Fadi Matta, MD

      Affiliations

    • Department of Research, St. Joseph Mercy Oakland Hospital, Pontiac, Mich
    • ,
  • Lawrence R. Goodman, MD

      Affiliations

    • Department of Radiology, Medical College of Wisconsin, Milwaukee
    • ,
  • John G. Weg, MD

      Affiliations

    • Department of Medicine, University of Michigan, Ann Arbor
    • ,
  • Charles A. Hales, MD

      Affiliations

    • Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston
    • ,
  • Russell D. Hull, MBBS, MSc

      Affiliations

    • Department of Medicine, University of Calgary, Calgary, Alberta, Canada
    • ,
  • Kenneth V. Leeper Jr., MD

      Affiliations

    • Department of Medicine, Emory University, Atlanta, Ga
    • ,
  • H. Dirk Sostman, MD

      Affiliations

    • Office of the Dean, Weill Cornell Medical College and Methodist Hospital, Houston, Tex
    • ,
  • Pamela K. Woodard, MD

      Affiliations

    • Department of Radiology, Washington University, St Louis, Mo.

Abstract 

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.

Keywords: Pulmonary embolism, Right ventricular dysfunction, Venous thromboembolism

 

 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.

PII: S0002-9343(07)00928-X

doi:10.1016/j.amjmed.2007.06.032

The American Journal of Medicine
Volume 121, Issue 1 , Pages 34-42, January 2008

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