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.

References 

  1. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(Suppl):401S–428S
  2. Cannon CP, Goldhaber SZ. Cardiovascular risk stratification of pulmonary embolism. Am J Cardiol. 1996;78:1149–1151
  3. Goldhaber SZ. Thrombolysis in pulmonary embolism (A large-scale clinical trial is overdue). Circulation. 2001;104:2876–2878
  4. Leacche M, Unic D, Goldhaber SZ, et al. Modern surgical treatment of massive pulmonary embolism: results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach. J Thorac Cardiovasc Surg. 2005;129:1018–1023
  5. Hamel E, Pacouret G, Vincentelli D, et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: results from a 128-patient monocenter registry. Chest. 2001;120:120–125
  6. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  7. Ghaye B, Ghuysen A, Willems V, et al. Severe pulmonary embolism: pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology. 2006;239:884–891
  8. Araoz PA, Gotway MB, Trowbridge RL, et al. Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism. J Thorac Imaging. 2003;18:207–216
  9. Araoz PA, Gotway MB, Harrington JR, et al. Pulmonary embolism: prognostic CT findings. Radiology. 2007;242:889–897
  10. Contractor S, Maldjian PD, Sharma VK, Gor DM. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr. 2002;26:587–591
  11. van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005;235:798–803
  12. Quiroz R, Kucher N, Schoepf UJ, et al. Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation. 2004;109:2401–2404
  13. Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation. 2004;110:3276–3280
  14. Reid JH, Murchison JT. Acute right ventricular dilatation: a new helical CT sign of massive pulmonary embolism. Clin Radiol. 1998;53:694–698
  15. Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000;101:2817–2822
  16. Kasper W, Konstantinides S, Geibel A, et al. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism. Heart. 1997;77:346–349
  17. Konstantinides S, Geibel A, Olschewski M, et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation. 1997;96:882–888
  18. Lim KE, Chan CY, Chu PH, et al. Right ventricular dysfunction secondary to acute massive pulmonary embolism detected by helical computed tomography pulmonary angiography. Clin Imaging. 2005;29:16–21
  19. ten Wolde M, Sohne M, Quak E, et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med. 2004;164:1685–1689
  20. Collomb D, Paramelle PJ, Calaque O, et al. Severity assessment of acute pulmonary embolism: evaluation using helical CT. Eur Radiol. 2003;13:1508–1514
  21. Jardin F, Dubourg O, Gueret P, et al. Quantitative two-dimensional echocardiography in massive pulmonary embolism: emphasis on ventricular interdependence and leftward septal displacement. J Am Coll Cardiol. 1987;10:1201–1206
  22. Kundel HL, Polansky M. Measurement of observer agreement. Radiology. 2003;228:303–308
  23. Wells PS, Anderson DR, Rodger M, et al. Excluding PE at the bedside without diagnostic imaging: management of patients with suspected PE presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98–107
  24. Kucher N, Goldhaber S. Risk stratification of acute pulmonary embolism. Semin Thromb Hemost. 2006;32:838–847
  25. Goldhaber SZ, Haire WD, Feldstein ML, et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet. 1993;341:507–511
  26. Wolfe MW, Lee RT, Feldstein ML, et al. Prognostic significance of right ventricular hypokinesis and perfusion lung scan defects in pulmonary embolism. Am Heart J. 1994;127:1371–1375
  27. Sukhija R, Aronow WS, Lee J, et al. Association of right ventricular dysfunction with in-hospital mortality in patients with acute pulmonary embolism and reduction in mortality in patients with right ventricular dysfunction by pulmonary embolectomy. Am J Cardiol. 2005;95:695–696
  28. Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002;347:1143–1150
  29. Vieillard-Baron A, Page B, Augarde R, et al. Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med. 2001;27:1481–1486
  30. Ribeiro A, Lindmarker P, Juhlin-Dannfelt A, et al. Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate. Am Heart J. 1997;134:479–487
  31. Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138:W1–W12
  32. Bossuyt PM, Reitsma JB, Bruns DE, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD Initiative. Ann Intern Med. 2003;138:40–44

 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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