PMID- 27746202
OWN - NLM
STAT- MEDLINE
DCOM- 20170524
LR  - 20181202
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 151
IP  - 2
DP  - 2017 Feb
TI  - Prognostic Significance of Right Heart Thrombi in Patients With Acute Symptomatic
      Pulmonary Embolism: Systematic Review and Meta-analysis.
PG  - 409-416
LID - S0012-3692(16)60765-1 [pii]
LID - 10.1016/j.chest.2016.09.038 [doi]
AB  - 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. Unrestricted searches were conducted of
      PubMed and Embase from 1980 through January 31, 2016, and used the terms "right
      heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was 
      used to pool study results; Begg rank correlation method was used to evaluate for
      publication bias; and I(2) testing was used to assess for heterogeneity. RESULTS:
      Six of 79 potentially relevant studies met the inclusion criteria (15,220
      patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died 
      (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95%
      CI, 4.0-4.7]). RHT had a significant association with short-term all-cause
      mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I(2) = 20%) and with
      PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I(2)
      = 76%). Results were consistent for the prospective (two cohorts, 514 patients;
      OR, 4.8 [95% CI, 1.7-13.6]; I(2) = 56%) and the retrospective (four cohorts,
      14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I(2) = 0%) studies. CONCLUSIONS:
      In patients diagnosed with acute PE, concomitant RHT were significantly
      associated with an increased risk of death within 30 days of PE diagnosis. TRIAL 
      REGISTRY: PROSPERO registry; No.: CRD42016033960; URL:
      https://www.crd.york.ac.uk/prospero/.
CI  - Copyright (c) 2016 American College of Chest Physicians. Published by Elsevier
      Inc. All rights reserved.
FAU - Barrios, Deisy
AU  - Barrios D
AD  - Respiratory Department, Ramon y Cajal Hospital, Universidad de Alcala (IRYCIS),
      Madrid, Spain.
FAU - Rosa-Salazar, Vladimir
AU  - Rosa-Salazar V
AD  - Department of Internal Medicine, Hospital Clinico Universitario Virgen de la
      Arrixaca, Murcia, Spain.
FAU - Morillo, Raquel
AU  - Morillo R
AD  - Respiratory Department, Ramon y Cajal Hospital, Universidad de Alcala (IRYCIS),
      Madrid, Spain.
FAU - Nieto, Rosa
AU  - Nieto R
AD  - Respiratory Department, Ramon y Cajal Hospital, Universidad de Alcala (IRYCIS),
      Madrid, Spain.
FAU - Fernandez, Sara
AU  - Fernandez S
AD  - Cardiology Department, Ramon y Cajal Hospital, Universidad de Alcala (IRYCIS),
      Madrid, Spain.
FAU - Zamorano, Jose Luis
AU  - Zamorano JL
AD  - Cardiology Department, Ramon y Cajal Hospital, Universidad de Alcala (IRYCIS),
      Madrid, Spain.
FAU - Monreal, Manuel
AU  - Monreal M
AD  - Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol,
      Badalona and Universidad Catolica de Murcia, Spain.
FAU - Torbicki, Adam
AU  - Torbicki A
AD  - Department of Cardiovascular and Pulmonary Thromboembolic Diseases, European
      Health Centre, Otwock, Poland.
FAU - Yusen, Roger D
AU  - Yusen RD
AD  - Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences,
      Washington University School of Medicine, St. Louis, MO.
FAU - Jimenez, David
AU  - Jimenez D
AD  - Respiratory Department, Ramon y Cajal Hospital, Universidad de Alcala (IRYCIS),
      Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20161014
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - AIM
SB  - IM
MH  - Cause of Death
MH  - Comorbidity
MH  - Echocardiography
MH  - Heart Diseases/diagnostic imaging/*epidemiology
MH  - Humans
MH  - Mortality
MH  - Prognosis
MH  - Pulmonary Embolism/epidemiology/*mortality
MH  - Thrombosis/diagnostic imaging/*epidemiology
OTO - NOTNLM
OT  - *meta-analysis
OT  - *mortality
OT  - *prognosis
OT  - *pulmonary embolism
OT  - *right heart thrombi
EDAT- 2016/10/18 06:00
MHDA- 2017/05/26 06:00
CRDT- 2016/10/18 06:00
PHST- 2016/08/15 00:00 [received]
PHST- 2016/09/26 00:00 [revised]
PHST- 2016/09/29 00:00 [accepted]
PHST- 2016/10/18 06:00 [pubmed]
PHST- 2017/05/26 06:00 [medline]
PHST- 2016/10/18 06:00 [entrez]
AID - S0012-3692(16)60765-1 [pii]
AID - 10.1016/j.chest.2016.09.038 [doi]
PST - ppublish
SO  - Chest. 2017 Feb;151(2):409-416. doi: 10.1016/j.chest.2016.09.038. Epub 2016 Oct
      14.