PMID- 37638233
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230829
IS  - 2589-5370 (Electronic)
IS  - 2589-5370 (Linking)
VI  - 62
DP  - 2023 Aug
TI  - Prevalence of long-term right ventricular dysfunction after acute pulmonary 
      embolism: a systematic review and meta-analysis.
PG  - 102153
LID - 10.1016/j.eclinm.2023.102153 [doi]
LID - 102153
AB  - BACKGROUND: Right ventricular dysfunction (RVD) is associated with adverse 
      outcomes of acute pulmonary embolism (PE). However, there are no studies 
      describing the long-term, full-spectrum right ventricular parameters on 
      morphology, pressure and function at certain follow-up time points after PE 
      onset. More exploration of right ventricular function would provide useful clues 
      for long-term management of patients with PE. METHODS: For this systematic review 
      and meta-analysis, we completed a literature search in Pubmed, EMBASE and 
      WebofScience (from Jan 1st, 1998 to April 20th, 2023). Studies of patients with 
      acute PE followed-up longer than 3 months with right ventricle assessment and 
      written in English-language were included. Right ventricular function was 
      assessed by either echocardiography or computed tomographic pulmonary angiography 
      (CTPA). The primary outcome was structural and functional parameters of the right 
      ventricle, and the secondary outcomes were functional assessments [New York Heart 
      Association (NYHA) functional classification and 6-min walk test distance 
      (6 MWD)], at each follow-up time points. Random effect meta-analyses were 
      performed using R software (PROSPERO: CRD42023433332). FINDINGS: A total of 33 
      studies (3920 patients) were included in the final analysis. The 3-month, 6-month 
      and 1-year prevalence of right ventricular dysfunction (RVD) was 0.34 [95% 
      confidence interval (CI) 0.21-0.48, I(2) = 96%], 0.26 (95% CI 0.17-0.36, 
      I(2) = 93%) and 0.34 (95% CI 0.19-0.48, I(2) = 94%), respectively. Pooled 
      tricuspid annulus plane systolic excursion (TAPSE), right ventricular to left 
      ventricular diameter (RV/LV) ratio and pulmonary artery systolic pressure (PASP) 
      at 1-year was 21.80 mm (95% CI 20.08-23.52, I(2) = 93%), 0.64 (95% CI 0.48-0.81, 
      I(2) = 92%) and 27.33 mmHg (95% CI 18.88-35.78) (I(2) = 96%), respectively. The 
      proportion of NYHA III-IV was 0.06 (95% CI 0.0-0.12) and the pooled 6 MWD was 
      462.98 m (95% CI 447.55-478.41) over 1 year. Patients treated with thrombolysis 
      had lower prevalence of RVD (1-year 0.17 and 0.07 in systemic thrombolysis and 
      catheter-directed thrombolysis, respectively) than those treated with 
      anticoagulation therapy alone (1-year 0.24) but the pooled risk ratio (RR) was 
      not statistically significant. INTERPRETATION: Although the conclusion of this 
      study may be limited by its high heterogeneity from varied study designs, 
      inclusion criteria and definition of RVD of each study, our findings suggested 
      that persistent RVD and functional impairment were of considerable high 
      prevalence during long-term follow-up after acute PE. Treatment strategy may 
      influence the prevalence of long-term RVD. FUNDING: This study is supported by 
      CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-061). The National 
      Key Research and Development Program of China (2016YFC0905600). National High 
      Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-02-03). CAMS 
      Institute of Respiratory Medicine Grant for Young Scholars (2023-ZF-8).
CI  - (c) 2023 The Author(s).
FAU - Wang, Dingyi
AU  - Wang D
AD  - National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China.
AD  - State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. 
      China.
AD  - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 
      P.R. China.
AD  - Department of Clinical Research and Data Management, Center of Respiratory 
      Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
FAU - Fan, Guohui
AU  - Fan G
AD  - National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China.
AD  - State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. 
      China.
AD  - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 
      P.R. China.
AD  - Department of Clinical Research and Data Management, Center of Respiratory 
      Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
FAU - Zhang, Xiaomeng
AU  - Zhang X
AD  - National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China.
AD  - State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. 
      China.
AD  - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 
      P.R. China.
AD  - China-Japan Friendship Hospital, Peking University Health Science Center, 
      Beijing, China.
AD  - Department of Pulmonary and Critical Care Medicine, Center of Respiratory 
      Medicine, China‑Japan Friendship Hospital, National Center for Respiratory 
      Medicine, Beijing, P.R. China.
FAU - Xi, Linfeng
AU  - Xi L
AD  - National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China.
AD  - State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. 
      China.
AD  - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 
      P.R. China.
AD  - Department of Pulmonary and Critical Care Medicine, Center of Respiratory 
      Medicine, China‑Japan Friendship Hospital, National Center for Respiratory 
      Medicine, Beijing, P.R. China.
AD  - China-Japan Friendship Hospital, Capital Medical University, Beijing, China.
FAU - Chen, Yinong
AU  - Chen Y
AD  - National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China.
AD  - State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. 
      China.
AD  - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 
      P.R. China.
AD  - China-Japan Friendship Hospital, Peking University Health Science Center, 
      Beijing, China.
AD  - Department of Pulmonary and Critical Care Medicine, Center of Respiratory 
      Medicine, China‑Japan Friendship Hospital, National Center for Respiratory 
      Medicine, Beijing, P.R. China.
FAU - Li, Aili
AU  - Li A
AD  - Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.
FAU - Zhai, Zhenguo
AU  - Zhai Z
AD  - National Clinical Research Center for Respiratory Diseases, Beijing, P.R. China.
AD  - State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, P.R. 
      China.
AD  - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 
      P.R. China.
AD  - Department of Pulmonary and Critical Care Medicine, Center of Respiratory 
      Medicine, China‑Japan Friendship Hospital, National Center for Respiratory 
      Medicine, Beijing, P.R. China.
LA  - eng
PT  - Journal Article
DEP - 20230811
PL  - England
TA  - EClinicalMedicine
JT  - EClinicalMedicine
JID - 101733727
PMC - PMC10448274
OTO - NOTNLM
OT  - Functional impairment
OT  - Long-term
OT  - Meta-analysis
OT  - Pulmonary embolism
OT  - Right ventricular function
COIS- The authors have no conflict of interest or financial relationships to disclose. 
      No form of payment was given to anyone to produce the manuscript.
EDAT- 2023/08/28 06:42
MHDA- 2023/08/28 06:43
PMCR- 2023/08/11
CRDT- 2023/08/28 05:01
PHST- 2023/06/07 00:00 [received]
PHST- 2023/07/24 00:00 [revised]
PHST- 2023/07/26 00:00 [accepted]
PHST- 2023/08/28 06:43 [medline]
PHST- 2023/08/28 06:42 [pubmed]
PHST- 2023/08/28 05:01 [entrez]
PHST- 2023/08/11 00:00 [pmc-release]
AID - S2589-5370(23)00330-9 [pii]
AID - 102153 [pii]
AID - 10.1016/j.eclinm.2023.102153 [doi]
PST - epublish
SO  - EClinicalMedicine. 2023 Aug 11;62:102153. doi: 10.1016/j.eclinm.2023.102153. 
      eCollection 2023 Aug.