Background: Right ventricular (RV) dysfunction predicts worse outcomes in acute pulmonary embolism (PE). CT pulmonary angiography visualizes cardiac structures and may be a potential method for assessing RV without the need for transthoracic echocardiography.
Aims: To conduct a systematic review and meta-analysis to assessing the diagnostic accuracy of CT scan findings for detecting RV dysfunction compared to echocardiography.
Methods: We searched MEDLINE and EMBASE from inception to April 2020 for studies comparing RV dysfunction on CT scan to echocardiography standard. Study quality was assessed with the QUADAS-2 risk of bias tool. Meta-analysis was performed using a bivariate mixed-effects regression framework.
Results: Overall, 26 studies (3,508 patients) were included. Indicators of RV dysfunction included reflux of contrast into the inferior vena cava (IVC reflux;4 studies; 445 patients), increased RV/LV ratio (21 studies; 3,111 patients), and septal deviation (5 studies; 459 patients). Septal deviation had the highest specificity of 0.98 (95% CI=0.90 – 1.00) a positive likelihood ratio of 13.6 (95% CI=3.1 – 60.4), and a positive predictive value of 0.92 (0.87-0.98) for RV dysfunction (Table 1). For combinations of measurements, any of septal deviation, IVC reflux, or RV/LV > 1.0 had 95% sensitivity and 88% specificity for RV dysfunction in one study (n=59). Overall, most studies were judged to be at high risk of bias by the QUADAS-2 tool (Figure 1).
Conclusions: CT scanning is performed in most patients with suspected PE. RV dysfunction can be detected by CT but the diagnostic accuracy compared to echocardiography varies depending on the specific findings. The presence of septal bowing appears to be highly specific for RV dysfunction suggesting that echocardiography is not necessary when it is present. Although preliminary, our findings suggest that findings on CT suggestive of RV dysfunction may negate the need for echocardiography – access to which may be delayed or not available. Further studies are warranted.
To cite this abstract in AMA style:Chornenki N, Poorzargar K, Shanjer M, Mbuagbaw L, Crowther M, Delluc A, Siegal D. Detection of Right Ventricular Dysfunction in Acute Pulmonary Embolism by CT Scan: A Systematic Review and Meta-analysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/detection-of-right-ventricular-dysfunction-in-acute-pulmonary-embolism-by-ct-scan-a-systematic-review-and-meta-analysis/. Accessed September 24, 2021.
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