Comment on right ventricle assessment in patients with pulmonary embolism at low risk for death based on clinical models: an individual patient data meta-analysis

There is an ongoing discussion on potential prognostic value of assessment of right ventricular dysfunction  (RVD) in low risk patients with acute pulmonary embolism (PE)  who are  are candidates for home treatment or short-hospital stay.  Dr Becattini tried to solve this  challenge  and  aimed at determining whether the  RVD assessment or elevated troponin improves identification of low-risk patients over clinical models alone. Thereore, they performend very elegant meta-analysis of pooled  individual patient (IPDMA) data of >5000 subjects  included into 18   studies assessing the relationship between RVD or elevated troponin and shortterm mortality in patients with acute PE at low risk for death based on clinical models (Pulmonary Embolism Severity Index, simplified Pulmonary Embolism Severity Index or Hestia) .  The primary outcome of IPDMA was short-term death defined as death occurring in hospital or within 30 days.  Short-term mortality was 0.7% [95% CI 0.4–1.3]. RVD at echocardiography, computed tomography or B-type natriuretic peptide  was associated with increased risk for short-term death (1.5 vs. 0.3%; OR 4.81, 95% CI 1.98–11.68), death within 3 months  and PE-related death (1.1 vs. 0.04%; OR 22.9, 95% CI 2.89–181).  Interestingly,  RVD at echocardiography and BNP or NT-proBNP levels were the most reliable predictors of death in low  rsik PE  patients. Indeed,  this study can help clinicians in decision making, beacuse  RVD assessment, mainly by BNP/NT-proBNP or echocardiography, should improve identification of low-risk PE  patients  and facilitate  their outpatient management or short hospital stay.