RESUMO
INTRODUCTION: In pulmonary embolism (PE) without hemodynamic compromise, the prognostic value of right ventricular (RV) dysfunction as measured by echocardiography, computed tomography (CT) or biological (natriuretic peptides) markers has only been assessed in small studies. METHODS: Databases were searched using the combined medical subject headings for right ventricular dysfunction or right ventricular dilatation with the exploded term acute pulmonary embolism. This retrieved 8 echocardiographic marker based studies (n = 1249), three CT marker based studies (n = 503) and 7 natriuretic peptide based studies (n = 582). A meta-analysis of these data was performed with the primary endpoint of mortality within three months after pulmonary embolism, and a secondary endpoint of overall mortality and morbidity by pulmonary embolism. RESULTS: Patients with PE without hemodynamic compromise on admission and the presence of RV dysfunction determined by echocardiography and biological markers were associated with increased short-term mortality (odds ratio (OR) ECHO = 2.36; 95% confidence interval (CI): 1.3-43; OR BNP = 7.7; 95% CI: 2.9-20) while CT was not (ORCT = 1.54-95% CI: 0.7-3.4). However, corresponding pooled negative and positive likelihood ratios independent of death rates were unsatisfactory for clinical usefulness in risk stratification. CONCLUSIONS: The presence of echocardiographic RV dysfunction or elevated natriuretic peptides is associated with short-term mortality in patients with pulmonary embolism without hemodynamic compromise. In contrast, the prognostic value of RV dilation on CT has yet to be validated in this population. As indicated both by positive and negative likelihood ratios the current prognostic value in clinical practice remains very limited.
Assuntos
Embolia Pulmonar/fisiopatologia , Disfunção Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Natriuréticos/sangue , Valor Preditivo dos Testes , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Medição de Risco/métodos , Tomografia Computadorizada por Raios X/métodos , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/diagnósticoRESUMO
Hypoplasia of the aorta is a rare entity comprising tubular hypotrophy of a large segment of the thoracic and the abdominal aorta. We report for the first time the case of a 26-year-old man with Emery-Dreifuss muscular dystrophy presenting severe and diffuse hypoplasia of the aorta.
Assuntos
Aorta/anormalidades , Lamina Tipo A/genética , Distrofia Muscular de Emery-Dreifuss/genética , Mutação , Malformações Vasculares/genética , Adulto , Aortografia/métodos , Cardiomiopatia Dilatada/genética , Análise Mutacional de DNA , Evolução Fatal , Predisposição Genética para Doença , Humanos , Masculino , Distrofia Muscular de Emery-Dreifuss/diagnóstico , Fenótipo , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnósticoRESUMO
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