Clinical Trial: Pulmonary Embolism: Multifunctional Assessment of Prognosis
Study Status: Completed
Recruit Status: Unknown status
Study Type: Observational
Official Title: Right Ventricular Dysfunction in Acute Pulmonary Embolism as Assessed by Spiral CT Scan: Comparison With Transthoracic Echocardiography and Evaluation of Prognostic Value
Brief Summary:
This is a prospective, observational, multicenter study. The primary aim of the study is to assess the accuracy of spiral CT scan to detect right ventricular dysfunction as compared to current 'gold standard'in patients with pulmonary embolism. At the purpose of this study right ventricular dysfunction as assessed by transthoracic echocardiography and serum levels of troponin are considered as gold standard.
The secondary aim of the study is to assess the prognostic value of right ventricular dysfunction as assessed by spiral CT scan.
Detailed Summary:
Pulmonary embolism (PE) is a common and life-threatening disease. The incidence of a first episode of PE in acute care hospitals in the United States has been found to be 0.23 per 1000 with in-hospital mortality ranging from 30%, in case of cardiogenic shock, to about 0% in absence of right ventricular overload or hemodinamic impairment (1). In the intermediate group of patients with right ventricular overload but no hemodinamic impairment, in hospital mortality has been assessed to be about 5%. Right ventricular dysfunction as assessed at echocardiography and serum levels of Troponin I and T have been proposed as qualifying criteria for the identification of a subgroup of patients with pulmonary embolism and no hemodinamic impairment at high risk for in-hospital death. These patients could potentially benefit from more aggressive treatment.
A number of studies reported in favor of the association between echocardiographic RVD and early adverse outcome (PE recurrence and mortality) in patients with acute PE (3-6). In-hospital mortality in PE patients with and without echocardiographic RVD has been found to be 18.4% and 5.7%, respectively, regardless of the hemodinamic status (3). In 126 patients with acute pulmonary embolism, Ribeiro et al. reported a 7.9% overall in-hospital mortality (7). Mortality was 14.3% in patients with severe RVD. In a cohort of 2454 unselected patients with acute pulmonary embolism included in the ICOPER registry, 2-week mortality was 15.9% in patients presenting with RVD in comparison to 8% in patients without RVD (8). In the MAPPET 10% of patients with RVD died within 30 days as compared to 4.1% of patients without (9). Recent data confirmed that patients with objectively confirmed PE, normal BP and echocardiographic evidence of RVD have a high incidence of adverse outcome and may potentially benefit from more aggressive treatment (10).
Sponsor: University Of Perugia
Current Primary Outcome:
Original Primary Outcome:
Current Secondary Outcome:
Original Secondary Outcome:
Information By: University Of Perugia
Dates:
Date Received: April 29, 2010
Date Started: January 2007
Date Completion:
Last Updated: May 14, 2010
Last Verified: October 2009
