• Deisy Barrios, Vladimir Rosa-Salazar, Raquel Morillo, Rosa Nieto, Sara Fernández, José Luis Zamorano, Manuel Monreal, Adam Torbicki, Roger D Yusen, and David Jiménez.
• Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcalá (IRYCIS), Madrid, Spain.
• Chest. 2017 Feb 1; 151 (2): 409-416.

BackgroundFor patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant right heart thrombi (RHT) lacks clarity.MethodsWe performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of echocardiography-detectable RHT for the primary outcome of short-term all-cause mortality and the secondary outcome of short-term PE-related mortality. Unrestricted searches were conducted of PubMed and Embase from 1980 through January 31, 2016, and used the terms "right heart thrombi," "pulmonary embolism," and "prognos.*" A random effects model was used to pool study results; Begg rank correlation method was used to evaluate for publication bias; and I(2) testing was used to assess for heterogeneity.ResultsSix of 79 potentially relevant studies met the inclusion criteria (15,220 patients). Overall, 99 of 593 patients with echocardiography-detectable RHT died (16.7% [95% CI, 13.8-19.9]) compared with 639 of 14,627 without RHT (4.4% [95% CI, 4.0-4.7]). RHT had a significant association with short-term all-cause mortality in all patients (OR, 3.0 [95% CI, 2.2 to 4.1]; I(2) = 20%) and with PE-related death (three cohorts, 12,955 patients; OR: 4.8 [95% CI, 2.0-11.3; I(2) = 76%). Results were consistent for the prospective (two cohorts, 514 patients; OR, 4.8 [95% CI, 1.7-13.6]; I(2) = 56%) and the retrospective (four cohorts, 14,706 patients; OR, 2.8 [95% CI, 2.1 to 3.8]; I(2) = 0%) studies.ConclusionsIn patients diagnosed with acute PE, concomitant RHT were significantly associated with an increased risk of death within 30 days of PE diagnosis.Trial RegistryPROSPERO registry; No.: CRD42016033960; URL: https://www.crd.york.ac.uk/prospero/.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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