Independent evaluation of a simple clinical prediction rule to identify right ventricular dysfunction in patients with shortness of breath

Abstract Background Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of emergency medicine 2015-04, Vol.33 (4), p.542-547
Main Authors: Russell, Frances M., MD, Moore, Christopher L., MD, Courtney, D. Mark, MD, Kabrhel, Christopher, MD, Smithline, Howard A., MD, Nordenholz, Kristen E., MD, Richman, Peter B., MD, O'Neil, Brian J., MD, Plewa, Michael C., MD, Beam, Daren M., MD, Mastouri, Ronald, MD, Kline, Jeffrey A., MD
Format: Article
Language:English
Subjects:
Angiography
Body mass index
Cardiovascular disease
Chronic obstructive pulmonary disease
Decision Support Techniques
Diagnosis, Differential
Dyspnea - diagnosis
Echocardiography
Emergency
Emergency medical care
Female
Humans
Male
Medical imaging
Medical treatment
Mortality
Predictive Value of Tests
Prospective Studies
Tomography, X-Ray Computed
Ventricular Dysfunction, Right - diagnosis
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background Many patients have unexplained persistent dyspnea after negative computed tomographic pulmonary angiography (CTPA). We hypothesized that many of these patients have isolated right ventricular (RV) dysfunction from treatable causes. We previously derived a clinical decision rule (CDR) for predicting RV dysfunction consisting of persistent dyspnea and normal CTPA, finding that 53% of CDR-positive patients had isolated RV dysfunction. Our goal is to validate this previously derived CDR by measuring the prevalence of RV dysfunction and outcomes in dyspneic emergency department patients. Methods A secondary analysis of a prospective observational multicenter study that enrolled patients presenting with suspected PE was performed. We included patients with persistent dyspnea, a nonsignificant CTPA, and formal echo performed. Right ventricular dysfunction was defined as RV hypokinesis and/or dilation with or without moderate to severe tricuspid regurgitation. Results A total of 7940 patients were enrolled. Two thousand six hundred sixteen patients were analyzed after excluding patients without persistent dyspnea and those with a significant finding on CTPA. One hundred ninety eight patients had echocardiography performed as standard care. Of those, 19% (95% confidence interval [CI], 14%-25%) and 33% (95% CI, 25%-42%) exhibited RV dysfunction and isolated RV dysfunction, respectively. Patients with isolated RV dysfunction or overload were more likely than those without RV dysfunction to have a return visit to the emergency department within 45 days for the same complaint (39% vs 18%; 95% CI of the difference, 4%-38%). Conclusion This simple clinical prediction rule predicted a 33% prevalence of isolated RV dysfunction or overload. Patients with isolated RV dysfunction had higher recidivism rates and a trend toward worse outcomes.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2015.01.026