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

The American Journal of Emergency Medicine
Frances M RussellJeffrey A Kline

Abstract

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. 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. 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, 1...Continue Reading

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Citations

Sep 8, 2015·Annals of Emergency Medicine·Susan R WilcoxRichard N Channick
Apr 30, 2017·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Matt A RutzFrances M Russell
May 19, 2020·The Western Journal of Emergency Medicine·Susan R WilcoxCarlos A Camargo
Oct 14, 2017·American Journal of Respiratory and Critical Care Medicine·Arunabh TalwarUNKNOWN Pulmonary Circulation Assembly
Aug 18, 2021·The American Journal of Emergency Medicine·Susan R WilcoxCarlos A Camargo

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