What does this research mean for the field?

In patients with pulmonary thromboembolism treated with rivaroxaban, the right-to-left ventricular diameter ratio correlates with disease severity but does not predict long-term clinical outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 17, 2022Open Access

Clinical Implication of the Right Ventricular/Left Ventricular Diameter Ratio in Patients with Pulmonary Thromboembolism

MMMasatsugu MiyagawaNihon University YOYasuo OkumuraElectrophysiology DFDaisuke FukamachiNihon University

Structured PICO

Does an RV/LV diameter ratio ≥ 1.0 predict long-term composite adverse events in Japanese patients with acute pulmonary thromboembolism treated with rivaroxaban?

Population

216 Japanese patients with acute pulmonary thromboembolism (PTE) with or without deep vein thrombosis, treated with rivaroxaban, who had right to left ventricular (RV/LV) diameter ratio data available from CT or echocardiography. Mean age 65 ± 16 years, 55.1% female.

Intervention

Exposure: RV/LV diameter ratio ≥ 1.0 measured on axial CT or transthoracic echocardiogram. All patients received background therapy of rivaroxaban (mostly 15 mg twice daily for 3 weeks, then 15 mg once daily).

Comparator

Exposure: RV/LV diameter ratio < 1.0. All patients received background therapy of rivaroxaban.

Outcome

Primary effectiveness outcome: recurrence or aggravation of a symptomatic VTE. Principal safety outcome: major bleeding according to ISTH criteria. The primary evaluated endpoint for the RV/LV ratio analysis was a composite of adverse events including recurrent VTEs, acute coronary syndrome, ischemic strokes, death from any cause, or major bleeding events.composite

In Japanese patients with acute pulmonary thromboembolism treated with rivaroxaban, an RV/LV diameter ratio ≥ 1.0 correlated with disease severity but did not independently predict long-term composite adverse events.

Abstract

The role of the right to left ventricular (RV/LV) diameter ratio in predicating long-term outcomes in patients with pulmonary thromboembolisms (PTEs) treated with direct oral anticoagulants is unclear.We investigated the association between the RV/LV diameter ratio and clinical outcomes in PTE patients under rivaroxaban from the data of a multicenter, prospective, observational study (J'xactly Study) in Japanese patients with acute venous thromboembolisms (VTEs) including deep vein thromboses, PTEs, or both. Of a total of 1,039 patients with an acute VTE (from December 2016 to April 2018), 429 were diagnosed with PTEs, however, the population in this study consists of 216 patients in whom the RV/LV diameter ratio measured on the axial CT or transthoracic echocardiogram was available.The RV/LV diameter ratio increased significantly with the severity of the PTE classification (nonmassive 0.79 0.67-0.93, submassive 1.10 0.83-1.31, massive 1.13 0.94-1.19, arrest or collapse 1.38 0.66-2.38, P < 0.001). During a median follow-up of 624 (550-690) days, a sum of the composite adverse events including recurrent VTEs, acute coronary syndrome, ischemic strokes, death from any cause, or major bleeding events occurred in 26 patients (12.0%, 7.58 events per 100 patient-years). Multivariate analysis revealed that an RV/LV diameter ratio ≥ 1.0 had no association with the incidence of composite adverse events (HR 1.34, 95% confidence interval 0.59-2.91, P = 0.48).In summary, in Japanese PTE patients under rivaroxaban, the RV/LV diameter ratio measured on the CT or transthoracic echocardiogram was associated with the PTE severity, but not with the clinical outcomes.

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Cite This Study

Miyagawa et al. (Thu,) studied this question.

synapsesocial.com/papers/6a198be9443d3ecd7cdebb49 https://doi.org/https://doi.org/10.1536/ihj.21-390

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