Rajendran Gunaseelan, Mahalingam Sasikumar, Ramkumar Anitha, Ganessane Ezhilkugan, Krishnamoorthy Yuvaraj, Kumaresh P T, Vijayan Vijayanthi, Elanjaeran Rajkumar, Aswin K
Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences (AIIMS), Madurai, Thoppur, Austinpatti (Post), Madurai, Tamilnadu, India.
Department of Emergency Medicine and Trauma, Sri Lakshmi Narayana Institute of Medical Sciences, Villianur, Puducherry, India.
Intern Emerg Med. 2025 Aug 25. doi: 10.1007/s11739-025-04089-w.
Intermediate-risk pulmonary embolism (IRPE) is a critical clinical entity with significant mortality risk due to normotensive shock, a condition marked by low cardiac index despite maintained blood pressure. Accurate and timely detection of hemodynamic compromise in IRPE remains a challenge. Velocity Time Integral (VTI), a Doppler echocardiographic parameter, has emerged as a potential non-invasive tool for predicting hospital outcomes, but the evidence remains fragmented. This systematic review and meta-analysis aim to evaluate the diagnostic accuracy of VTI in this context. A systematic literature search encompassing PubMed, EMBASE, and SCOPUS Databases was conducted from inception till December 2024. Studies assessing VTI's diagnostic accuracy for predicting hospital outcomes in IRPE were included. A bivariate random-effects model was used to pool sensitivity and specificity, with heterogeneity analyzed via I statistics and meta-regression. Literature search yielded 9 studies with 2038 patients. Pooled sensitivity and specificity of VTI for predicting hospital outcomes in IRPE were 79% (95% CI 69-86%) and 81% (95% CI 70-88%), respectively. Diagnostic odds ratio was 15.58 (95% CI: 7.42-32.69). Heterogeneity was moderate to high (I = 66.59%), with specificity showing greater variability. Meta-regression identified study-level characteristics, including risk of bias and VTI measurement site (LVOT vs. RVOT), as sources of variability. VTI demonstrates moderate sensitivity and specificity in predicting hospital outcomes such as mortality, in-hospital mortality, resuscitated cardiac arrest, hemodynamic instability or the need for reperfusion therapy. VTI, offers a non-invasive, real-time diagnostic option. However, study heterogeneity and methodological limitations highlight the need for further research.
中危肺栓塞（IRPE）是一种关键的临床病症，因血压正常性休克而具有显著的死亡风险，血压正常性休克的特征是尽管血压维持正常，但心脏指数较低。准确及时地检测IRPE中的血流动力学损害仍然是一项挑战。速度时间积分（VTI）是一种多普勒超声心动图参数，已成为预测医院结局的潜在非侵入性工具，但证据仍然零散。本系统评价和荟萃分析旨在评估在此背景下VTI的诊断准确性。从数据库建立至2024年12月，对PubMed、EMBASE和SCOPUS数据库进行了系统的文献检索。纳入评估VTI对预测IRPE医院结局的诊断准确性的研究。采用双变量随机效应模型汇总敏感性和特异性，并通过I统计量和荟萃回归分析异质性。文献检索得到9项研究，共2038例患者。VTI预测IRPE医院结局的汇总敏感性和特异性分别为79%（95%CI 69-86%）和81%（95%CI 70-88%）。诊断比值比为15.58（95%CI：7.42-32.69）。异质性为中度至高（I=66.59%），特异性显示出更大的变异性。荟萃回归确定了研究水平特征，包括偏倚风险和VTI测量部位（左心室流出道与右心室流出道）作为变异性来源。VTI在预测死亡率、院内死亡率、复苏后心脏骤停、血流动力学不稳定或再灌注治疗需求等医院结局方面显示出中度敏感性和特异性。VTI提供了一种非侵入性的实时诊断选择。然而，研究异质性和方法学局限性凸显了进一步研究的必要性。
