The Bottom Line: A recent study found the ratio of systolic to diastolic blood pressure ≤1.7 to be a strong indicator of right ventricle dysfunction. In his review of the article, Pallin (2017) notes that the results should not change current practice and must be considered preliminary, since there was no external validation. If validated in other populations, this simple bedside measure may help decide whether to manage patients with PE in the outpatient setting.
Reference: Ates H, Ates I, Kundi H, et al. A novel clinical index for the assessment of RVD in acute pulmonary embolism: Blood pressure index. American Journal of Emergency Medicine. 2017 April 12; S0735-6757(17)30283-8. doi: 10.1016/j.ajem.2017.04.019. [Epub ahead of print].
Pallin DJ. New bedside predictor of right ventricular dysfunction in acute pulmonary emobolism. NEJM Journal Watch. 2017 May 8.
Summary: The study enrolled 539 patients with acute PE diagnosed by computed tomography. Of these, 74% had right ventricular dysfunction, which was diagnosed by tricuspid annular plane systolic excursion ≤17 mm on echocardiography. The mortality rate was 9.5% in patients with right ventricular dysfunction and 1.4% in those without. BPI ≤1.7 had a 100% positive predictive value and 42% negative predictive value for right ventricular dysfunction. For mortality, BPI ≤1.4 had a 98.5% positive predictive value and an 11.9% negative predictive value (Pallin 2017).