A right ventricle/left ventricle (RV/LV) ratio >1.0 was not associated with fewer favorable outcomes in patients with symptomatic acute pulmonary embolism (PE) who were otherwise considered low risk, , according to study results published in The American Journal of Respiratory and Critical Care Medicine.

In this patient-level post-hoc analysis of 2 Dutch clinical trials (Hestia; Netherlands Trial Register Identifier: NTR1319 and Vesta; Netherlands Trial Register Identifier: NTR2603), RV/LV diameter ratios obtained via tomographic pulmonary angiography (CTPA) from patients with symptomatic acute PE were analyzed. Patient risk scores for outpatient treatment was assessed according to the Hestia criteria. Outcomes of interest included the proportion of patients treated at home with a RV/LV ratio >1.0 and comparing the 3-month incidence of recurrent venous thromboembolism and mortality in patients with and without RV dilatation.

Of the 1627 patients eligible for the study, RV/LV ratios were available for 1474 patients, of whom 752 were treated at home. Of the 752 patients who received outpatient treatment, 225 (30%), had an RV/LV diameter ratio >1. No relevant differences were found in vital parameters in patients with vs those without RV dilatation. The incidence of adverse events was 6 of 224 patients with a RV/LV diameter ratio >1.0 compared with 12 of 527 patients with a normal RV/LV ratio.

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“In this study, in patients with acute PE treated at home based on absence of all Hestia criteria, our most important finding was that there was no difference in the incidence of adverse events in those with RV/LV diameter ratio >1.0 on CTPA compared to those without an abnormal RV/LV diameter ratio” “…RV function assessment may not be necessary to guide management in all low risk PE patients.”

Disclosure: Study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Hendriks SV, Klok FA, den Exter PL, et al; on behalf of the Hestia/Vesta Investigators.  RV/LV ratio measurement seems to have no role in low risk patients with pulmonary embolism treated at home triaged by Hestia criteria [published March 23, 2020]. Am J Respir Crit Care Med. doi:10.1164/rccm.202002-0267LE