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Mavromanoli, A.C.; Barco, S.; Ageno, W.; Bouvaist, H.; Brodmann, M.; Cuccia, C.; ... ; PEITHO-2 Investigators (2022)

Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2

Article / Letter to editor
BackgroundRight ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe. MethodsEchocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure. ResultsRV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as...Show moreBackgroundRight ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe. MethodsEchocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure. ResultsRV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as day 6, RV size remained normal or improved in 260 patients (64.7%), RV free wall/tricuspid annulus motion in 301 (74.9%), RV pressure overload in 297 (73.9%), and RA/central venous pressure in 254 (63.2%). At day 180, the frequencies slightly increased. The median NT-proBNP level decreased from 1448 pg/ml at baseline to 256.5 on day 6 and 127 on day 180. ConclusionIn the majority of patients with acute intermediate-risk PE switched early to a direct oral anticoagulant, echocardiographic parameters of RV function normalised within 6 days and remained normal throughout the first 6 months. Almost one in four patients, however, continued to have evidence of RV dysfunction over the long term.Show less
Echocardiography
Right ventricle
Dysfunction
Pulmonary embolism
Intermediate-risk
All authors
Mavromanoli, A.C.; Barco, S.; Ageno, W.; Bouvaist, H.; Brodmann, M.; Cuccia, C.; Couturaud, F.; Dellas, C.; Dimopoulos, K.; Duerschmied, D.; Empen, K.; Faggiano, P.; Ferrari, E.; Galie, N.; Galvani, M.; Ghuysen, A.; Giannakoulas, G.; Huisman, M.V.; Jimenez, D.; Kozak, M.; Lang, I.M.; Meneveau, N.; Munzel, T.; Palazzini, M.; Petris, A.O.; Piovaccari, G.; Salvi, A.; Schellong, S.; Schmidt, K.H.; Verschuren, F.; Schmidtmann, I.; Toenges, G.; Klok, F.A.; Konstantinides, S.V.; PEITHO-2 Investigators
Date
2022-12-21
Journal
Clinical Research in Cardiology
Volume
112
Pages
1372 - 1381
DOI
doi:10.1007/s00392-022-02138-4