1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland
Background: Despite an increasing number of catheter-interventional treatments of patients presenting with acute pulmonary artery embolism (PE), there is uncertainty on the efficacy of this treatment when compared to the guideline-directed standard of systemic anticoagulation and/or systemic fibrinolysis upon hemodynamic compromise. A faster reperfusion therapy might have positive effects on longterm outcomes of PE by immediately lowering pressure on the right ventricle (RV) and effectively preventing longterm elevation of PA-pressure and following RV-remodelling. We aimed to compare the effects of interventional and conventional therapy on RV-function in a single-center cohort of patients with acute PE.
Methods: All patients with PE who underwent follow-up echocardiography after receiving either invasive or conservative treatment at our center between january 2019 and october 2023 were retrospectively included. Patients in the interventional group and the conservative group were compared by clinical baseline characteristics and echocardiographic parameters focussing on right ventricular changes.
Results: A total of 57 patients (mean age 69±12 years) were included into this analysis, 41 in the conventional treatment group and 16 in the interventional treatment group.
At baseline, there were no significant differences in TAPSE (16±5 vs. 19±6, p=0.13), sPAP (44±16mmHg vs. 44±17mmHg, p=0.87) or TAPSE/sPAP (0.47±0.23 vs. 0.49±0.25, p=0.17) between the interventional and conservative group. At follow up after 3 to 6 months, sPAP was significantly reduced by 8±12mmHg (17%) and 11±14mmHg (26%) and TAPSE/sPAP significantly increased by 0.22±0.23 (55%) and 0.22±0.46 (45%) in both groups (p=0.02 and p<0.001 as well as p=0.002 and p=0.004, respectively). TAPSE increased only in the interventional but not in the conservative treatment group (4±6 (27%), p=0.02 vs. 0.6±7 (3%), p=0.63).
RV/LV-ratio was significantly higher at baseline in the interventional group (mean 1.28±0.24 vs. 0.91±0.18, p<0.001), and was significantly reduced in both groups (p<0.001 and p<0.001). Relative reduction of RV/LV-ratio was significantly larger in the interventional than in the conventional therapy group (28±16% vs. 9±16%, p-value for between-group comparison <0.001).
Conclusion:
In patients with PE undergoing interventional treatment, RV-function seems to improve significantly more than in patients receiving conservative treatment.