Background: Right 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. Methods: Echocardiographic 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. Results: RV 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. Conclusion: In 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. Graphical Abstract: [Figure not available: see fulltext.].

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

Ageno W.;
2022-01-01

Abstract

Background: Right 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. Methods: Echocardiographic 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. Results: RV 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. Conclusion: In 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. Graphical Abstract: [Figure not available: see fulltext.].
2022
Dysfunction; Echocardiography; Intermediate-risk; Pulmonary embolism; Right ventricle
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.; Freire, J. A. A.; Akin, I.; Anusic, T.; Becker, D.; Bertoletti, L.; Bettoni, G.; Binder, H.; Carels, R.; Di Pasquale, G.; Durschmied, D.; Enea, I.; Ficker, J.; Genth-Zotz, S.; Girard, P.; Gorbulev, S.; Held, M.; Hobohm, L.; Huisman, M. V.; Konstantinides, S. V.; Kronfeld, K.; Lang, I. M.; Lankeit, M.; Lehmacher, W.; Miguel, C. P. L.; Martin, N.; Meyer, G.; Pareznik, R.; Quitzau, K.; Parepa, I. R.; Martin, P. R.; Righini, M.; Todea, S. B.; Torbicki, A.; Valerio, L.; Vanassche, T.; Vida-Simiti, L. A.; Wolf-Putz, A.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2148365
 Attenzione

L'Ateneo sottopone a validazione solo i file PDF allegati

Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? 0
social impact