TTE-derived PASP systematically overestimated mPAP (mean bias -12.8 mmHg, p<0.0001) but aligned more closely with invasive pPAP (mean bias +2.6 mmHg, p=0.21) in acute PE patients undergoing CDT.
Cohort (n=47)
No
Does TTE-derived pulmonary artery systolic pressure accurately reflect invasive catheter-based pulmonary artery pressures in patients with acute pulmonary embolism undergoing thrombectomy?
In patients with acute pulmonary embolism, TTE-derived pulmonary artery systolic pressure correlates moderately with invasive peak pulmonary artery pressure but poorly with mean pulmonary artery pressure, suggesting it better reflects instantaneous systolic load.
Effect estimate: mean bias -12.8 mmHg (mPAP) and +2.6 mmHg (pPAP) (95% CI LoA -46 to +20 mmHg (mPAP); -24 to +29 mmHg (pPAP))
p-value: p=<0.0001 (mPAP); 0.21 (pPAP)
Abstract Rationale In acute pulmonary embolism (PE), transthoracic echocardiography (TTE) is essential for bedside evaluation of right ventricular (RV) dysfunction. Pulmonary artery systolic pressure (PASP) serves as a surrogate for RV afterload, yet its agreement with invasive hemodynamics in acute PE remains unclear. Catheter-directed thrombectomy (CDT) allows direct measurement of mean and peak pulmonary artery pressures (mPAP, pPAP), providing an opportunity to compare TTE and CDT measurements. Methods We conducted a retrospective cohort study at a community tertiary hospital using the Pulmonary Embolism Response Team registry (12/31/2022-7/31/2025). Patients ≥18 years with acute PE who underwent CDT and had a TTE-derived PASP 48 hours prior to CDT were included. Agreement between TTE PASP and CDT mPAP and pPAP was analyzed using Bland-Altman analysis, intra-class correlation coefficient (ICC), Pearson correlation (r), and weighted κ statistics. Results A total of 47 patients were analyzed for PASP vs mPAP and 45 for PASP vs pPAP (two lacked pPAP documentation). TTE systematically overestimated mPAP with a mean bias of -12.8 mmHg (p0.0001, n = 46, 1 excluded due to missing pressure difference). The 95% limits of agreement (LoA) were -46 to + 20 mmHg, and 77% of patients had higher PASP than mPAP. Correlation was weak (r = 0.15, p = 0.32) and reliability negligible (ICC=0.006; κ = 0.03-0.17). Agreement improved when comparing PASP to pPAP. The mean bias was +2.6 mmHg (p = 0.21) for PASP vs pPAP (95% LoA -24 to + 29 mmHg), with a moderate correlation (r = 0.52, p = 0.0002) and ICC =0.49 (p 0.001). Weighted κ suggested fair agreement (κ = 0.31-0.38). Conclusions This study is the first real-world comparative analysis of TTE-derived PASP with invasive PAPs in acute PE patients undergoing CDT. PASP consistently overestimated mPAP, while PASP more closely aligned with invasive pPAP, showing smaller bias (though p 0.05), narrower LoA, and stronger correlation - suggesting that TTE-derived PASP better reflects pPAP rather than mPAP in the acute PE setting. While invasive measurements are often viewed as a reference, our findings do not establish a definitive gold standard. A study correlating noninvasive and invasive pressures with clinical outcomes would help establish a definitive standard. We conclude that TTE-derived PASP aligns more closely with pPAP on CDT in acute PE, suggesting PASP reflects instantaneous systolic load rather than mean hemodynamic load. These findings help clinicians interpret and understand the correlation between these common measurements. Further research correlating CDT and TTE pressures with clinical outcomes is warranted to better understand their prognostic value. This abstract is funded by: None
Mitchell et al. (Fri,) conducted a cohort in Acute pulmonary embolism (n=47). Transthoracic echocardiography (TTE) derived PASP vs. Catheter-directed thrombectomy (CDT) derived mPAP and pPAP was evaluated on Agreement between TTE PASP and CDT mPAP and pPAP (mean bias -12.8 mmHg (mPAP) and +2.6 mmHg (pPAP), 95% CI LoA -46 to +20 mmHg (mPAP); -24 to +29 mmHg (pPAP), p=<0.0001 (mPAP); 0.21 (pPAP)). TTE-derived PASP systematically overestimated mPAP (mean bias -12.8 mmHg, p<0.0001) but aligned more closely with invasive pPAP (mean bias +2.6 mmHg, p=0.21) in acute PE patients undergoing CDT.