Clinical predictors of pulmonary hypertension at 1 year follow-up after pulmonary embolism treated by catheter-directed therapies

Abstract Introduction Residual pulmonary hypertension (PH) after pulmonary embolism (PE) impairs functional recovery and survival. Among patients treated with percutaneous therapy, determinants of late PH are insufficiently characterized. We aimed to identify 1-year predictors of PH in a cohort treated with transcatheter intervention. Methods and Results Out of the 275 PE patients undergoing percutaneous treatment enrolled in the USAT IH-PE Registry, echocardiographic follow-up was available in 135. The primary endpoint was residual PH, defined as systolic pulmonary artery pressure (sPAP) 40 mmHg at ≈1 year, which occurred in 15/135 (11.1%). On univariable analyses, baseline sPAP 60 mmHg (30.8% vs 8.2%; p=0.014), prior deep-vein thrombosis (25.0% vs 8.2%; p=0.018), prior PE (30.0% vs 9.6%; p=0.048), and need for non-invasive ventilation (26.7% vs 9.5%; p=0.049) were associated with the endpoint; thrombus location across bilateral principal, bilateral lobar, and unilateral principal was related (p=0.017). Multivariable logistic regression identified baseline sPAP 60 mmHg (adjusted odds ratio aOR 12.20, 95% CI 1.73–85.98; p=0.012) and prior deep-vein thrombosis (aOR 12.66, 95% CI 1.53–104.61; p=0.018) as independent predictors. Bilateral principal involvement was associated with lower odds (aOR 0.092; p=0.029). Conclusions In PE patients after percutaneous therapy, severe baseline PH and prior venous thromboembolism identify high risk of 1-year residual PH.PASP across time points in both groupsFor image description, please refer to the figure legend and surrounding text.