Does catastrophic PE increase in-hospital mortality and adverse outcomes compared to high-risk PE?
Catastrophic pulmonary embolism (presenting with cardiac arrest) is associated with a twofold higher risk of in-hospital mortality and significantly greater resource utilization compared to high-risk PE without cardiac arrest.
Denervation (PADN) in this high-risk phenotype which is made by sympathetic overdrive.Methods: We performed a systematic review of trials that examined PADN in Group 2 CpcPH (PVR >3.0 WU).Randomised PADN-5 trial (6month and 3-year cohorts) and preliminary feasibility were amalgamated.Outcomes: 6-minute walk distance (6MWD), PVR, and worsening of clinical condition.Results: 98 randomized patients from the PADN-5 were involved in the analysis.The PADN was better than sildenafil and sham in HF-CpcPH.The response in PADN was +83m at 6MWD at 6 months in sildenafil controls (p<0.01).In the HFpEF subgroup, there was sustained neurohormonal benefit with a 55% decrease in NT-proBNP compared to 10% in controls after long-term PADN-5 analysis (3 years).Notably, PADN decreased clinical worsening (death/rehospitalization) by 3 years significantly (HR 0.15; 95% CI: 0.04-0.58;p=0.006).PVR was reduced without an increase in LV filling pressures.Conclusions: PADN is effective in managing Group 2 CpcPH providing long-term changes in exercise capacity and NT-proBNP not observed in drug therapy.Reduction in the clinical worsening over the 3 years implies that PADN alters disease progression in heart failurerelated PH
Modi et al. (Wed,) studied this question.