Clinical predictors of residual pulmonary hypertension at 1-year follow-up after pulmonary embolism treated by catheter-directed therapies, a sub-analysis of the USAT IH-PE registry

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, 135 were included. 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). At the multivariable logistic regression analysis, three variables emerged as independent predictors of residual pulmonary hypertension at 1 year follow-up: a prior history of DVT (OR, 5.33; 95% CI, 1.05–26.9; p=0.043), baseline hemoglobin level at admission (OR for 1g/dl increase, 0.76; 95% CI, 0.59–0.98; p=0.032) and sPAP ≥ 60 mmHg at presentation (OR, 7.65; 95% CI, 1.50–39.1; p=0.014). Conclusions In PE patients after percutaneous therapy, severe baseline PH and prior venous thromboembolism identify a high risk of 1-year residual PH.