Acute-on-chronic PE in patients undergoing USAT was associated with higher rates of post-PE impairment or CTEPH compared to acute PE (13% vs 2.0%; OR 7.0, 95% CI 1.4-40).
Cohort (n=180)
Single-blind
Does the presence of radiologic signs of chronic thromboembolism affect the hemodynamic response to ultrasound-assisted catheter-directed thrombolysis and the risk of post-PE impairment or CTEPH in patients with acute pulmonary embolism?
Ultrasound-assisted catheter-directed thrombolysis provides similar immediate hemodynamic improvement in acute and acute-on-chronic PE, but patients with acute-on-chronic PE have a significantly higher risk of developing post-PE impairment or CTEPH.
Effect estimate: OR 7.0 (95% CI 1.4-40)
Absolute Event Rate: 13% vs 2%
BACKGROUND: Radiologic signs of chronic thrombi are present in approximately 20 % of patients with acute pulmonary embolism (PE). We assessed the effectiveness of ultrasound-assisted catheter-directed thrombolysis (USAT) in patients with acute PE with or without signs of chronic PE and the accuracy of radiologic parameters predicting chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Index CT scans of patients who underwent USAT for acute PE with right ventricular strain were reviewed by three radiologists blinded to clinical and hemodynamic outcomes. At least 3 validated radiological criteria of chronic thromboembolism defined acute-on-chronic PE. Changes in mean pulmonary arterial pressure (mPAP) 20 h after USAT and presence of post-PE impairment (PPEI) or CTEPH at 3-6 months were compared between patients with and without acute-on-chronic PE. RESULTS: Among 180 consecutive patients (median age 65 years), 31 (17 %) had acute-on-chronic PE. Absolute mPAP reduction was 11 (Q1-Q3: 5-17) mmHg in acute vs. 10 (Q1-Q3: 5-17) mmHg in acute-on-chronic PE from similar baseline mPAP. PPEI or CTEPH were recorded in 2.0 % of patients in the acute group vs. 13 % in the acute-on-chronic group (odds ratio 7.0, 95 %C.I. 1.4-40). Of 3 (1.7 %) patients diagnosed with CTEPH, all presented with ≥3 radiological criteria suggesting pre-existing CTEPH at index CT scan. CONCLUSIONS: CT signs of chronic thromboembolism at the time of acute PE did not appear to influence the immediate hemodynamic response to USAT in most patients but may raise the suspicion of pre-existing CTEPH if ≥3 validated radiological criteria are present.
Fumagalli et al. (Fri,) conducted a cohort in Acute pulmonary embolism with right ventricular strain (n=180). Ultrasound-assisted catheter-directed thrombolysis (USAT) in acute-on-chronic PE vs. USAT in acute PE was evaluated on Post-PE impairment (PPEI) or CTEPH at 3-6 months (OR 7.0, 95% CI 1.4-40). Acute-on-chronic PE in patients undergoing USAT was associated with higher rates of post-PE impairment or CTEPH compared to acute PE (13% vs 2.0%; OR 7.0, 95% CI 1.4-40).