Association of advanced therapies for intermediate- to high-risk pulmonary embolism with improved right ventricular function on outpatient follow-up among survivors

Figure 1. A flowchart depicting the inclusion and exclusion of patients. CDE, Catheter-directed embolectomy; CDT, catheter-directed thrombolysis; SPE, surgical pulmonary embolectomy.

Figure 2. Love plot of absolute standardized mean differences on matching variables between the target and control groups. Matching variables included age, BMI, PESI score, ESC risk group, Composite PE Shock score and systemic thrombolysis. Target group consisted of patients who received CDE, CDT or SPE, while the control group consisted of patients who did not receive any advanced therapy. BMI, Body mass index; ESC, European Society of Cardiology; PE, pulmonary embolism; PESI, PE Severity Index.

Figure 3. Correlation plots of echocardiographic parameters on pre- and post-echocardiography scans. AT, Acceleration time; FAC, fractional area change; LVEF, left ventricular ejection fraction; PW, pulsed-wave Doppler; RA, right atrium; RAP, right atrial pressure; RV, right ventricle; RVOT, right ventricular outflow tract; TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation; Vmax, maximum velocity; VTI, velocity time integral (stroke distance).

Figure 4. Forest plot depicting the marginal means of change in echocardiographic parameters on follow-up echocardiography among target and control groups. Non-parametric propensity score matching was performed with the target group consisting of patients who received any advanced reperfusion therapy, while the control group consisted of patients who did not receive any such therapy. AT, Acceleration time; FAC, fractional area change; PASP, pulmonary artery systolic pressure; PW, pulsed-wave Doppler; RA, right atrium; RAP, right atrial pressure; RV, right ventricle; RVOT, right ventricular outflow tract; Ś, lateral tricuspid annulus peak systolic velocity (on tissue Doppler); TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation; Vmax, maximum velocity; VTI, velocity time integral.

Figure 5. Forest plot depicting the marginal odds ratios for normalization of echocardiographic parameters on follow-up echocardiography between the two groups. Non-parametric propensity score matching was performed with the target group consisting of patients who received any advanced reperfusion therapy, while the control group consisted of patients who did not receive any such therapy. AT, Acceleration time; FAC, fractional area change; FVE, flow velocity envelope; OR, odds ratio; PASP, pulmonary artery systolic pressure; PW, pulsed-wave Doppler; RA, right atrium; RAP, right atrial pressure; RV, right ventricle; RVOT, right ventricular outflow tract; Ś, lateral tricuspid annulus peak systolic velocity (on tissue Doppler); TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation; Vmax, maximum velocity; VTI, velocity time integral. * Marginal odds for normalization of echocardiographic parameter; † marginal odds for improvement in TR grade.

Figure 6. Visual summary. In this propensity score-matched retrospective analysis of 122 patients with acute pulmonary embolism, receipt of any advanced reperfusion therapy (CDT, CDE or SPE) was associated with statistically significant improvements in echocardiographic parameters of RV function as well as lower odds of 30-day major bleeding. CDE, catheter-directed embolectomy; CDT, catheter-directed thrombolysis; mM, marginal mean; mOR, marginal odds ratio; PE, pulmonary embolism; TR, tricuspid regurgitation; RV, right ventricle; RVOT, right ventricular outflow tract; SPE, surgical pulmonary embolectomy; VTI, velocity time integral.