Pulmonary Artery Pulsatility Index in Acute and Chronic Pulmonary Embolism

Figures

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  Figure 1. Study designs of included studies. (a) Animals were randomized to six consecutive PE inductions or sham with evaluations performed at baseline and 5 min after each induction [13]. (b) Animals were randomized to acute PE or sham with evaluations performed at BL and after 1, 7, and 30 days to induce CTED [12]. (c) Animals with PE received increased FiO2 to reduce pulmonary pressure [14]. (d) Animals with PE were randomized to four escalating doses (D1–4) of three different inodilators [15]. (e) Patients with acute, intermediate-risk PE were evaluated before and after treatment with sildenafil [16]. (f) Patients with CTEPH were evaluated at baseline and 6 months following either balloon pulmonary angioplasty, pulmonary endarterectomy, or pharmacological treatment only [17]. Abbreviations: BL, baseline; CTED, chronic thromboembolism pulmonary disease; CTEPH, chronic thromboembolic pulmonary hypertension; D, dose; FiO2, fraction of inspired oxygen; PE, pulmonary embolism; PEA, pulmonary endarterectomy.

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  Figure 2. Pulmonary artery pulsatility index (PAPi) in the experimental PE. (a) Changes in PAPi five minutes after the induction of consecutive, autologous PE (PE1–6) or sham procedure with saline infusion. (b) Changes in PAPi after the induction of acute PE and after 1-, 7-, and 30-day follow-up. (c) Compared to PAPi after PE induction, the inodilators levosimendan and dobutamine (but not milrinone) increased PAPi in a dose-dependent manner. Abbreviations: PAPi, pulmonary artery pulsatility index; PE, pulmonary embolism.

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  Figure 3. Correlation between PAPi and CO (a,c) or measures of right ventricular–pulmonary artery coupling (b,d). See text for details. Baseline measures of CO and PAPi (a) and baseline right ventricular Ees/Ea (derived from invasive pressure–volume loop acquisition) and PAPi (b) from the included experimental studies, n = 46. Baseline measures of CO and PAPi (c) and baseline measures TAPSE/PASP (derived from transthoracic echocardiography) and PAPi (d) in patients with CTEPH, n = 130. Abbreviations: CO, cardiac output; CTEPH, chronic thromboembolic pulmonary hypertension; Ea, arterial elastance; Ees, end-systolic elastance; PAPi, pulmonary artery pulsatility index; PASP, pulmonary artery systolic pressure; TAPSE, tricuspid annular plane systolic excursion.