Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2
Anna C. Mavromanoli, Stefano Barco, Walter Ageno, Hélène Bouvaist, Marianne Brodmann, Claudio Cuccia, Françis Couturaud, Claudia Dellas, Konstantinos Dimopoulos, Daniel Duerschmied, Klaus Empen, Pompilio Faggiano, Émile Ferrari, Nazzareno Galiè, Marcello Galvani, Alexandre Ghuysen, George Giannakoulas, Menno V. Huisman, David Jiménez, Matija Kozak, Iréne Lang, Nicolas Méneveau, Thomas Münzel, Massimiliano Palazzini, Antoniu Octavian Petriş, Giancarlo Piovaccari, Aldo Salvi, Sebastian Schellong, Kai‐Helge Schmidt, Franck Verschuren, Irene Schmidtmann, Gerrit Toenges, Frederikus A. Klok, Stavros Konstantinides, The PEITHO-2 Investigators, Jaime Antonio Abelaira Freire, İbrahim Akın, Toni Anušić, Dorothea Becker, Laurent Bertoletti, Giuseppe Bettoni, Harald Binder, Regina Carels, Giuseppe Di Pasquale, Daniel Dürschmied, Iolanda Enea, Joachim H. Ficker, Sabine Genth‐Zotz, Philippe Girard, Stanislav Gorbulev, Matthias Held, Lukas Hobohm, Menno V. Huisman, Stavros Konstantinides, Kai Kronfeld, Iréne Lang, Mareike Lankeit, Walter Lehmacher, Patricia López-Miguel, Nadine Martin, Guy Meyer, Roman Parežnik, Kurt Quitzau, Irinel Raluca Parepa, Purificación Ramírez Martín, Marc Righini, Silviu Bogdan Todea, Adam Torbicki, Luca Valerio, Thomas Vanassche, L Vida-Simiti, Anamaria Wolf-Pütz
Abstract
BACKGROUND: Right ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe. METHODS: Echocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure. RESULTS: RV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as day 6, RV size remained normal or improved in 260 patients (64.7%), RV free wall/tricuspid annulus motion in 301 (74.9%), RV pressure overload in 297 (73.9%), and RA/central venous pressure in 254 (63.2%). At day 180, the frequencies slightly increased. The median NT-proBNP level decreased from 1448 pg/ml at baseline to 256.5 on day 6 and 127 on day 180. CONCLUSION: In the majority of patients with acute intermediate-risk PE switched early to a direct oral anticoagulant, echocardiographic parameters of RV function normalised within 6 days and remained normal throughout the first 6 months. Almost one in four patients, however, continued to have evidence of RV dysfunction over the long term.