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Mavromanoli AC, Barco S, Ageno W, Bouvaist H, Brodmann M, Cuccia C, Couturaud F, Dellas C, Dimopoulos K, Duerschmied D, Empen K, Faggiano P, Ferrari E, Galiè N, Galvani M, Ghuysen A, Giannakoulas G, Huisman MV, Jiménez D, Kozak M, Lang IM, Meneveau N, Münzel T, Palazzini M, Petris AO, Piovaccari G, Salvi A, Schellong S, Schmidt KH, Verschuren F, Schmidtmann I, Toenges G, Klok FA, Konstantinides SV. Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2. Clin Res Cardiol 2023; 112:1372-1381. [PMID: 36539534 PMCID: PMC10562278 DOI: 10.1007/s00392-022-02138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
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.
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Affiliation(s)
- Anna C Mavromanoli
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Hélène Bouvaist
- Department of Cardiology, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, La Tronche, France
| | | | - Claudio Cuccia
- Cardiovascular Department, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Brest, France
- INSERM U1304-GETBO, FCRIN INNOVTE, Brest University, Brest, France
| | - Claudia Dellas
- Clinic of Paediatric Cardiology and Intensive Care, ACHD Center, University Medical Center Goettingen, Goettingen, Germany
| | - Konstantinos Dimopoulos
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Empen
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | | | - Emile Ferrari
- Service de Cardiologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero and Dipartimento DIMES-Università di Bologna, Bologna, Italy
| | - Marcello Galvani
- Division of Cardiology, Department of Cardiovascular Diseases - AUSL Romagna, Ospedale Morgagni-Pierantoni, Forli, Italy
- Cardiovascular Research Unit, Fondazione Cardiologica Myriam Zito Sacco, Forli, Italy
| | | | - George Giannakoulas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - David Jiménez
- Department of Respiratory Diseases, Ramon y Cajal Hospital, Universidad de Alcalá (IRYCIS), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Matija Kozak
- Department of Vascular Diseases, University Medical Center, Ljubljana, Slovenia
| | - Irene M Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
- EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Thomas Münzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Massimiliano Palazzini
- Cardiology Unit, IRCCS Azienda Ospedaliero and Dipartimento DIMES-Università di Bologna, Bologna, Italy
| | - Antoniu Octavian Petris
- Cardiology Clinic, "St. Spiridon" County Clinical Emergency Hospital, Grigore T. Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Giancarlo Piovaccari
- Department of Cardiovascular Diseases, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Aldo Salvi
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - Sebastian Schellong
- Department of Internal Medicine 2, Municipal Hospital Dresden, Dresden, Germany
| | - Kai-Helge Schmidt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Franck Verschuren
- Emergency Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Frederikus A Klok
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
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