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Background: Acute massive and submassive pulmonary embolism (PE) causes right ventricular (RV) systolic dysfunction, which can result in hemodynamic compromise and adverse patient outcomes. Ultrasound-assisted catheter directed thrombolysis (UA-CDT) is an effective method of treatment by quickly reducing thrombus burden and RV pressure afterload. We sought to investigate the improvement in RV systolic function in patients with massive and submassive PE who underwent UA-CDT.
Methods: In 44 consecutive patients presenting with massive and submassive PE treated with UA-CDT, two-dimensional echocardiography with tissue Doppler imaging was performed both prior to and after completion of UA-CDT. Invasive pulmonary artery pressure measurements were also performed pre- and post-UA-CDT.
Results: The mean patient age was 54 ± 16 years (43% male) with mean pulmonary embolism severity index score of 105 ± 22 at presentation. There were significant reductions in peak systolic and mean pulmonary arterial pressure, with significant improvements in RV systolic function parameters following UA-CDT (Figure). The average alteplase dose administered was 24 ± 7 mg, with bleeding complications requiring blood transfusions occurring in 4 patients (9%) and no instances of intracranial hemorrhage. There was 1 in-hospital mortality following UA-CDT (2%).
Conclusion: Treatment of patients with massive and submassive PE with UA-CDT results in rapid improvements in pulmonary pressures and RV systolic function.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Updates on Pulmonary Embolism Management in 2017
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1141-002
- 2017 American College of Cardiology Foundation