Significant pulmonary arterial pressure reduction with multi-day versus single-day catheter directed thrombolysis of submassive pulmonary embolism

AbstractThe authors seek to evaluate hemodynamic parameters as potential clinical markers of real-time clinical improvement among patients with massive pulmonary embolism (PE) in correlation with post-thrombolytic pulmonary arterial pressure improvement and overall clinical outcome. Thirteen patients with submassive or massive PE were admitted to the interventional radiology service and treated with catheter-directed thrombolysis. Among the four patients who qualified as massive PE, systolic blood pressure (BP) and vasopressor dependence suggested meaningful trends toward clinical improvement, after only 26.4% of treatment course/dose. Hemodynamic parameters such as systolic BP and inotropic vasopressor dependence may be considered in future treatment protocols as early indicators of treatment response.

Download Full-text

Tissue plasminogen activator dose and pulmonary artery pressure reduction in catheter directed thrombolysis of submassive pulmonary embolism

PLoS ONE ◽

10.1371/journal.pone.0211701 ◽

2019 ◽

Vol 14 (2) ◽

pp. e0211701 ◽

Cited By ~ 1

Author(s):

Darshan C. Patel ◽

Ron C. Gaba ◽

Li Liu ◽

R. Peter Lokken

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Pulmonary Artery Pressure ◽

Pressure Reduction ◽

Artery Pressure ◽

Catheter Directed Thrombolysis ◽

Submassive Pulmonary Embolism ◽

Tissue Plasminogen

Download Full-text

Factors Associated with elevated Pulmonary Arterial Pressure Levels on the Echocardiographic Assessment in Patients with Prior Pulmonary Embolism

Thrombosis Research ◽

10.1016/j.thromres.2013.01.034 ◽

2013 ◽

Vol 131 (5) ◽

pp. e191-e195 ◽

Cited By ~ 6

Author(s):

Remedios Otero ◽

Teresa Elías ◽

Luis Jara ◽

Javier Trujillo-Santos ◽

Laurent Bertoletti ◽

...

Keyword(s):

Pulmonary Embolism ◽

Arterial Pressure ◽

Pulmonary Arterial Pressure ◽

Factors Associated ◽

Echocardiographic Assessment ◽

Pulmonary Arterial

Download Full-text

Right ventricular adaptation in the critical phase after acute intermediate-risk pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620925253 ◽

2020 ◽

pp. 204887262092525 ◽

Cited By ~ 1

Author(s):

Mads Dam Lyhne ◽

Jacob Gammelgaard Schultz ◽

Anders Kramer ◽

Christian Schmidt Mortensen ◽

Jens Erik Nielsen-Kudsk ◽

...

Keyword(s):

Pulmonary Embolism ◽

Arterial Pressure ◽

Right Ventricular ◽

Acute Pulmonary Embolism ◽

Pulmonary Arterial Pressure ◽

Intermediate Risk ◽

Right Ventricular Afterload ◽

Mean Pulmonary Arterial Pressure ◽

Ventricular Afterload ◽

Pulmonary Arterial

Background The haemodynamic response following acute, intermediate-risk pulmonary embolism is not well described. We aimed to describe the cardiovascular changes in the initial, critical phase 0–12 hours after acute pulmonary embolism in an in-vivo porcine model. Methods Pigs were randomly allocated to pulmonary embolism ( n = 6) or sham ( n = 6). Pulmonary embolism was administered as autologous blood clots (20 × 1 cm) until doubling of mean pulmonary arterial pressure or mean pulmonary arterial pressure was greater than 34 mmHg. Sham animals received saline. Cardiopulmonary changes were evaluated for 12 hours after intervention by biventricular pressure–volume loop recordings, invasive pressure measurements, arterial and central venous blood gas analyses. Results Mean pulmonary arterial pressure increased ( P < 0.0001) and stayed elevated for 12 hours in the pulmonary embolism group compared to sham. Pulmonary vascular resistance and right ventricular arterial elastance (right ventricular afterload) were increased in the first 11 and 6 hours, respectively, after pulmonary embolism ( P < 0.01 for both) compared to sham. Right ventricular ejection fraction was reduced ( P < 0.01) for 8 hours, whereas a near-significant reduction in right ventricular stroke volume was observed ( P = 0.06) for 4 hours in the pulmonary embolism group compared to sham. Right ventricular ventriculo–arterial coupling was reduced ( P < 0.05) for 6 hours following acute pulmonary embolism despite increased right ventricular mechanical work in the pulmonary embolism group ( P < 0.01) suggesting right ventricular failure. Conclusions In a porcine model of intermediate-risk pulmonary embolism, the increased right ventricular afterload caused initial right ventricular ventriculo–arterial uncoupling and dysfunction. After approximately 6 hours, the right ventricular afterload returned to pre-pulmonary embolism values and right ventricular function improved despite a sustained high pulmonary arterial pressure. These results suggest an initial critical and vulnerable phase of acute pulmonary embolism before haemodynamic adaptation.

Download Full-text