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Open Access 21-12-2022 | Echocardiography | Original Paper

Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2

Authors: Anna C. Mavromanoli, Stefano Barco, Walter Ageno, Hélène Bouvaist, Marianne Brodmann, Claudio Cuccia, Francis Couturaud, Claudia Dellas, Konstantinos Dimopoulos, Daniel Duerschmied, Klaus Empen, Pompilio Faggiano, Emile Ferrari, Nazzareno Galiè, Marcello Galvani, Alexandre Ghuysen, George Giannakoulas, Menno V. Huisman, David Jiménez, Matija Kozak, Irene M. Lang, Nicolas Meneveau, Thomas Münzel, Massimiliano Palazzini, Antoniu Octavian Petris, Giancarlo Piovaccari, Aldo Salvi, Sebastian Schellong, Kai-Helge Schmidt, Franck Verschuren, Irene Schmidtmann, Gerrit Toenges, Frederikus A. Klok, Stavros V. Konstantinides, The PEITHO-2 Investigators

Published in: Clinical Research in Cardiology | Issue 10/2023

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.

Graphical Abstract

Available only for authorised users

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Title: Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2
Authors: Anna C. Mavromanoli
Stefano Barco
Walter Ageno
Hélène Bouvaist
Marianne Brodmann
Claudio Cuccia
Francis Couturaud
Claudia Dellas
Konstantinos Dimopoulos
Daniel Duerschmied
Klaus Empen
Pompilio Faggiano
Emile Ferrari
Nazzareno Galiè
Marcello Galvani
Alexandre Ghuysen
George Giannakoulas
Menno V. Huisman
David Jiménez
Matija Kozak
Irene M. Lang
Nicolas Meneveau
Thomas Münzel
Massimiliano Palazzini
Antoniu Octavian Petris
Giancarlo Piovaccari
Aldo Salvi
Sebastian Schellong
Kai-Helge Schmidt
Franck Verschuren
Irene Schmidtmann
Gerrit Toenges
Frederikus A. Klok
Stavros V. Konstantinides
The PEITHO-2 Investigators
Publication date: 21-12-2022
Publisher: Springer Berlin Heidelberg
Keywords: Echocardiography
Echocardiography
Published in: Clinical Research in Cardiology / Issue 10/2023
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-022-02138-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

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