Cardiovascular revascularization medicine : including molecular interventions · 2025
The role of Pulmonary Artery Pulsatility Index to assess the outcomes following catheter directed therapy in patients with intermediate-to-high and high-risk pulmonary embolism.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Iannaccone Mario, Sławek-Szmyt Sylwia, Gamardella Marco, Fumarola Federica, Mangione Riccardo, Savio Daniele, Russo Filippo, Boccuzzi Giacomo, Araszkiewicz Aleksander, Chieffo Alaide
Аннотация
BACKGROUND: The clinical impact of catheter-directed therapy (CDT) for pulmonary embolism (PE) on right ventricular function and procedural outcomes remains undefined.
METHODS: This observational retrospective study included consecutive patients who underwent CDT for PE at San Giovanni Bosco Hospital, Italy, and First Department of Cardiology, Poznan University Clinical Hospital, Poland, between 2021 and 2023. Clinical characteristics, PE risk stratification, pre and post-interventional invasive pulmonary artery pressure (PAP), and Pulmonary Artery Pulsatility Index (PAPi) were collected. The primary endpoint was in-hospital death.
RESULTS: Among 165 patients (53 % male, mean age 63 ± 5.6 years), 65.6 % had multiple PE risk factors. 32.7 % were classified as high-risk (HR) PE, and 67.3 % as intermediate-high risk (IHR). Treatments included transcatheter thrombolysis (17 %), FlowTriever device (10 %), and Indigo Cath8 or Lightning 12 device (73 %), with 7 % requiring ECMO support. In IHR patients, mean PAP significantly decreased from 31.7 ± 7.1 to 23.4 ± 6.1 mmHg (p < 0.01) and PAPi from 3.1 ± 0.1 to 2.9 ± 0.1 (p < 0.01). HR patients had no significant changes in PAP or PAPi overall, but those who survived without events showed significant reductions in PAP (29.1 ± 8.7 to 23.8 ± 5.5, p < 0.02) and increases in PAPi (1.5 ± 0.6 to 2.0 ± 0.5, p < 0.01). In the HR group, a delta PAPi >0.45 predicted positive outcomes with 65.7 % sensitivity and 75 % specificity (AUC 0.83).
CONCLUSION: CDT for PE significantly impacts PAP and PAPi in acute PE patients. Normalization of PAPi in IHR patients and its increase in HR patients may indicate procedural success and right ventricular recovery. Hemodynamic changes could serve as important markers for procedural efficacy and outcome assessment in these groups.
METHODS: This observational retrospective study included consecutive patients who underwent CDT for PE at San Giovanni Bosco Hospital, Italy, and First Department of Cardiology, Poznan University Clinical Hospital, Poland, between 2021 and 2023. Clinical characteristics, PE risk stratification, pre and post-interventional invasive pulmonary artery pressure (PAP), and Pulmonary Artery Pulsatility Index (PAPi) were collected. The primary endpoint was in-hospital death.
RESULTS: Among 165 patients (53 % male, mean age 63 ± 5.6 years), 65.6 % had multiple PE risk factors. 32.7 % were classified as high-risk (HR) PE, and 67.3 % as intermediate-high risk (IHR). Treatments included transcatheter thrombolysis (17 %), FlowTriever device (10 %), and Indigo Cath8 or Lightning 12 device (73 %), with 7 % requiring ECMO support. In IHR patients, mean PAP significantly decreased from 31.7 ± 7.1 to 23.4 ± 6.1 mmHg (p < 0.01) and PAPi from 3.1 ± 0.1 to 2.9 ± 0.1 (p < 0.01). HR patients had no significant changes in PAP or PAPi overall, but those who survived without events showed significant reductions in PAP (29.1 ± 8.7 to 23.8 ± 5.5, p < 0.02) and increases in PAPi (1.5 ± 0.6 to 2.0 ± 0.5, p < 0.01). In the HR group, a delta PAPi >0.45 predicted positive outcomes with 65.7 % sensitivity and 75 % specificity (AUC 0.83).
CONCLUSION: CDT for PE significantly impacts PAP and PAPi in acute PE patients. Normalization of PAPi in IHR patients and its increase in HR patients may indicate procedural success and right ventricular recovery. Hemodynamic changes could serve as important markers for procedural efficacy and outcome assessment in these groups.