No effect of epoprostenol on right ventricular diameter in patients with acute pulmonary embolism: a randomized controlled trial

Abstract

Background: Right ventricular dilatation in the setting of acute pulmonary embolism is associated with an adverse prognosis. Treatment with a pulmonary vasodilator has never been studied systematically. We evaluated the effect of epoprostenol on right ventricular diameter and function in patients with acute pulmonary embolism and right ventricular dilatation.

Methods: In a randomized, single-blind study, 14 patients with acute pulmonary embolism received epoprostenol or placebo infusion for 24 hours on top of conventional treatment. Effects on right ventricular end-diastolic diameter, systolic pulmonary artery pressure, right ventricle fractional area change and tricuspid annular plane systolic excursion were assessed by serial echocardiography. Furthermore Troponin T and NT-proBNP were measured serially.

Results: Compared to placebo, epoprostenol was associated with a relative change from baseline in right ventricular end-diastolic diameter of +2% after 2.5 hours and -8% after 24 hours. Epoprostenol did not have a significant effect on systolic pulmonary artery pressure, right ventricular fractional area change and tricuspid annular plane systolic excursion, nor on biochemical parameters.

Conclusion: In patients with acute pulmonary embolism and right ventricular overload, treatment with epoprostenol did not improve right ventricular dilatation or any other measured variables of right ventricular overload.

Registration: URL: NCT01014156Medical ethical committee: Medisch-ethische toetsingscommissie (METc) from the VUmc (free university medical centre).

Figure 1

Patient flow.

Figure 2

Mean (± SD) right ventricular end-diastolic diameter (RVED) for both treatment groups at baseline, 2.5 and 24 hours after initiation of treatment and 48 hours after treatment was stopped (measurement 1, 2, 3 and 4, respectively).

Figure 3

Mean (± SD) systolic PAP for both treatment groups at baseline, 2.5 and 24 hours after initiation of treatment and 48 hours after treatment was stopped (measurement 1, 2, 3 and 4 respectively).