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Clinical Trial
. 2023 Oct;112(10):1372-1381.
doi: 10.1007/s00392-022-02138-4. Epub 2022 Dec 21.

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

Anna C Mavromanoli  1 , Stefano Barco  1   2 , Walter Ageno  3 , Hélène Bouvaist  4 , Marianne Brodmann  5 , Claudio Cuccia  6 , Francis Couturaud  7   8 , Claudia Dellas  9 , Konstantinos Dimopoulos  10   11 , Daniel Duerschmied  12 , Klaus Empen  13 , Pompilio Faggiano  14 , Emile Ferrari  15 , Nazzareno Galiè  16 , Marcello Galvani  17   18 , Alexandre Ghuysen  19 , George Giannakoulas  20 , Menno V Huisman  21 , David Jiménez  22 , Matija Kozak  23 , Irene M Lang  24 , Nicolas Meneveau  25   26 , Thomas Münzel  27 , Massimiliano Palazzini  16 , Antoniu Octavian Petris  28 , Giancarlo Piovaccari  29 , Aldo Salvi  30 , Sebastian Schellong  31 , Kai-Helge Schmidt  27 , Franck Verschuren  32 , Irene Schmidtmann  33 , Gerrit Toenges  33 , Frederikus A Klok  1   21 , Stavros V Konstantinides  34   35 ; PEITHO-2 Investigators
Collaborators, Affiliations
Clinical Trial

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

Anna C Mavromanoli et al. Clin Res Cardiol. 2023 Oct.

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.

Keywords: Dysfunction; Echocardiography; Intermediate-risk; Pulmonary embolism; Right ventricle.

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Conflict of interest statement

SB reports grants or contracts from Bayer, INARI, Boston Scientific, Medtronic, Bard, SANOFI, and Concept Medical; consulting fees from INARI; payment or honoraria from INARI, Boston Scientific, and Concept Medical; and support for attending meetings and/or travel from Bayer and Daiichi Sankyo. WA reports grants or contracts from Bayer; payment or honoraria from Bayer, Daiichi Sankyo, Pfizer-BMS, Werfen, Aspen, and Leo Pharma; and participation on a Data Safety Monitoring Board or Advisory Board for Bayer, BMS-Pfizer, Sanofi, Viatris, Norgine, and Leo Pharma. FC reports grants or contracts from Bayer and BMS Pfizer; consulting fees from Bayer, BMS, Pfizer, and Astra; and support for attending meetings and/or travel from Bayer, BMS/Pfizer, Leo Pharma, and Actelion. KD reports unrestricted research support and speaker/consultant fees from Janssen. DD reports consulting fees from Boston Scientific; payment or honoraria from Bayer Healthcare, Daiichi Sankyo, BMS/Pfizer, and Leo Pharma; support for attending meetings and/or travel from Bayer Healthcare, Daiichi Sankyo, and BMS/Pfizer; and participation on a Data Safety Monitoring Board or Advisory Board for Bayer Healthcare and Daiichi Sankyo. KE reports consulting fees from Bayer Vital. GG reports consulting fees, payment or honoraria from Bayer, Boehringer Ingelheim, Leo, and Pfizer. MVH reports grants from ZonMW Dutch Healthcare Fund, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Bayer Health Care, Aspen, and Daiichi-Sankyo. DJ reports grants or contracts from Daiichi Sankyo, Sanofi, and ROVI; and consulting fees, payment or honoraria from Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, Pfizer, ROVI, and Sanofi. MK reports payment or honoraria from Pfizer, Boehringer Ingelheim, and Bayer AG. IML reports grants or contracts and consulting fees from Janssen and AOPHealth; payment or honoraria from MSD, Ferrer, Janssen, and AOPHealth; and support for attending meetings and/or travel from Novomed. NM reports grants or contracts from BMS/Pfizer, Bayer Healthcare, Medtronic, and Abbott; consulting fees from INARI, Boston Scientific, Terumo, and Abbott; payment or honoraria and support for attending meetings and/or travel from BMS-Pfizer, Bayer Healthcare, and Abbott; and participation on a Data Safety Monitoring Board or Advisory Board for INARI, Boston Scientific, Terumo, and Abbott. AOP reports payment or honoraria from AlfaSigma Romania SRL, Terapia SA Romania, Servier Pharma SRL, Pfizer Romania SRL, Boehringer Ingelheim, SC Bayer SRL, Egis Pharmaceuticals RLC, Novartis Pharma Services Romania SRL, S > C > Berlin-Chemie Menarini SRL, Zentiva SRL, and Sanofi Romania RL. SS reports consulting fees and speaker fees from Aspen and Boehringer Ingelheim, speaker fees from Bayer AG and Daiichi-Sankyo, and project funding and speaker fees from Pfizer/Bristol-Myers Squibb. FV reports research grants from Daiichi-Sanyo, Boehringer Ingelheim, Radiometer, and Biomerieux. IS reports stock or stock options from Dräger. FAK reports grants or contracts from Bayer, BMS, Boehringer Ingelheim, MSD, Daiichi Sankyo, and Actelion. SVK reports grants or contracts from Bayer AG; consulting fees from Bayer AG, Daiichi Sankyo, and Boston Scientific; and payment or honoraria from Bayer AG, Boston Scientific, MSD, Pfizer, and Bristol-Myers Squibb. All other authors (ACM, HB, MB, CC, CD, PF, EF, NG, MG, AG, TM, MP, GP, AS, K-HS, GT) declare no competing interests.

Figures

Fig. 1
Fig. 1
Algorithm for echocardiographic assessment of right ventricular function during follow-up based on four key categories of ultrasound parameters. D1 basal end-diastolic diameter, IVC inferior vena cava, LV left ventricular, RA right atrial, RV right ventricular, SRVP systolic right ventricular pressure, TAPSE tricuspid annular plane systolic excursion, TRV tricuspid regurgitant jet velocity
Fig. 2
Fig. 2
Changes in echocardiographic parameters of right ventricular function across the 6-month follow-up: green color represents ‘normal’ and red ‘abnormal’ result at the end of follow-up. RA right atrial, RV right ventricular
See this image and copyright information in PMC

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