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Right ventricular function in acute pulmonary embolism: does fibrinolytic therapy improve it and does its persistence as an impact on prognosis?
Session:
Posters 3 - Écran 3 - Circulação / Embolia Pulmonar
Speaker:
David Cabrita Roque
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
David Cabrita Roque; Joana Simões; João Augusto; Daniel Candeias Faria; João Baltazar Ferreira; Hilaryano Ferreira; Marco Beringuilho; Pedro Magno; Carlos Sequeira De Morais
Abstract
<p><strong>INTRODUCTION:</strong> Right ventricular (RV) dysfunction is found in at least 25% of pts with acute pulmonary embolism (PE). The presence of RV dysfunction at diagnosis is a determinant of risk stratification and early clinical outcomes. However, it is not well known whether RV dysfunction at diagnosis is improved by fibrinolytic therapy (FT) and if its persistence at discharge as an impact on prognosis.</p> <p><strong>PURPOSE:</strong> To evaluate 1) the effect of FT on RV function in acute PE and 2) the effect of persistent RV dysfunction at the time of discharge.</p> <p><strong>METHODS:</strong> Retrospective study of 428 consecutive pts admitted for acute PE in a single-center hospital for 2 consecutive years. We identified those who underwent transthoracic echocardiogram (TTE) and who were found to have RV dysfunction at hospital admission (n=103, 24.1%). RV dysfunction was defined as the presence of either RV dilatation, TAPSE <16mm, S’ <10 cm/s or tricuspid regurgitant jet systolic velocity >2.6 m/s. For the 1<sup>st</sup> endpoint pts found to have RV dysfunction at admission were divided in 2 groups: those who have undergone FT (1, n=14; 31.1%) and those who have not undergone FT (2, n=31; 68.9%). As for the 2<sup>nd</sup> endpoint pts were also divided in 2 groups: those in whom RV dysfunction was present at the moment of their hospital admission, but not at discharge (3, n=19; 42.2%) and those in whom RV dysfunction was present at hospital admission and persisted at discharge (4, n=26; 57.8%). A second TTE was performed at discharge and the persistence of RV dysfunction was looked for.</p> <p><strong>RESULTS</strong>: We included a total of 45 patients with acute PE and RV dysfunction at admission who had a reevaluation TTE at discharge (mean age 66.2±17.8y, 28.9% males). We found no differences in terms of RV dysfunction persistence between patients in group 1 and group 2 (42.9 vs. 41.9%, respectively; p=0.954), also well as no differences in proBNP values (mean 9973 vs. 8694pg/mL; p=0.901). For the 2<sup>nd</sup> endpoint the median FUP time was 495 (interquartile range (IQR) 417) days. Mortality rate after discharge was 8.9%. Median proBNP was significantly superior in group 4 vs 3 (median 12.597 vs. 293 pg/mL; p = 0.029). Similarly, patients in group 4 had significantly higher mortality rate than patients in group 3 (0.0 vs. 21.1%; p = 0.026).</p> <p><strong>CONCLUSIONS</strong>: In acute PE, FT seems not to improve RV function in patients found to have RV dysfunction at admission and mortality seems to be higher in those with persistent RV dysfunction before discharge.</p>
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