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Acute Pulmonary Embolism Catheter-Directed Therapy: first results of a multiparametric follow-up protocol
Session:
Comunicações Orais (Sessão 4) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 1 - Foco no TEP e Hipertensão Pulmonar
Speaker:
André Grazina
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
André Grazina; Luís Almeida Morais; António Fiarresga; Ruben Ramos; Lídia de Sousa; João Reis; Ana Galrinho; José Miguel Viegas; Isabel Cardoso; Rita Teixeira; Helena Teles Antunes; Rita Barata Moura; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Introduction: </span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Intermediate-high- and high-risk pulmonary embolism (PE) patients treated with anticoagulation alone are associated with a considerable risk of circulatory collapse, death or long-term pulmonary hypertension. </span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Although systemic fibrinolysis decreases this risk, it significantly increases the risk of major bleeding. </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Pulmonary Embolism Response Teams (PERT) have been created to deliver PE patients a better care. Catheter Directed Therapies (CDT), </span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">with mechanical thrombolysis and/or local fibrinolysis,</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"> are innovative techniques, that allow faster reperfusion and hemodynamic improvement without the systemic hemorrhagic effects of systemic thrombolysis. </span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">The clinical evidence of its benefits is still limited.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Objectives:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"> This analysis aims to describe the initial experience of CDT in intermediate-high- and high-risk acute PE patients and compare their evolution in a predefined multiparametric follow-up protocol. </span></span></span></span></span></p> <h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"><strong>Methods:</strong> </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">During 2021, consecutive intermediate-high- and high-risk PE patients considered suitable for CDT from our PERT, were prospectively enrolled in a single tertiary center. CDT options included mechanical thrombolysis using the Penumbra aspiration system and local alteplase perfusion (1mg/h, for 12 hours) through a 5F McNamara catheter in the pulmonary artery (PA). A multiparametric protocol was designed to include baseline characteristics, blood tests, transthoracic echocardiogram (TTE), CT-scan, pulmonary angiogram and right heart catheterization (RHC) data collected at admission and at 3 months after CDT. </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif">The paired samples t-Test was used for the analysis of the variables.</span></span></span></span></h1> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Results:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"> Of the 14 patients, </span></span></span></span><span style="font-size:12.0pt"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">2 patients died (one for oncologic disease and the another from unknown cause after hospital discharge). Of the remaining, on the date, 6 patients (50% male, mean age 52.2 years old) have completed the follow-up and were included in this analysis. CT-scan showed a decrease in the right ventricle/ left ventricle ratio by 0.47 (1.32 vs 0.85, p0.002). TTE showed a significant increase in TAPSE by 5.5mm (15.2 vs 20.7, p0.03). RHC showed a significant reduction in right atrium and PA systolic and mean pressures by 2.7mmHg (10.0 vs 7.3, p0.007), 17.3mmHg (61.1 vs 43.8, p0.013) and 12.7mmHg (38.2 vs 25.5, p0.012), respectively, as well as a significant increase in cardiac output and index by 2.01L/min (4.71 vs 6.72, p0.039) and 1.00L/min/m<sup>2</sup> (2.41 vs 3.41, p0.029), respectively. Pulmonary angiogram showed a reduction in clot burden, using the modified Miller Index, in 6.8 points (8.6 vs 1.8, p0.005).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:"Arial Narrow",sans-serif"><span style="color:black"> This analysis shows encouraging data of our early experience of CDT in PERT selected intermediate-high and high-risk PE patients. In this follow-up analysis we verified a clinical, laboratorial and hemodynamic improvement with significative reduction in pulmonary vasculature pressures, thrombus burden and right ventricular function. </span></span></span></span></span></span></p>
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