Clinical predictors of residual pulmonary hypertension at 1-year follow-up after pulmonary embolism treated by catheter-directed therapies, a sub-analysis of the USAT IH-PE registry
M Bertaina, M Iannaccone, C Colombo, V Paragliola, R Senkeev, M Solcia, N Capsoni, E Gualini, F Fumarola, D Savio, F Russo, G G Boccuzzi, F Oliva, A SaccoAbstract
Introduction
Residual pulmonary hypertension (PH) after acute pulmonary embolism (PE) adversely affects functional recovery and long-term prognosis. Among patients treated with catheter-directed therapies (CDTs), data on the incidence and predictors of late PH after these interventions remain limited.
Purpose
To assess the incidence of echocardiographically estimated residual PH at 1 year and to identify its clinical and haemodynamic predictors in patients with acute PE treated with CDTs.
Methods
This is a sub-analysis of the multicentre USAT IH-PE registry, including consecutive intermediate-high (IHR) and high-risk (HR) PE patients treated with CDTs in five Italian centers. Patients with available echocardiographic systolic pulmonary artery pressure (sPAP) at baseline and at 1-year follow-up were included. Primary endpoint (P.E.) was residual PH at one year follow-up, defined as sPAP ≥40 mmHg. Univariate and multivariate analyses were performed to identify independent predictors of residual PH.
Results
Between 2018 and 2025, 135 PE patients (mean age 64±14 years, 53% women) were considered for the present analysis (93 % IHR and 7 % HR), treated with transcatheter thrombolysis in 83 % of cases. Mean sPAP significantly decreased from admission to post-procedure and further at follow-up (50.1±12.8, 38.1±10.8 and 29.4±8.6 mmHg, respectively; p<0.01). At one year follow-up, residual PH occurred in 15 cases (11.1%). Patients with persistent PH had more commonly baseline sPAP ≥60 mmHg (30.8% vs 8.2%; p=0.014), prior deep-vein thrombosis (DVT, 25.0% vs 8.2%; p=0.018), prior PE (30.0% vs 9.6%; p=0.048), need for non-invasive ventilation (26.7% vs 9.5%; p=0.049) and lower Hb levels (11.2 ± 4.3 g/dL vs. 13.1 ± 2.1 g/dL, p=0.006); thrombus location across bilateral principal, bilateral lobar, and unilateral principal was also associated with the P.E. (p=0.017), while the type of CDT device used was not (p=0.54).After multivariable adjustment, baseline sPAP ≥60 mmHg (adjOR 7.65, 95% CI 1.50–39.1; p=0.014), prior DVT (adjOR 5.33, 95% CI 1.05–26.9; p=0.043), and baseline haemoglobin (adjOR per 1 g/dL increase 0.76, 95% CI 0.59–0.98; p=0.032) remained significantly associated with the primary endpoint.
Conclusions
Incidence of residual PH at 1 year follow-up is not negligible among IHR and HR PE patients treated with CDT. The presence of severe baseline PH, prior DVT’s episode and lower haemoglobin levels were associated with an increased risk of persistent PH.