Tapse/spap and rv/lv ratio in pulmonary embolism treated by ultrasound-assisted, catheter-directed thrombolysis versus mechanical thrombectomy: single center experience
J Bogoviku, S Dinesh, J G Westphal, F Haertel, S Moebius-Winkler, P C SchulzeAbstract
Background
Patients with intermediate-high or high-risk pulmonary embolism (PE) present with a high morbidity and mortality. Ultrasound-assisted, catheter-directed thrombolysis and mechanical thrombectomy are emerging interventional therapies which are used in the acute and subacute phase, especially in the event of acute right heart failure. TAPSE/sPAP ratio represents a non-invasive Evaluation of RV-PA coupling and right heart failure. RV/LV ratio demonstrates right ventricular load.
Aim / Purpose
The aim of this retrospective analysis was to evaluate the impact of USAT and MT in intermediate-high or high-risk PE.
Methods
Patients who presented with intermediate-high or high-risk PE between October 2017 and September 2024 and treated with USAT or MT were evaluated retrospectively. Both procedures were performed within 24 hours following hospital admission. Transthoracic echocardiography was assessed before the procedure, 24 hours after, at discharge and at 6 months follow up.
Results
127 patients received interventional treatment. 101 patients were treated using USAT and 26 using MT. Baseline characteristics are highlighted in Table 1. TAPSE/sPAP ratio increased in both cohorts and at 6 months follow up it was greater in the MT cohort, reaching a statistical significance (∆ 0.65 ± 0.38 [0.3-0.99] vs 0.33 ± 0.22 [0.23-0.43]; p= 0.032). RV/LV ratio decreased in both cohorts and the absolute change from pre procedural didn’t show any statistical significance (Table 2).
Conclusion
Our data suggest that the interventional therapy can rapidly ameliorate TAPSE/sPAP and RV/LV ratios. This effect is sustainable after 6 months. We detected a statistically stronger change in TAPSE/sPAP ratio in the MT cohort at follow up. This result may translate in lower rates of right heart failure and pulmonary hypertension.For image description, please refer to the figure legend and surrounding text.TAPSE/sPAP and RV/LV ratioFor image description, please refer to the figure legend and surrounding text.