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• W3093162713 abstract "SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Catheter directed thrombolysis (CDL) is increasingly utilized as therapy for acute intermediate-risk pulmonary embolism (PE). Acute PE can lead to mild pulmonary hypertension (PHTN) but the role for CDL in patients with moderate to severe PHTN is uncertain. We investigate the impact of CDL on lowering PA pressure in PE patients with baseline hemodynamics suggestive of underlying PHTN. METHODS: 70 consecutive patients referred for CDL with acute intermediate-risk PE at two academic centers were included in this study. CT scan confirmed PE in all cases and intermediate risk was defined as having RV enlargement and/or troponin elevation without need for vasopressors. CDL was performed using a perfusion catheter with or without ultrasound and infusing t-PA at 1 mg/hour. Baseline hemodynamics were recorded at right heart catheterization, and post treatment pressures were measured through the perfusion catheter. RESULTS: The overall study population was 51% male, average age was 58 years, average presenting heart rate was 112 bpm, and average PESI score was 114. 38 patients had pre-procedure mean PA pressure of < 35 mmHg (designated as Group I) and 32 had pre-procedure mean PA pressure ≥ 35 mmHg (Group II). Admission vital signs, sex, and PESI scores were similar between groups. Group II was statistically younger (53 vs 62, p=0.01) and more likely to have had prior venous thromboembolic disease (37.5% vs 7.9%, p = 0.007). As defined, PA systolic pressure (36 mmHg vs 56 mmHg) and mean pressure (29 mmHg vs 44 mmHg) in Group I was lower than in Group II. In group II, 56% of patients had a mean PA of 35-44 mmHg and 44% of patients had a mean PA of ≥ 45 mmHg. The mean PAP decreased by 6 mmHg in Group I and by 8 mmHg in Group II compared to their pre-procedure values. Cardiac index increased significantly in both groups from 2.0 to 2.5 in group I, and from 1.8 to 2.2 L/min/m² in group II (p < 0.05 for both). After treatment, 60% of patients in group I had a mean PA pressure < 25 mmHg where only 3% in group II had achieved a normal PA pressure. The median dosage of t-PA was 12 mg in both groups. CONCLUSIONS: Treatment with CDL seems to benefit acute PE patients with mild as well as moderate-severe PHTN. Further prospective randomized studies are needed to determine the potential benefit of CDL over anticoagulation and the long-term impact on these patients. CLINICAL IMPLICATIONS: There has been reluctance to treat PE patients with higher PA pressures over concern that there was chronic PHTN present. Our data suggests that even in patients with a mean PAP ≥ 35 mmHg prior to treatment can derive benefit and lowering of PA pressures. DISCLOSURES: no disclosure on file for Lindsey Cilia; No relevant relationships by Matthew Herzig, source=Web Response No relevant relationships by Sameer Khandhar, source=Web Response No relevant relationships by Mili Mehta, source=Web Response No relevant relationships by Mili Mehta, source=Web Response Advisory Committee Member relationship with Actelion/Janssen Please note: $5001 - $20000 Added 05/20/2020 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: $5001 - $20000 Added 05/20/2020 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with Acceleron Please note: $1001 - $5000 Added 05/20/2020 by Harold Palevsky, source=Web Response, value=Honoraria no disclosure on file for Catalin Toma" @default.
• W3093162713 created "2020-10-22" @default.
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• W3093162713 date "2020-10-01" @default.
• W3093162713 modified "2023-10-15" @default.
• W3093162713 title "USE OF CATHETER-DIRECTED THROMBOLYSIS TO TREAT ACUTE INTERMEDIATE-RISK PULMONARY EMBOLISM ASSOCIATED WITH BASELINE PULMONARY HYPERTENSION" @default.
• W3093162713 doi "https://doi.org/10.1016/j.chest.2020.08.1910" @default.
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