AngioJet rheolytic thrombectomy (ART) has been used as a catheter-based treatment for acute pulmonary embolism (PE). In this study, based on our 7-year experience with ART in patients with PE, we evaluated the efficacy and safety outcomes of ART. Our study is based on retrospective evaluation of 56 patients with high- and intermediate-high-risk PE, with an average age of 62 years [interquartile range (IQR) 50–73 years] who underwent ART. High and intermediate-high risks were noted in 21.4% and 78.6% of the patients, respectively. The ART duration was 304 (IQR: 246–468) seconds. Measures of obstruction, right to left ventricle diameter ratio, right to left atrial diameter ratio, and pulmonary arterial pressures were improved (p<0.001 for all). During the hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, right ventricle strain, and hemodynamics in patients with PE at high and intermediate-high risk. Aging increased the risk of post-procedural nephropathy, whereas baseline high-risk status predicted in-hospital and long-term mortality.

Pulmonary arterial hypertension,mortality,pregnancy

Background: Currently available risk stratification models for acute pulmonary embolism (PE) include hemodynamic status, cardiac biomarkers, right ventricle (RV) dysfunction on imaging, and clinical scores. Focusing on the length–tension relationship of the ventricle might have a superior predictive capability over RV dysfunction in terms of mortality and classification of patients with acute PE. In this study, our hypothesis suggests that the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio has superior predictive capability for in-hospital mortality in patients with acute PE compared to TAPSE or sPAP as distinct measures. Materials and Methods: This single-center study comprised retrospectively evaluated 703 patients referred to our tertiary cardiovascular center with acute PE. We divided patients into quartiles based on the TAPSE/sPAP ratio. Different models were developed to quantify the predictive relationship between in-hospital death and echocardiographic measurements. A base model was created with variables including risk status and RV/LV ratio >1. Then, to evaluate the predictive contribution of each measurement; TAPSE/sPAP, TAPSE, and sPAP were sequentially added to the base model. After that, the performance of each model was evaluated. Results: Predictive and discriminative power was the highest in model containing TAPSE/sPAP. There was still a significant inverse association between TAPSE/sPAP and the risk of in-hospital death even after adjusting for risk status and RV/LV ratio >1. Receiver operating characteristic curve analysis for TAPSE/sPAP revealed the best cut-off value as 0.34. Conclusion: The outcomes of our study reveal that the ratio of TAPSE/sPAP serves as a more potent predictor of mortality than either of the 2 measurements taken separately. The interpretation and utilization of the TAPSE/sPAP cut-off value in acute PE can assist in identifying patients at risk of deterioration and guide the consideration of more intensive treatment options across all risk groups.

Acute pulmonary embolism,ultrasound-assisted thrombolysis,eosinophil to monocyte ratio,rheolytic thrombectomy,prognostic biomarkers

Macitentan,pulmonary arterial hypertension,Eisenmenger syndrome,REVEAL-Lite 2,COMPERA,SPAHR

Background: Given the bleeding risk associated with full-dose intravenous thrombolytic treatment and the absence of randomized clinical trial evidence, current guidelines do not recommend reperfusion treatments as first-line therapy for intermediate-high risk (IHR) pulmonary embolism (PE). The aim of this study was to evaluate the effectiveness and safety of ultrasound-assisted catheter-directed thrombolysis (USAT) compared to anticoagulation therapy alone in patients with IHR PE. Methods: A total of 425 patients diagnosed with acute PE and determined as IHR, 203 of whom underwent USAT, and 222 patients receiving only anticoagulants as the control group, were included. Baseline and post-treatment right ventricle (RV) function in echocardiography, tomographic RV/left ventricle (RV/LV) ratio, Qanadli score (Qs), and % changes from baseline were taken as primary effectiveness outcomes. For safety outcomes, major and minor bleeding and in-hospital all-cause death were adopted. Propensity score analysis was performed to reduce confounders and bias. Results: The USAT treatment was found to be associated with improved RV function and decreased Qs, but no significant effect was observed on the RV/LV ratio and its change. Bleeding events were more frequent in the USAT group (P < .001 for both), and no difference was observed in terms of mortality. Conclusion: The study, based on real-life data, has shown that a moderate-dose, slow-infusion tissue-type plasminogen activator regimen is superior to anticoagulant therapy alone in terms of reducing pulmonary arterial thrombus burden, restoring RV dysfunction, and improving clinical outcomes in acute PE patients at IHR. However, it has also resulted in a slight increase in bleeding events.