Echocardiographic evolution of pulmonary artery pressure after acute pulmonary embolism. Results from IPER registry

• Published in: Thrombosis research Vol. 134; no. 6; pp. 1224 - 1228
• Main Authors: Casazza, Franco, Bongarzoni, Amedeo, Forgione, Chiara, Cuccia, Claudio, Imperadore, Ferdinando, Arrigo, Girolamo, Floriani, Irene, Pignataro, Luigi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01-12-2014
• Subjects: Acute Disease; Acute pulmonary embolism; Adolescent; Adult; Aged; Aged, 80 and over; Blood Pressure; Blood Pressure Determination - statistics & numerical data; Causality; Chronic thromboembolic pulmonary hypertension; Comorbidity; Disease Progression; Echocardiographic follow-up; Echocardiography, Doppler - statistics & numerical data; Female; Hematology, Oncology and Palliative Medicine; Humans; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - epidemiology; Hypertension, Pulmonary - physiopathology; Incidence; Italy - epidemiology; Male; Middle Aged; Prognosis; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - epidemiology; Pulmonary Embolism - physiopathology; Recurrence; Registries; Risk Factors; Young Adult; RVD; pulmonary artery systolic pressure; RV; pulmonary hypertension; PAsP; Italian pulmonary embolism registry; RA; FU; chronic thromboembolic pulmonary hypertension; follow-up; SD; right ventricle; PE; right atrium; IPER; PH; TL; thrombolysis; Acute pulmonary embolism; right ventricular dysfunction; CTEPH; pulmonary embolism; Echocardiographic follow-up; standard deviation; Chronic thromboembolic pulmonary hypertension
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2014.09.026

Abstract Aims The aim of the study is to describe the course of the echocardiographically measured pulmonary artery systolic pressure (PAsP) in a series of patients included in the Italian Pulmonary Embolism Registry (IPER). Methods Patients with confirmed PE received an echo-Doppler evaluation within 24 hours from hospital admission and after one year. Pulmonary hypertension (PH) was considered “likely” , “possible” or “unlikely” with a right ventricular-right atrial (RV-RA) pressure gradient > 45 mm Hg, between 32 and 45 mm Hg and ≤ 31 mm Hg and no additional echocardiographic variables suggestive of PH, respectively. Results We studied 286 patients (169 females and 117 males, mean age 67 ± 15; mean follow-up 387 ± 45 days): 240 had a baseline tricuspid regurgitation (TR) and a RV-RA gradient of variable degree. PH was considered likely, unlikely and possible in 97, 93 and 50 patients respectively. At FU echocardiography, 6 patients (2.1%) had a likely PH and all of them were part of the group of 97 patients with a baseline likely PH; 24 patients (8.4%) had a possible PH, and 67% of them had an initial likely PH. No patients with a baseline unlikely PH or without TR developed a follow-up PH (both likely or possible). The probability to show a likely PH at FU echocardiography for patients with a baseline RV-RA gradient > 45 mm Hg was 6.2%, while the probability not to have a likely PH for patients with a baseline RV-RA gradient ≤ 45 mm Hg was 100%. Conclusion In our study population of patients with acute PE, we observed that those presenting with a baseline echocardiographic RV-RA pressure gradient ≤ 45 mm Hg were completely free from a likely PH after 1-year.