The importance and acute impact of interventional therapy for intermediate high-risk pulmonary artery embolism on right ventricular hemodynamics and echocardiographic parameters is unclear.

Patients and Methods:

In this prospective study, 17 symptomatic patients with intermediate high-risk pulmonary artery embolism (right ventricular dilatation and positive troponin) were included (11 men/ 6 women, mean age 65 ± 10 years). All patients had a sPESI score of 1 or more. An immediate pre-/post-interventional echocardiography / right heart catheter were carried out. The interventional thrombectomy was performed using the INARI aspiration system®.

Results:

In all 17 patients, the interventional treatment could be carried out successfully without serious complications. The mean pulmonary arterial pressure decreased from 35 ± 9 mmHg to 28 ± 9 mmHg (p<0.001). Right ventricular function (TAPSE) on echocardiography improved from 14 ± 4 mm to 20 ± 3 mm (p<0.001). The RV diameter decreased from 49 ± 7 mm to 39 ± 8 mm (p<0.001). The TAPSE/sPAP ratio improved from 0.4 ± 0.3 mm/mmHg to 0.7 ± 0.5 mm/mmHg (p<0.04).

Conclusion:

Within the scope of this non-controlled pilot study, a relevant acute improvement in right ventricular function/hemodynamics could be shown. Randomized studies are required to demonstrate the haemodynamic/prognostic impact of interventional therapy in intermediate high-risk pulmonary artery embolism compared to conventional therapy.