Echocardiographic evolution of pulmonary artery pressure after acute pulmonary embolism. Results from IPER registry |
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Authors: | Franco Casazza Amedeo Bongarzoni Chiara Forgione Claudio Cuccia Ferdinando Imperadore Girolamo Arrigo Irene Floriani Luigi Pignataro |
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Affiliation: | 1. UO Cardiologia, Ospedale S. Carlo Borromeo, Milano, Italy;2. UO Cardiologia Fondazione Poliambulanza, Brescia, Italy;3. UO Cardiologia, Ospedale S. Maria del Carmine, Rovereto, TN, Italy;4. UO Nefrologia, Ospedale S. Carlo Borromeo, Milano, Italy;5. IRCCS Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy |
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Abstract: | AimsThe 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).MethodsPatients 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.ResultsWe 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%.ConclusionIn 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. |
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Keywords: | PE, pulmonary embolism PH, pulmonary hypertension CTEPH, chronic thromboembolic pulmonary hypertension RVD, right ventricular dysfunction RV, right ventricle RA, right atrium FU, follow-up PAsP, pulmonary artery systolic pressure IPER, Italian pulmonary embolism registry SD, standard deviation TL, thrombolysis |
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