Preservation of Cardiopulmonary Function in Patients Treated with Ultrasound-Accelerated Thrombolysis in the Setting of Submassive Pulmonary Embolism

Knox, Michael F.; Langholz, David; Berjaoui, Wael; Eberhart, Lenora

doi:10.1016/j.jvir.2018.08.027

Cited by 14 publications

(5 citation statements)

References 29 publications

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“… 1 – 3 , 24 – 30 A single-center prospective study of 25 patients with submassive PE, treated with ultrasound-facilitated, catheter-directed fibrinolysis, demonstrated significant reduction in echocardiographically measured RV-to-LV diameter ratio from baseline to 72 hours after the procedure and preservation of RV recovery at 90 days. 31 In the current study, we demonstrated that accelerated lower-dose regimens improved echocardiographic markers of RV remodeling, including RV-to-LV diameter ratio and TAPSE, in the short-term and at 1 year.…”

Section: Discussionsupporting

confidence: 57%

One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism

Piazza

Sterling

Tapson³

et al. 2020

Circ: Cardiovascular Interventions

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Background: Accelerated tPA (tissue-type plasminogen activator) dosing regimens for ultrasound-facilitated, catheter-directed fibrinolysis improve short-term computed tomographic-measured right ventricular (RV)-to-left ventricular diameter ratio in massive and submassive pulmonary embolism. The impact on RV remodeling, functional status, and quality of life over the long-term remains unclear. Methods: To study 1-year changes in RV remodeling, functional status, and quality of life, we assessed patients with acute submassive pulmonary embolism randomly assigned to 1 of 4 tPA dosing regimens for ultrasound-facilitated, catheter-directed fibrinolysis in the OPTALYSE-PE trial (Optimum Duration and Dose of r-tPA With the Acoustic Pulse Thrombolysis Procedure for Intermediate-Risk Pulmonary Embolism; 8 mg/2 hours, 8 mg/4 hours, 12 mg/6 hours, and 24 mg/6 hours). Echocardiographic assessment included RV-to-left ventricular diameter ratio within 4 hours of treatment end, and at 48 hours, 30 days, 90 days, and 1 year. Functional status was assessed by 6-minute walk test at 30 days, 90 days, and 1 year and PROMIS-PF-6b scores at 30 days, 90 days, 180 days, 270 days, and 1 year. Quality of life was evaluated by PEmb-QOL scores at 30 days, 90 days, 180 days, 270 days, and 1 year. Results: Mean RV-to-left ventricular diameter ratio decreased from baseline to 4 hours and further at 48 hours and 30 days, with reductions maintained at 90 days and 1 year in all groups. Mean 6-minute walk distance, PROMIS-PF-6b, and PEmb-QOL scores improved over the course of 1 year in all groups. Conclusions: Accelerated lower-dose tPA regimens for ultrasound-facilitated, catheter-directed fibrinolysis resulted in sustained recovery of RV-to-left ventricular diameter ratio and tricuspid annular plane systolic excursion and improvements in functional status and quality of life over 1 year. Registration: URL: https://www.ClinicalTrials.gov . Unique Identifier: NCT02396758.

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Section: Discussionsupporting

confidence: 57%

One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism

Piazza

Sterling

Tapson³

et al. 2020

Circ: Cardiovascular Interventions

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“…Our finding is in line with previous studies that showed a supervised exercise CR program improved RV function in single case diagnosed with acute PE (10), chronic obstructive pulmonary disease (COPD) patients (34), patients with post coronary artery bypass graft surgery (35), and patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension (36). Of interest, the HIIT-induced adaptation in RV/LV diameter ratio is consistent with that seen after medical therapy, showing that the percentage reduction after ultrasound-assisted thrombolysis was −33% and −39% at 72 h and 90 d, respectively, when compared with baseline (37).…”

Section: Discussionmentioning

confidence: 78%

High-Intensity Interval Training in Patients with Pulmonary Embolism: A Randomized Controlled Trial

Jenab

Soori

Choobineh

et al. 2021

Medicine &Amp; Science in Sports &Amp; Exercise

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PurposeHigh-intensity interval training (HIIT) appears to be safe and effective in cardiovascular diseases. However, there is a paucity of data on the effect of HIIT for patients with acute pulmonary embolism (PE). The present randomized controlled trial (RCT) therefore examined the efficiency and safety of HIIT in patients with acute PE.MethodsIn single-center parallel open-label RCT, 24 patients (5 women) discharged recently with a diagnosis of intermediate–high-risk acute PE were randomized (1:1) to supervised HIIT (n = 12) or control (n = 12) group. The primary outcomes were exercise capacity evaluated in terms of the estimated maximal oxygen uptake (eV˙O2max), lung function (forced expiratory volume in 1 s [FEV1]), right ventricular (RV) function (RV/left ventricular diameter [LV] ratio), and health-related quality of life (HRQoL). Safety was the secondary outcome.ResultsEight weeks of HIIT improved eV˙O2max (+65%, P < 0.001), FEV1 (%) (+17%, P = 0.031), and RV/LV ratio diameter (−27%, P = 0.005), as well as HRQoL. All patients in the HIIT group tolerated exercise training without serious adverse events. The control group did not improve (P > 0.05) eV˙O2max, RV/LV ratio diameter, or HRQoL; however, FEV1 (%) was slightly reduced (−6%, P = 0.030).ConclusionsThe present RCT of a tailored center-based HIIT intervention provides preliminary evidence that this intervention could improve exercise capacity, lung function, RV function, and HRQoL without serious adverse events, which could provide marked clinical benefits after PE. Further larger multicenter randomized controlled studies are needed to confirm these promising findings.

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“…Sin embargo, éstos no han sido estudiados para evaluar la respuesta a TLUS, por lo que utilizamos sólo los parámetros habi-tuales de función VD según ecocardiograma o Angio-TAC pulmonar, que se han correlacionado directamente con aumento de mortalidad 37 . Estudios recientes incluso han correlacionado la reversión precoz de la relación VD/VI post TLUS con la preservación de la función cardiovascular en el mediano plazo 39 . Finalmente, debemos recordar que esta estrategia debe ser integrada en el contexto de un conjunto de medidas que incluyen: el inicio precoz de la anticoagulación, oxigenoterapia o el uso de inótropos/vasopresores cuando sea necesario.…”

Section: Referenciasunclassified

Experiencia inicial con el uso de Trombolisis local asistida por Catéter de Ultrasonido terapeútico (EKOSonic®) en pacientes con Tromboembolismo Pulmonar Agudo

et al. 2020

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Preservation of Cardiopulmonary Function in Patients Treated with Ultrasound-Accelerated Thrombolysis in the Setting of Submassive Pulmonary Embolism

Cited by 14 publications

References 29 publications

One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism

One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism

High-Intensity Interval Training in Patients with Pulmonary Embolism: A Randomized Controlled Trial

Experiencia inicial con el uso de Trombolisis local asistida por Catéter de Ultrasonido terapeútico (EKOSonic®) en pacientes con Tromboembolismo Pulmonar Agudo

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