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Associations Between Hemodynamic Recovery and Functional Capacity After Percutaneous Reperfusion for Acute Pulmonary Embolism
Session:
Sessão de Posters 51 - Circulação pulmonar, pericárdio e cuidados agudos
Speaker:
Mariana Caetano Coelho
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mariana Caetano Coelho; Julien Lopes; Daniela Pinheiro; Bárbara Lacerda Teixeira; André Grazina; João Reis; Pedro Costa; Ana Galrinho; Melanie Ferreira; Pedro Coelho; Rui Cruz Ferreira; Luis Almeida Morais
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11px"><strong>Background:</strong> Pulmonary embolism (PE) is increasingly prevalent, and although therapeutic strategies have advanced, many survivors continue to experience functional limitations. Nearly half of patients exhibit exercise intolerance, defined as a VO2max < 80% of the predicted value, and a subset develop chronic thromboembolic pulmonary hypertension (CTEPH). Beyond CTEPH, a broader “post-PE syndrome” encompasses patients with persistent dyspnea or reduced exercise capacity that cannot be explained by residual thrombotic obstruction. Understanding whether hemodynamic recovery following reperfusion therapy leads to meaningful improvements in functional capacity is crucial for optimizing long-term patient management.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11px"><strong>Aim:</strong> To assess whether improvements in pulmonary vascular and right-heart hemodynamic parameters following percutaneous treatment of acute PE are associated with enhanced functional capacity, as measured by peak oxygen consumption (VO2).</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11px"><strong>Methods:</strong> We conducted an observational study including 45 patients (46% female; median age 61 ± 17.5 years) treated with advanced percutaneous reperfusion techniques for acute PE. Therapeutic strategies included in situ fibrinolysis (71%), aspiration thrombectomy (13%), or a combined approach (16%). Pulmonary artery systolic pressure (PASP) and cardiac output (CO) were recorded at baseline and at 6-month follow-up. Functional capacity was evaluated by cardiopulmonary exercise testing with measurement of peak VO2.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11px"><strong>Results:</strong> The mean peak VO2 in the cohort was 84.7% ± 22.4 of the predicted value. Women showed a mean VO2 of 81.4% ± 5.2 and men 90% ± 4.7, with no statistically significant sex-related difference (p = 0.229). Overall, 44% of patients had exercise intolerance (VO2max < 80%). Regarding the presence of CTEPH, patients who developed CTEPH demonstrated a mean VO2 of 85% ± 10, compared with 86% ± 3.7 in those without CTEPH (p = 0.944). Hemodynamic recovery was positively associated with functional performance at 6 months. Greater reductions in PASP correlated significantly with higher peak VO2 values (r = 0.376, p = 0.011), indicating that right-ventricular unloading was accompanied by improved exercise capacity. Similarly, increases in cardiac output were significantly associated with higher VO2 during cardiopulmonary exercise testing (r = 0.381, p = 0.010). Patients exhibiting larger hemodynamic improvements demonstrated superior functional recovery.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11px"><strong>Conclusion</strong>: Improvements in PASP and CO following percutaneous reperfusion therapy for acute PE are significantly associated with enhanced functional capacity at 6-month follow-up. These findings suggest that both reduced pulmonary vascular load and improved cardiac pump function contribute meaningfully to medium-term functional recovery and may serve as useful indicators of post-PE rehabilitation and prognosis.</span></span></p>
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