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Hemodynamic profile of patients with CTEPH and a prior episode of acute PE treated with CDT
Session:
Sessão de Posters 27 - Abordagem e avanços terapêuticos na hipertensão pulmonar
Speaker:
Daniela Nascimento Pinheiro
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.5 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Prevention
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Daniela Pinheiro; Julien Lopes; Bárbara Lacerda Teixeira; André Grazina; João Reis; Luís Morais; Rui Cruz Ferreira; Ana Galrinho
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Pulmonary embolism (PE) is an important risk factor for chronic thromboembolic pulmonary hypertension (CTEPH). Catheter-directed therapy (CDT) is an emerging treatment modality for acute PE. It allows to achieve rapid thrombus reduction and to improve right ventricular function in the acute setting. However, whether CDT influences long-term pulmonary vascular remodeling or alters the progression to CTEPH remains uncertain.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Objective:</strong> To compare hemodynamic variables between CTEPH patients with a history of acute PE treated with CDT and those managed without CDT. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Retrospective analysis of consecutive patients with prior PE and established CTEPH under regular follow-up at a specialized PH center. Echocardiographic and hemodynamic parameters were collected and compared between those with CDT and those without. Chi-square test and t-test for independent samples were used to compare groups.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Results: </span></strong><span style="font-family:"Calibri",sans-serif">38 patients with CTEPH and prior PE were evaluated (mean age 66± 15.2 years, 64% females). 84.6% had an intermedia-high PE, 29%(n=11) treated with CDT. CDT group was younger (57.1±22.3 vs 70.1±9.5 years, p= 0.088) and predominantly female (91%). Hemodynamic assessment showed significantly higher cardiac output (6.0±1.2 vs. 4.6±1.2 L/min; p=0.002) and cardiac index (3.2±0.7 vs. 2.5±0.5 L/min/m²; p<0.001) in the CDT group. Mean pulmonary artery pressure and pulmonary vascular resistance were lower in CDT-treated patients, although not significantly. Venous oxygen saturation demonstrated a non-significant trend toward higher values (p=0.052). Echocardiography revealed lower estimated PASP (40.4±15.5 vs. 63.5±22.2 mmHg; p=0.012) and a higher TAPSE/PASP ratio (0.53±0.09 vs. 0.34±0.21; p=0.035) in the CDT group, while other right heart structural parameters did not differ.</span></span></span></p> <p style="text-align:justify"><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif"> Overall, CDT during acute PE was associated with a more favorable hemodynamic profile at CTEPH diagnosis. </span></span><span style="font-size:13.0pt"><span style="font-family:AppleSystemUIFont">Th</span></span><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">ese findings are in alignment with recent clinical trials and registries that suggest early catheter-directed reperfusion may positively influence long-term pulmonary vascular remodeling, potentially attenuating disease severity or even lowering the likelihood of progression to CTEPH. More data and long-term follow-up are needed to prove this theory. </span></span></p>
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