Recovery of right ventricular function after intermediate-risk pulmonary embolism: results from the multicentre Pulmonary Embolism International Trial (PEITHO)-2
Authors: Mavromanoli Anna C. , Barco Stefano , Ageno Walter , Bouvaist Hélène , Brodmann Marianne , Cuccia Claudio , Couturaud Francis , Dellas Claudia , Dimopoulos Konstantinos , Duerschmied Daniel , Empen Klaus , Faggiano Pompilio , Ferrari Emile , Galiè Nazzareno , Galvani Marcello , Ghuysen Alexandre , Giannakoulas George , Huisman Menno V. , Jiménez David , Kozak Matija , Lang Irene M. , Meneveau Nicolas , Münzel Thomas , Palazzini Massimiliano , Petris Antoniu Octavian , Piovaccari Giancarlo , Salvi Aldo , Schellong Sebastian , Schmidt Kai-Helge , Verschuren Franck , Schmidtmann Irene , Toenges Gerrit , Klok Frederikus A. , Konstantinides Stavros V. ,   The PEITHO-2 Investigators, Freire Jaime Antonio Abelaira , Akin Ibrahim , Anusic Toni , Becker Dorothea , Bertoletti Laurent , Bettoni Giuseppe , Binder Harald , Carels Regina , Di Pasquale Giuseppe , Dürschmied Daniel , Enea Iolanda , Ficker Joachim , Genth-Zotz Sabine , Girard Philippe , Gorbulev Stanislav , Held Matthias , Hobohm Lukas , Huisman Menno V , Konstantinides Stavros V , Kronfeld Kai , Lang Irene Marthe , Lankeit Mareike , Lehmacher Walter , Miguel Concepcion Patricia Lopez , Martin Nadine , Meyer Guy , Pareznik Roman , Quitzau Kurt , Parepa Irinel Raluca , Martin Purificacion Ramirez , Righini Marc , Todea Silviu Bogdan , Torbicki Adam , Valerio Luca , Vanassche Thomas , Vida-Simiti Luminita Animarie , Wolf-Pütz Anamaria 
Published: December 2022

Abstract
Background
Right ventricular (RV) function plays a critical role in the pathophysiology and acute prognosis of pulmonary embolism (PE). We analyzed the temporal changes of RV function in the cohort of a prospective multicentre study investigating if an early switch to oral anticoagulation in patients with intermediate-risk PE is effective and safe.

Methods
Echocardiographic and laboratory examinations were performed at baseline (PE diagnosis), 6 days and 6 months. Echocardiographic parameters were classified into categories representing RV size, RV free wall/tricuspid annulus motion, RV pressure overload and right atrial (RA)/central venous pressure.

Results
RV dysfunction based on any abnormal echocardiographic parameter was present in 84% of patients at baseline. RV dilatation was the most frequently abnormal finding (40.6%), followed by increased RA/central venous pressure (34.6%), RV pressure overload (32.1%), and reduced RV free wall/tricuspid annulus motion (20.9%). As early as day 6, RV size remained normal or improved in 260 patients (64.7%), RV free wall/tricuspid annulus motion in 301 (74.9%), RV pressure overload in 297 (73.9%), and RA/central venous pressure in 254 (63.2%). At day 180, the frequencies slightly increased. The median NT-proBNP level decreased from 1448 pg/ml at baseline to 256.5 on day 6 and 127 on day 180.

Conclusion
In the majority of patients with acute intermediate-risk PE switched early to a direct oral anticoagulant, echocardiographic parameters of RV function normalised within 6 days and remained normal throughout the first 6 months. Almost one in four patients, however, continued to have evidence of RV dysfunction over the long term.

Graphical Abstract