Diuretics versus volume expansion in acute submassive pulmonary embolism

Abstract

The benefit of volume expansion (VE) in submassive pulmonary embolism (PE) with right ventricular (RV) dysfunction is unclear. To compare the effects of diuretic treatment versus VE in patients hospitalized for PE with RV dysfunction. We prospectively included 46consecutive patients with submassive PE treated on admission with a 40mg bolus of furosemide (D group, n=24) or 500mL of saline infusion (VE group, n=22). The primary endpoint was the timing of normalization of B-type natriuretic peptide and troponinIc concentrations. The secondary endpoints were variations in RV function variables, recorded at baseline, at the 4thhour after treatment initiation (H4) and every day until discharge, and a clinical composite endpoint of thrombolysis or death at 7 and 30days. No differences were observed between patients at baseline. The primary endpoint occurred earlier in the D group than in the VE group (67.5±34.8 vs 111.6±63.3hours; P=0.006). Furosemide treatment on admission was well tolerated, and was not associated with serious adverse events. At H4, substantial improvements were observed in the D group versus the VE group in terms of heart rate reduction (-8.15±21.0 vs -0.71±6.30 beats/min; P<0.01) and peak tricuspid annular systolic velocity (Doppler tissue imaging) (11.4±2.10 vs 9.90±2.80cm/s; P=0.02). There was no significant difference between groups in terms of severe outcomes at 7 and 30days. In the acute management of submassive PE patients, a single furosemide bolus on admission seems to produce significant and earlier improvements in RV function markers compared with VE, without adverse events.