PROTOCOLIZED USE OF CATHETER-DIRECTED THROMBOLYSIS AND ECHOCARDIOGRAPHY IS HIGHLY EFFECTIVE IN REVERSING ACUTE RIGHT HEART DYSFUNCTION IN SEVERE SUBMASSIVE PULMONARY EMBOLISM PATIENTS

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: The purpose of this study was to evaluate the efficacy of protocolized use of catheter-directed thrombolysis and echocardiography in submassive pulmonary embolism patients presenting with severe right heart dysfunction. METHODS: A retrospective study at a single academic institution of 23 patients that presented with submassive pulmonary embolism (PE) from July 2016 to April 2018 was performed. All patients were diagnosed using chest computed tomography (CT) demonstrating clot in the pulmonary vasculature as well as right ventricle dysfunction based on abnormal right ventricle to left ventricle (RV/LV ratio). Patients with severe right heart dysfunction (RV/LV≥ ratio 1.4) were protocolized to receive catheter directed thrombolysis via EkoSonic catheters (EKOS Corporation, Bothell, WA) in the pulmonary vasculature for thrombolysis with Alteplase (tPA) at 1 mg per hour total. Transthoracic Echocardiography was then performed the following day to assess right ventricle function and determine the need to continue thrombolysis. Patients after discharge then received follow up echocardiograms at 6 weeks to determine new post-treatment baseline. RESULTS: The mean patient age was 54.7 years and mean body mass index (BMI) was 35.3. Mean RV/LV ratio on admission CT imaging was 1.68, with a mean troponin of 0.35. Interval mean RV/LV ratio on echocardiography during thrombolysis therapy was 1.00 (P<.00001). Patients were tachycardic on admission (mean heart rate 102 beats per minute (BPM) with improvement by completion of thrombolysis (mean heart rate 74 BPM) (P<.00001). Twelve of 23 patients (52%) had thrombolysis terminated at 24 hours interval based on echocardiography findings, with the remainder receiving 24 additional hours of therapy. There was a 0% incidence of peri-procedural complications. Overall 30-day complication rate was 8.7% (N=1 arrythmia, N=1 delayed intracranial hemorrhage). At 6-week follow up, 89% of patients who received echocardiography had normal right ventricular function. CONCLUSIONS: This retrospective study demonstrates the effectiveness of protocolized use of catheter-directed thrombolysis and echocardiography in reversing severe right heart dysfunction in submassive pulmonary embolism patients. CLINICAL IMPLICATIONS: Protocolized use of Echocardiography with catheter-directed thrombolysis is effective at reversing severe right heart dysfunction in submissive pulmonary embolism patients without requiring repeat imaging studies or invasive follow up procedures. DISCLOSURES: No relevant relationships by Jaideep Das Gupta, source=Web Response No relevant relationships by Sundeep Guliani, source=Web Response No relevant relationships by John Marek, source=Web Response No relevant relationships by Jon Marinaro, source=Web Response No relevant relationships by Mohammed Rana, source=Web Response