Clinical InvestigationSix-Month Echocardiographic Study in Patients With Submassive Pulmonary Embolism and Right Ventricle Dysfunction: Comparison of Thrombolysis With Heparin
Section snippets
Population
From January 2005 to June 2009, we prospectively studied 72 consecutive patients aged between 18 and 75 years, with a first episode of SPE.
Inclusion Criteria
Patients had to meet all the following criteria: (1) symptoms onset since no more than 6 hours, for first episode of acute SPE; (2) normal blood pressure [systolic blood pressure (SBP) > 100 mm Hg]; (3) RVD at echocardiogram; (4) positive lung spiral computed tomography (CT) and (5) dyspnea, chest pain, tachypnea, hypoxemia PO2 ≤ 75 mm Hg, PCO2 < 40 mm Hg,
RESULTS
Of the 2318 patients admitted to hospital within 6 hours from onset of sudden acute dyspnea, 1025 were patients with acute coronary syndrome (ST segment elevation myocardial infarction or non ST segment elevation myocardial infarction), 368 with severe chronic obstructive pulmonary disease, 761 with acute heart failure, 7 with recent intracranial bleeding, 5 had recent ischemic stroke (< 2 months), 4 had recent surgery (< 10 days), 6 had hemorrhagic disorder with thrombocytopenia (< 100,000), 9
DISCUSSION
Overall, the study shows the feasibility of thrombolysis treatment in patients with acute SPE and does not raise safety concerns. Moreover, this study suggests that thrombolysis could be used in patients with acute SPE. Our study suggests that thrombolysis is more effective than heparin in obtaining an early reduction of RVD in hemodynamically stable patients with acute SPE with subsequent beneficial effects in the 180-day follow-up. Probably, the beneficial effects in RVD observed may have
CONCLUSIONS
Our data suggest that, in hemodynamically stable patients with SPE, thrombolysis is associated with a more rapid reduction of RVD and this reduction shows a favorable trend in clinical outcome; however, this effect is still to be defined. The echocardiographic data of RVD might have important prognostic implications and might affect the choice of therapy. We believe that thrombolytic treatment in patients who show RVD should merit consideration and the analysis of RV function would be
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