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Background <p>Sparse data are available on the long-term course of acute pulmonary embolism (PE) after ultrasound-assisted catheter-directed thrombolysis (USAT).</p> Methods <p>We included consecutive patients with intermediate-high or high-risk acute PE treated with USAT (alteplase 20&#xa0;mg over 15&#xa0;h) and therapeutic anticoagulation at a tertiary center, who underwent a structured post-interventional follow-up. The following outcomes were analyzed for patients with at least 3&#xa0;months of follow-up: all-cause death, persistent dyspnea, symptomatic post-PE cardiac impairment, chronic thromboembolic pulmonary hypertension (CTEPH) or chronic thromboembolic pulmonary disease (CTEPD). Symptomatic post-PE cardiac impairment was defined as residual respiratory symptoms with at least one echocardiographic parameter of right ventricular dysfunction.</p> Results <p>Among 300 patients (41% women, median age 65 [52–74] years), 254 (85%) had intermediate-high and 46 (15%) had high-risk PE. Follow-up data beyond the first 3&#xa0;months (median 6.1 [3.6–12] months) were available for 260 (88%) survivors. At follow-up, 45 (17%) patients reported persistent respiratory symptoms and 18 (6.9%) met the criteria for post-PE cardiac impairment. CTEPH was diagnosed in 7 (2.7%) patients, deemed pre-existing in all cases based on radiological reassessment of index imaging. CTEPD was confirmed in 2 (0.8%) patients. The 1-year death rate was 2.9% after intermediate-high risk and 21% after high-risk PE.</p> Conclusions <p>After a median of 6&#xa0;months after acute PE, almost one in five patients treated with USAT had persistent respiratory symptoms, although post-PE cardiac impairment was rare. CTEPH was diagnosed in 2.7% of patients and deemed pre-existing in all cases.</p> Graphical abstract <p></p>

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Post-pulmonary embolism cardiac impairment and chronic thromboembolic pulmonary hypertension after ultrasound-assisted catheter-directed thrombolysis for acute pulmonary embolism

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Riccardo M. Fumagalli,
  • Stephanie Zbinden,
  • Silvia Cardi,
  • Aline Fürbringer-Schwarz,
  • Olivier A. Gyolay,
  • Davide Voci,
  • Frederikus A. Klok,
  • Stavros V. Konstantinides,
  • Conrad Von Stempel,
  • Nils Kucher,
  • Stefano Barco

摘要

Background

Sparse data are available on the long-term course of acute pulmonary embolism (PE) after ultrasound-assisted catheter-directed thrombolysis (USAT).

Methods

We included consecutive patients with intermediate-high or high-risk acute PE treated with USAT (alteplase 20 mg over 15 h) and therapeutic anticoagulation at a tertiary center, who underwent a structured post-interventional follow-up. The following outcomes were analyzed for patients with at least 3 months of follow-up: all-cause death, persistent dyspnea, symptomatic post-PE cardiac impairment, chronic thromboembolic pulmonary hypertension (CTEPH) or chronic thromboembolic pulmonary disease (CTEPD). Symptomatic post-PE cardiac impairment was defined as residual respiratory symptoms with at least one echocardiographic parameter of right ventricular dysfunction.

Results

Among 300 patients (41% women, median age 65 [52–74] years), 254 (85%) had intermediate-high and 46 (15%) had high-risk PE. Follow-up data beyond the first 3 months (median 6.1 [3.6–12] months) were available for 260 (88%) survivors. At follow-up, 45 (17%) patients reported persistent respiratory symptoms and 18 (6.9%) met the criteria for post-PE cardiac impairment. CTEPH was diagnosed in 7 (2.7%) patients, deemed pre-existing in all cases based on radiological reassessment of index imaging. CTEPD was confirmed in 2 (0.8%) patients. The 1-year death rate was 2.9% after intermediate-high risk and 21% after high-risk PE.

Conclusions

After a median of 6 months after acute PE, almost one in five patients treated with USAT had persistent respiratory symptoms, although post-PE cardiac impairment was rare. CTEPH was diagnosed in 2.7% of patients and deemed pre-existing in all cases.

Graphical abstract