Acute Hemodynamics Changes with PE.pptx

1、Jonathan Paul,MD,FACCAssociate Professor of MedicineDirector,Pulmonary Embolism Response Team(PERT)Co-Director,Comprehensive Venous Thrombosis+PE ProgramUniversity of Chicago Medicine,Hemodynamics in Acute Pulmonary Embolism,Jonathan_PaulMD,Disclosures,I have the following relevant financial relatio

2、nships to disclose:Grant/Research Support:Inari MedicalAdvisor:AIDOCFounder/Equity:Flow MedicalI will not discuss off label use and/or investigational use in my presentation,2,3,Risk Category and Mortality 90 day,Secemsky,Weinberg.Am.J.Med 2018,Death from PE Acute Increase in PVR,4,Smulders YM.Cardi

3、ovascular Research.2000.,5,Acute rise in pulmonary vascular resistance RV pressure overload septal shift LV preload hypotension.RVPA uncoupling precedes overt shock;tachycardia and rising lactate signal limited reserve.,ESC 2019 Risk Stratification Model,6,Thrombolytics,ECMO,Thrombectomy,Anticoagula

4、tion,?Hemodynamics matter!,Konstantinides et al.,Eur Heart J.2020,7,Normotensive Patients are Often Sicker Than They Appear,8,RV/LV Ratio on CT surrogate marker,Measurement made onaxialimaging.Ratio 0.9 considered positive.Highly dependent on LV size.May be falsely reassuring with underlying LV dysf

5、unctionDoes not take into account other important variables:RV functionRA sizePulmonary artery diameterTTE can be very helpful,9,TTE:Beyond RV/LV Ratio,Konstantinides et al.,Eur Heart J.2020,https:/,10,Catheter Based Therapy:RV/LV Reduction in Context,11,Catheter Directed Thrombolysis-Effects on PA

6、Pressure,25%decrease in sPAP across studies,12,Reduction of PA Obstruction Greater with Lytics!,Remember!:PVR primarily determined by smaller vesselsAlso Remember!:hypoxic pulmonary vasoconstriction also primary affects smaller vessels,13,Cardone et al.TCT 202