Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
J Vasc Surg Venous Lymphat Disord. 2023 Nov;11(6):1157-1164. doi: 10.1016/j.jvsv.2023.06.003. Epub 2023 Jun 22.
Chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is a morbid complication with suboptimal treatment. We aimed to evaluate the biomarker profile and functional outcomes in patients with submassive PE (sPE) treated with catheter-directed thrombolysis (CDT) compared with anticoagulation alone (ACA). We performed a secondary biomarker and survey analysis of the SUNSET sPE (standard vs ultrasound-assisted catheter thrombolysis for submassive pulmonary embolism) randomized trial comparing standard CDT to ultrasound-assisted thrombolysis in patients with sPE.
As a part of the SUNSET sPE study, patients who did not receive an intervention were enrolled in the medical (ACA) arm. The biomarkers associated with CTEPH in the literature (ie, CCL2, CXCL10, PTX3, GDF-15, RAGE, BCA-1, TFPI) were collected and measured using a multiplex assay at diagnosis, discharge, and 3-month follow-up. Patients underwent a 6-minute walk test and answered quality-of-life questionnaires (pulmonary embolism quality of life; University of California, San Diego, shortness of breath questionnaire; 36-item short-form survey) at 3 months after diagnosis. Comparisons were made using the Student t test. Nonparametric tests were used when the distributions were not normal. Significance was set at P ≤ .05.
A total of 72 patients (age, 56 ± 15 years; 40.3% women) were included in the present analysis. Of these 72 patients, 53 underwent CDT and 19 were included in the ACA arm. The baseline right ventricle/left ventricle ratios were similar between the two groups (CST, 1.8; ACA, 1.7). The survival and complication rates were similar between the two groups. At discharge, CXCL10 (768.9 ± 148.6 pg/mL vs 3032.0 ± 1201.0 pg/mL; P = .018) and PTX3 (3203.5 ± 1298.0 pg/mL vs 12,716.2 ± 6961.5 pg/mL; P = .029) were lower in the CDT group and displayed a quicker return to baseline than in the ACA group. This trend, although not significant, was also seen with the other biomarkers. At 3 months, the 6-minute walking distance and quality-of-life scores were similar between both groups.
In patients with sPE, the biomarkers of CTEPH were lower with CDT compared with ACA. At 3 months, both groups demonstrated similar biomarker levels, 6-minute walking distances, and quality-of-life scores.
肺栓塞（PE）后慢性血栓栓塞性肺动脉高压（CTEPH）是一种预后不良的严重并发症，治疗效果并不理想。本研究旨在评估接受导管溶栓治疗（CDT）的亚大面积肺栓塞（sPE）患者的生物标志物谱和功能结局，并与单纯抗凝治疗（ACA）进行比较。我们对 SUNSET sPE 随机试验进行了二次生物标志物和调查分析，该试验比较了标准 CDT 与超声辅助溶栓治疗 sPE 患者的疗效。
作为 SUNSET sPE 研究的一部分，未接受干预的患者被纳入药物治疗（ACA）组。本研究收集了文献中与 CTEPH 相关的生物标志物（即 CCL2、CXCL10、PTX3、GDF-15、RAGE、BCA-1、TFPI），并使用多重分析在诊断时、出院时和 3 个月随访时进行了测量。患者在诊断后 3 个月进行 6 分钟步行测试并回答生活质量问卷（PE 生活质量问卷；加利福尼亚大学圣地亚哥分校呼吸困难问卷；36 项简短健康调查问卷）。采用学生 t 检验进行比较。当分布不正常时，使用非参数检验。显著性水平设为 P ≤.05。
本研究共纳入 72 例患者（年龄 56±15 岁；40.3%为女性）。其中 53 例接受了 CDT，19 例接受了 ACA。两组间基线右心室/左心室比值相似（CST，1.8；ACA，1.7）。两组间生存率和并发症发生率无差异。出院时，CDT 组 CXCL10（768.9±148.6 pg/mL 比 3032.0±1201.0 pg/mL；P=.018）和 PTX3（3203.5±1298.0 pg/mL 比 12716.2±6961.5 pg/mL；P=.029）水平较低，且较 ACA 组更快恢复到基线水平。尽管这一趋势没有统计学意义，但其他生物标志物也有类似趋势。3 个月时，两组间 6 分钟步行距离和生活质量评分相似。
在 sPE 患者中，与 ACA 相比，CDT 治疗的 CTEPH 生物标志物水平较低。3 个月时，两组的生物标志物水平、6 分钟步行距离和生活质量评分相似。
