Association of left ventricular outflow tract velocity-time integral with severity of pulmonary embolism in patients treated with catheter-directed therapies.

Pulmonary embolism is a leading cause of cardiovascular death. Given the increased use of catheter directed therapies (CDT), tools for patient selection have become more impactful today. Several parameters have been used to identify vulnerable patients. These include demographic, physical, imaging and laboratory findings which can be used collectively to risk stratify patients. Left ventricular outflow tract (LVOT) velocity time index (VTI) is not incorporated in these calculators, but data suggests it is effective in prognostication. Using a retrospective review, we assessed 105 consecutive pulmonary embolism response team (PERT) patients who underwent either thrombectomy with a FlowTriever Device (Inari Medical) or ultrasound assisted thrombolysis with EKOS (Boston Scientific) and compared their pre-procedural LVOT VTI indexed to body surface area to markers of pulmonary embolism severity. Of the 105 patients, 57 were male, 80 were Caucasian, 70 were ESC intermediate-high risk and 16 were ESC high risk, 76 were sPESI positive, and 62 were PESI class III or higher. Traditional demographic markers of increased risk, including heart and lung disease, along with cancer, were low. RV strain was present in 96 patients. VTI indexed to BSA, HR and LVOT diameter had a significant negative correlation with imaging parameters of RV dysfunction, ESC and sPESI classification and a significant positive correlation with pulse pressure and TAPSE. There were no procedural deaths, with three mortalities (2.9%) at 30 days in patients with available follow up. Indexed LVOT VTI correlates with established predictors of increased pulmonary embolism severity in a group of pulmonary embolism response team patients who underwent CDT. An analysis of indexed LVOT VTI in pulmonary embolism patients who did not undergo CDT will enhance our knowledge on patient selection.