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Diuretics Versus Volume Expansion in the Initial Management of Acute Intermediate High-Risk Pulmonary Embolism

  • ACUTE PULMONARY EMBOLISM
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Abstract

Aims

The very early management of pulmonary embolism (PE), a part from antithrombotic treatment, has been little studied. Our aim was to compare the effects of diuretic therapy (DT) versus volume expansion (VE) in patients hospitalized for PE with RV dysfunction.

Methods and Results

We conducted a randomized open-label multicentric study including patients with intermediate high-risk PE. Patients were randomized between diuretics or saline infusion. The primary endpoint was time to troponin (Tp) normalization. Secondary endpoints were time to normalization of B-type natriuretic peptide (BNP), changes in echocardiographic RV function parameters and treatment tolerance. Sixty patients presenting intermediate high-risk PE were randomized. Thirty received DT and 30 VE. We noted no changes in Tp kinetics between the two groups. In contrast, faster normalization of BNP was obtained in the DT group: 56 [28–120] vs 108 [48–144] h: p = 0.05, with a shorter time to 50%-decrease from peak value 36 [24–48] vs 54 [41–67] h, p = 0.003 and a higher rate of patients with a lower BNP concentration within the first 12 h (42% vs 12% p < 0.001). RV echocardiographic parameters were unchanged between the groups. One dose 40 mg furosemide was well-tolerated and not associated with any serious adverse events.

Conclusion

In the acute management of intermediate high-risk PE, initial therapy including diuretic treatment is well-tolerated and safe. Although changes in Tp kinetics and echocardiographic RV dysfunction parameters did not differ, normalization of BNP is achieved more quickly in the DT group. This finding, which need to be confirmed in trials with clinical end points, may reflects a rapid improvement in RV function using one dose 40 mg furosemide.

Trial Registry

Clinical Trial Registration NCT02531581.

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Acknowledgements

The authors thanks the participating centers: Department of Cardiology: CHU de Nice (Pr FERRARI.E); Department of Cardiology: CHG de Cannes (Dr BERKANE. N); Department of Medical Intensive Care: CHU de Nice (Dr DOYEN.D).

Funding

This study was sponsored by the Centre Hospitalier Universitaire de Nice (AOI 2017).

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Authors and Affiliations

  1. Cardiology Department, Centre Hospitalier Universitaire de Nice, 30, Avenue de la voie romaine, CS 51069, 06001, Nice Cedex 1, France

    Emile Ferrari, Benjamin Sartre, Mohamed Labbaoui, Nathan Heme, Florian Asarisi, Nassim Redjimi, Etienne Fourrier, Fabien Squara, Sithy Bun, Jean Philippe Breittmayer & Pamela Moceri

  2. Cardiology Department, Centre Hospitalier de Cannes, Cannes, France

    Nathalie Berkane

  3. Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nice, Nice, France

    Denis Doyen

  4. UR2CA, Université Côte d’Azur, Nice, France

    Denis Doyen & Pamela Moceri

Authors
  1. Emile Ferrari
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  2. Benjamin Sartre
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  3. Mohamed Labbaoui
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  4. Nathan Heme
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  7. Etienne Fourrier
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  8. Fabien Squara
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  11. Jean Philippe Breittmayer
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  12. Denis Doyen
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Correspondence to Emile Ferrari.

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Ferrari, E., Sartre, B., Labbaoui, M. et al. Diuretics Versus Volume Expansion in the Initial Management of Acute Intermediate High-Risk Pulmonary Embolism. Lung 200, 179–185 (2022). https://doi.org/10.1007/s00408-022-00530-5

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  • DOI: https://doi.org/10.1007/s00408-022-00530-5

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