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No prior study has prospectively observed a cohort of patients with submassive PE, defined using the standard criteria, and reported the outcomes of each patient, including follow-up RV function and estimated pressure, as well as dyspnea severity and exercise capacity. These studies have reported an incidence of CTEPH well below 5% within 3 years after PE. An important secondary question is whether adjunctive fibrinolysis will improve RV function and reduce RVSP to a sufficient degree to mitigate the symptoms of dyspnea and to improve exercise tolerance in the months after the diagnosis of submassive PE.Įxisting studies 4, 5, 12, 13 that have observed survivors of PE for > 3 months have focused on rates of mortality and the severe end point of chronic thromboembolic pulmonary hypertension (CTEPH). Although the addition of fibrinolysis to heparin anticoagulation appears to accelerate the resolution of RV dysfunction and to reduce RV systolic pressure (RVSP) in the short term, aggregated data from existing clinical trials 8– 11 show no evidence of survival benefit. 3 Patients with submassive PE treated with heparin followed by oral anticoagulation experience a low mortality rate, and many experts think 4– 7 that the majority of patients resolve their pulmonary vascular perfusion defects over a period of 6 to 12 months.

2 The echocardiographic findings that define RV strain in patients with submassive PE, and the optimal treatment of patients with these findings, remain the subject of ongoing debate. 1 Patients with submassive PE can be further stratified based on the presence or absence of abnormalities seen on echocardiography suggesting the presence of right ventricular (RV) strain. Note: We do not offer technical support for developing or debugging scripted downloading processes.Submassive pulmonary embolism (PE) is generally defined as a PE that is not severe enough to cause arterial hypotension.

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