Relative Contribution of High Dose Outliers to Cumulative Occupational Radiation Dose in the Catheterization Laboratory

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Among pulmonary embolism (PE) patients evaluated for catheter-directed therapy (CDT), predictors of treatment response are limited. While a ≥25% drop in mean pulmonary artery (PA) pressure defines response, decision to treat often relies on clinical judgment and noninvasive tools (sPESI, CPES). We compared pre-treatment invasive hemodynamics and noninvasive markers in predicting CDT response.

Methods: We retrospectively analyzed 21 PE patients treated with CDT and Swan-Ganz catheter monitoring between 2022–2025. Treatment response was defined as ≥25% PA pressure reduction. Initial invasive hemodynamics (RA, CI, MvO2, PAPI, RV-CPO, RV-MPS [=PAPI×CPO×1.5]) and noninvasive markers (sPESI, CPES, troponin, RV/LV ratio) were analyzed using t-tests between responders and non-responders.

Results: CPES was the only noninvasive marker significantly different (5 vs 4, p=0.027); sPESI, troponin, RV/LV ratio were not associated with response. In contrast, invasive metrics were strongly associated with response: PA mean filling pressure (35 vs 23.5, p=0.001), MvO2 (59 vs 70.65, p=0.042), PAPI (1.79 vs 4.42, p=0.004), and RV-MPS (0.23 vs 0.41, p=0.007). Fick cardiac index was not associated with response to CDT.

Conclusion: Invasive hemodynamics—especially PA pressure, MvO2, PAPI, and RV-MPS— demonstrate a stronger and more consistent association than non-invasive markers. These findings support RV-PA coupling (the ratio of RV contractility to RV afterload) as a physiologic predictor of CDT response. CPES may aid selection, but non-invasive markers such as sPESI, RV/LV Ratio, troponin may not correspond with robust treatment response. Although further research is needed to assess recoupling dynamics post-intervention, our data suggest that initial invasive hemodynamic assessment can better stratify CDT responders versus non-responders.

Volume

86

Issue

17 Suppl

First Page

B454

Comments

American College of Cardiology Thirty-Seventh Annual Transcatheter Cardiovascular Therapeutics Symposium, October 25-28, 2025, San Francisco, CA

Frederik Meijer Heart & Vascular Institute

Last Page

B455

DOI

10.1016/j.jacc.2025.09.1264

ISSN

1558-3597

Link to Full Text

Share

COinS