Biomarkers of heart failure show early reversal with catheter thrombolysis compared to anticoagulation alone in SUNSET sPE secondary analysis

Elizabeth Andraska (L) and Efthymios Avgerinos (R)

In a secondary analysis of the SUNSET sPE randomised controlled trial, Efthymios Avgerinos (University of Pittsburgh Medical Centre, Pittsburgh, USA) and colleagues found differences in biomarker levels in response to treatment with catheter-directed therapies compared to anticoagulation alone. These data were presented at the 2022 annual meeting of the American Venous Forum (AVF; 23–26 February, Orlando, USA).

Speaking to Venous News, Avgerinos notes that endovascular interventions for submassive pulmonary embolism (sPE) are becoming increasingly popular, and that device options are diversifying rapidly. A few years ago, the ULTIMA trial compared ultrasound-assisted thrombolysis (USAT) to anticoagulation alone and found an earlier reversal in RV:LV ratio in the USAT group, suggesting an earlier recovery with catheter-based therapy. However, the consequences of these findings on early changes in biomarker profile and functional outcomes have not been investigated.

The multicentre SUNSET sPE randomised controlled trial compared USAT to standard catheter-directed thrombolysis and found no differences in rates of thrombus resolution between the groups. As a secondary analysis of this study, biomarker data and functional outcomes of patients with sPE treated with catheter-directed therapies were compared to patients receiving anticoagulation alone.

Elizabeth Andraska, a fifth-year vascular surgery resident at the University of Pittsburgh, presented the results of this secondary analysis at AVF. They reported that baseline characteristics, biomarker, and RV:LV ratios were similar between the two groups. While three-month functional outcomes, as well as the quality of life metrics, were no different between groups, biomarkers CXCL10 and Pentraxin 3, which are associated with heart failure and adverse cardiac remodelling, returned to baseline more rapidly after catheter thrombolysis compared to anticoagulation only (p=0.04). According to Avgerinos, these results may suggest a role for biomarker analysis when evaluating response to therapy and long-term outcomes. “The group is excited to evaluate the implications of these findings on long-term outcomes,” he tells Venous News.

Looking ahead, Avgerinos remarks: “Biomarker profiling will ultimately help us better identify those acute PE patients who will progress to a long-term PE syndrome and implement early therapeutic strategies. Catheter thrombolytics seem to normalise faster heart failure biomarkers but it remains unknown if this correlates to a clinically meaningful long-term protection.”

This work was awarded as the top abstract of AVF 2022 and will also be presented in the forthcoming European Venous Forum meeting.


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