Cardiac output measurement in patients with pulmonary embolism: the decision for catheter-directed mechanical thrombectomy

Pulmonary embolism (PE) remains a major cause of cardiovascular mortality. In particular, intermediate–high-risk patients represent a distinct group requiring thorough initial assessment and continuous monitoring for potential escalation of therapy (thrombectomy, thrombolysis). The minimally invasive measurement of cardiac output using the Vigileo© device is a safe, cost-effective, and simple method for assessing disease severity.

At our center, between April 2023 and April 2025, we included 45 patients, of whom 28 (44.4%) underwent thrombectomy and 33 (55.6%) did not. The mean age was 63.6±15.8 years in the thrombectomy group and 66.5±17.7 years in the non-thrombectomy group, with women comprising 60% of each cohort.

Comorbidities and PE risk factors such as hypertension, dyslipidemia, chronic kidney disease, malignancy, and recent surgery were similarly distributed between groups, with no statistically significant differences observed (all p>0.05).

At presentation, the thrombectomy group showed more pronounced right ventricular dysfunction, with an RV/LV ratio of 1.17±0.12 compared to 0.99±0.17 in the conservatively managed group (p=0.0007). Hemodynamic and respiratory parameters on admission were as follows: SBP 122.1±24.6 mmHg vs. 123.1±25.4 mmHg, DBP 77.0±14.5 mmHg vs. 77.9±12.4 mmHg, HR 114.3±16.6 bpm vs. 98.4±23.2 bpm, respiratory rate 26.0±3.0 bpm vs. 32.8±21.4 bpm, SpO₂ 91.0±3.5% vs. 92.7±4.6%, and FiO₂ 26.2±9.2% vs. 25.5±18.0% (thrombectomy vs. conservative management, respectively).

Baseline cardiac index (CI) was lower in the thrombectomy group (2.52±0.62) compared to the control group (2.90±0.40, p=0.029). Moreover, improvement in CI over 48 hours (ΔCI) was significantly greater in the thrombectomy group (1.37±0.57 vs. 0.20±0.29, p<0.001).

In our intermediate–high-risk acute PE patients, minimally invasive cardiac output measurement proved valuable both for risk stratification and for post-intervention monitoring.For image description, please refer to the figure legend and surrounding text.