Diuretic Vascular Filling in the Initial Management of Acute PE With Right Ventricular Dysfunction Normotensive
Diuretic Vascular Filling in the Initial Management of Acute PE With Right Ventricular Dysfunction Normotensive
Pulmonary embolism (PE) is a serious disease with frequent intra hospital mortality remains
 high. If anticoagulation is perfectly codified, the remainder of the initial management has
 been less studied.

 In particular, the "conditioning" Initial often involves systematic plasma volume of 250 to
 500 cc, by analogy to other situations. But this treatment option is not based on factual
 data. In the right ventricular dysfunction that often accompany severe EP, volume expansion
 may instead be harmful, according to the law of Frank Starling. A retrospective study has
 recently shown a benefit of diuretic therapy in patients hospitalized for severe normotensive
 EP.

 The proposed study is interventional, prospective, multicenter, randomized, require to
 include 60 patients.

 The main objective of the study is the comparison of the troponin normalization period Ic
 (biomarker of right ventricular dysfunction) in patients hospitalized in the initial phase of
 a serious normotensive EP, between the 2 groups diuretic and filling Vascular.

 The primary endpoint is the time in hours standardization of troponin Ic.

 The secondary endpoints will be:

 -  the period of normalization of Brain Natriuretic Peptide (BNP)

 -  changes in echocardiographic parameters of right ventricular dysfunction

 -  a composite endpoint: cardiovascular death / cardiogenic shock / use of amines / use of
 thrombolysis.
Main objective:

 Compared with the time of normalization of cTnI (biomarker of right ventricular dysfunction)
 in hospitalized patients in the initial phase of a serious EP normotensive between the 2
 groups diuretic and vascular filling

 PRINCIPAL INCLUSION CRITERIA

 -  older than 18 Patient

 -  Hospitalized in the first 24 hours of a serious EP normotensive formally diagnosed (by a
 chest CT)

 The serious nature without hypotension is defined by the presence of:

 -  From biological criteria: troponin and / or BNP positive AND

 -  In sonographic criteria: dilated right ventricle defined by echocardiography right over
 left ventricle ratio (VG)> 0.9 in apical 4- chamber or 0.7 in large parasternal axis and
 right ventricular systolic dysfunction (TAPSE <16 mm and S 'pulsed TDI tricuspid <10 cm
 / sec) or pulmonary arterial hypertension (PAH) Pulmonary Arterial Pressure with
 systolic (PAPs)> 35 mmHg or paradoxical septum

 -  Informed consent signed

 -  Affiliation to social security

 PRINCIPAL EXCLUSION CRITERIA

 -  Thrombolysis before inclusion

 -  State of cardiogenic shock defined as systolic BP <90 mmHg or a drop of> 40 mmHg in
 systolic BP for> 15 minutes

 -  severe chronic renal impairment defined by clearance <30 ml / min.

 -  pregnant or nursing woman (a pregnancy test will be performed for XML File Identifier:
 cthC5Fc14NkHBXHkFCiTvGcJ8a8= Page 15/26 women of childbearing age and the results will
 be communicated to the patient by a doctor of his choice)

 -  Most People under guardianship

 -  hospitalized without their consent and not protected by law No

 -  Private person of liberty

 -  Residence time of more than 24 hours in another department after the positive diagnosis
 of pulmonary embolism
Inclusion Criteria:

 -  Hospitalized in the first 24 hours of a serious EP normotensive formally diagnosed (by
 a chest CT)

 The serious nature without hypotension is defined by the presence of:

 -  From biological criteria: troponin and / or BNP positive AND

 -  In sonographic criteria: dilated right ventricle defined by echocardiography right
 over left ventricle ratio (VG)> 0.9 in apical 4- chamber or 0.7 in large parasternal
 axis and right ventricular systolic dysfunction (TAPSE <16 mm and S 'pulsed TDI
 tricuspid <10 cm / sec) or pulmonary arterial hypertension (PAH) Pulmonary Arterial
 Pressure with systolic (PAPs)> 35 mmHg or paradoxical septum

 -  Informed consent signed

 -  Affiliation to social security

 Exclusion Criteria:

 -  Thrombolysis before inclusion

 -  State of cardiogenic shock defined as systolic BP <90 mmHg or a drop of> 40 mmHg in
 systolic BP for> 15 minutes

 -  severe chronic renal impairment defined by clearance <30 ml / min.

 -  pregnant or nursing woman (a pregnancy test will be performed for XML File Identifier:
 cthC5Fc14NkHBXHkFCiTvGcJ8a8=

 -  women of childbearing age and the results will be communicated to the patient by a
 doctor of his choice)

 -  Most People under guardianship

 -  hospitalized without their consent and not protected by law No

 -  Private person of liberty

 -  Residence time of more than 24 hours in another