28th Great Wall International Congress of Cardiology (GW-ICC), 2017, News: Multidisciplinary PERT treatment of pulmonary embolism
28th GW-ICC, Beijing, China, October 2017 – an interview with Professor Nie Shaoping, Professor Victor F. Tapson and Professor Aaron S. Weinberg
Professor Nie Shaoping, Professor Victor F Tapson, Professor, Aaron s. Weinberg, Professor He Xiaonan
Professor He Xiaonan: we are honored to invite Professor Nie Shaoping, Professor Victor F Tapson, and Dr. Aaron S. Weinberg here today to explore the multidisciplinary treatment of pulmonary embolism: PERT. Massachusetts General Hospital is the first hospital in the world that established a multidisciplinary rapid response team for the diagnosis and treatment of pulmonary embolism, integrating research and education framework, which has become a milestone in the history of diagnosis and treatment of pulmonary embolism (PE). First of all, let’s welcome Professor Victor F Tapson to introduce the incidence and prognosis of pulmonary embolism for us.
Professor Victor F Tapson: The incidence of PE ranks the third among cardiovascular diseases, only behind coronary heart disease and hypertension among, which is the third leading cause of death in the United States, right after tumors and myocardial infarction. The mortality rate of untreated PE is 20%, and the mortality rate can be decreased to 2% to 8% after diagnosis and treatment. At present, there is no characteristic clinical manifestations of PE recognized worldwide. Many doctors and patients are not alert to PE, resulting in higher rate of missed diagnosis. Therefore, early diagnosis of PE is a great challenge for clinicians. The mortality rate remains high even in PE survivors. About 1% to 5% first-time PE patients will develop chronic thromboembolic pulmonary hypertension (CTEPH), a syndrome including chronic vascular blockage, pulmonary hypertension and continuously deteriorating right ventricular failure. PE seriously affects the quality of life in patients. About 1/2 to 1/3 patients will have limited activity one year after onset. Post PE syndrome refers to the presence of persistent symptoms or decreased cardiorespiratory function in patients with no apparent pulmonary hypertension.
Professor He Xiaonan: Professor Tapson, as chairman of the International PERT consortium, would you please introduce to us the concept and development process of the pulmonary embolism response team?
Professor Victor F Tapson: PERT is the abbreviation of Pulmonary Embolism Response Team. In 2012, doctors of the Massachusetts General Hospital concepted and established a multidisciplinary team for the treatment of acute pulmonary embolism, providing rapid and individualized special diagnosis and treatment (including intervention) for patients suffering complicated acute pulmonary embolism. American scholar Kenneth Rosenfield initiated the consortium of pulmonary embolism treatment team in 2015 to guide the construction and development of PERT team and improve the level of diagnosis and treatment of severe pulmonary embolism. At present, more than 50 medical centers in the United States, and medical centers in Europe, Africa and other countries have joined the consortium, and its influence is growing. At the same time, new technology and clinical research of PE is also constantly being introduced globally.
Professor He Xiaonan: clinical guidelines support systemic thrombus therapy for acute massive pulmonary embolism (PE). When anticoagulation or thrombolytic therapy fails or is contraindicated, how do you choose the best treatment based on your years of clinical experience and scientific research?
Doctor Aaron S. Weinberg: When anticoagulation or thrombolysis fails or is contraindicated in PE patients, percutaneous transcatheter thrombolytic drug (rt-PA) therapy or surgical techniques could be considered. More patients need individualized multidisciplinary treatment. Personally, I think treatment options need to be chosen based on a large number of clinical studies combined with literature reports. We should use different methods for risk stratification in patients with PE, for example using biomarkers, such as TnI or BNP. The use of FlowTriever device for acute large area pulmonary embolism thrombus aspiration could be used in some patients, which can quickly and effectively improve the patient's heart function.
Professor He Xiaonan: Professor Nie Shaoping, as the chairman of China PERT consortium, would you please tell us about the establishment and future planning of China PERT consortium?
Professor Nie Shaoping: Today is the fourth world thrombosis day. It is a great honor to have the world's top experts join us in discussing the topic of multidisciplinary treatment of pulmonary embolism. The concept of PERT is still unfamiliar to many Chinese doctors. PERT calls for rapid response, early diagnosis, and individualized treatment. After establishment of the organization, a series of work has been carried out, including clinical and basic research work. Chinese experts also had the honor to participate the annual meeting of international PERT held in Boston, USA this year, and An Zhen Hospital has been included as a member of the International consortium of pulmonary embolism response team.
On July 5, 2017, under the guidance of President of the International PERT Consortium, Professor Victor F Tapson and Dr. Aaron S. Weinberg, the first Asian “quick reaction force” focusing on multidisciplinary treatment of pulmonary embolism was established in An Zhen Hospital, Beijing. Nearly 20 officers and backbone experts from center of emergency critical care, department of respiratory and critical care, department of cardiac surgery, department of vascular, department of interventional, Department of Hematology, cardiac critical care center, department of ultrasound, and other clinical departments, gathered together to discuss the treatment of pulmonary embolism, declaring the establishment of Anzhen PERT, aiming to improve the comprehensive treatment level of pulmonary embolism in our hospital by establishing an interdisciplinary collaboration group to achieve rapid response, joint decision-making and optimized treatment. Through the joint efforts of many disciplines, we have successfully treated several cases of acute pulmonary embolism, and the effect is very significant. This shows that China has entered a new era for the treatment of pulmonary embolism. Pulmonary embolism used to be treated by a single department, such as critical care medicine or department of respiration, which has now adopted a team treatment model. Patients can receive catheter directed thrombolysis, surgical thrombectomy or adjuvant ECMO treatment as soon as possible.
Pulmonary embolism is one of the three most fatal cardiovascular diseases, and it is also one of the “ten heart and lung diseases to be solved in twenty-first Century”. Autopsy studies in the United States have shown that about 60% of all hospitalized deaths with unknown causes suffered pulmonary embolism. Studies have shown that one of every 6 syncope patients suffer pulmonary embolism. We expect more Chinese doctors to pay attention to the treatment of pulmonary embolism.
Professor He Xiaonan: epidemiological studies of the national pulmonary embolism plan of China showed that China has a large number of patients suffering pulmonary embolism, which requires Chinese doctors to provide treatment for patients suffering complicated acute pulmonary embolism. Do you have any good suggestions for the diagnosis and treatment of pulmonary embolism in China?
Professor Victor F Tapson: the international PERT consortium is also at development stage. We will continue to actively improve and perfect. We have established a number of branches, including research associations, training associations, cooperative agreements, and many American hospitals have joined the work of the international PERT consortium for the treatment of pulmonary embolism. The Chinese doctor team is one of the most important members of the international PERT consortium. We will carry out scientific research and training work with the China PERT consortium led by Professor Nie Shaoping. International cooperation between China and the United States will focus on multi center, multidisciplinary cooperation, aiming to tackle pulmonary embolism!
Kenneth Rosenfield, MD
Kenneth Rosenfield, MD, Professor, FSCAI, FACC, Former Chairman of the American Consortium of Pulmonary Embolism Response Team (PERT), former Chairman of the American Society of Cardiovascular Angiography and Intervention (SCAI), Director of Department of Vascular Medicine and Intervention, Massachusetts General Hospital, Chairman of the STEMI Quality Improvement Committee.
Victor F. Tapson, MD
Victor F. Tapson, MD, Professor, Chairman of the American Consortium of Pulmonary Embolism Response Team (PERT), Director of the Women's Association for Lung Disease Clinical Research, Director of the Venous Thrombosis and Pulmonary Vascular Disease Research Project, Deputy director of pulmonary vascular and severe disease, Cedars-Sinai Medical Center.
Dr. Nie Shaoping, Professor, Chief Physician, MD, PhD supervisor, first batch instructor of coronary heart disease intervention training in Cardiovascular Disease Intervention Training Base of the Ministry of Health, International Director of American Society of Cardiovascular Angiography and Intervention (SCAI), International Member (FESC) of European Society of Cardiology (ESC). Current director of the Beijing Anzhen Hospital Emergency Center.