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Patients with PE were randomized to a single oral dose of sildenafil 50\u00a0mg (n\u2009=\u200910) or placebo (n\u2009=\u200910) as add-on to conventional therapy. The time from hospital admission to study inclusion was 2.3\u2009\u00b1\u20090.7\u00a0days. Right ventricular function was evaluated immediately before and shortly after (0.5\u20131.5\u00a0h) randomization by right heart catheterization (RHC), trans-thoracic echocardiography (TTE), and cardiac magnetic resonance (CMR). The primary efficacy endpoint was cardiac index measured by CMR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients had acute intermediate-high risk PE verified by computed tomography pulmonary angiography, systolic blood pressure of 135\u2009\u00b1\u200918 (mean\u2009\u00b1\u2009SD) mmHg, increased right ventricular\/left ventricular ratio 1.1\u2009\u00b1\u20090.09 and increased troponin T 167\u2009\u00b1\u2009144\u00a0ng\/L. Sildenafil treatment did not improve cardiac index compared to baseline (0.02\u2009\u00b1\u20090.36\u00a0l\/min\/m2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.89) and neither did placebo (0.00\u2009\u00b1\u20090.34\u00a0l\/min\/m2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.97). Sildenafil lowered mean arterial blood pressure (\u2212\u200919\u2009\u00b1\u200910\u00a0mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) which was not observed in the placebo group (0\u2009\u00b1\u20099\u00a0mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.97).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A single oral dose of sildenafil 50\u00a0mg did not improve cardiac index but lowered systemic blood pressure in patients with acute intermediate-high risk PE. The time from PE to intervention, a small patient sample size and low pulmonary vascular resistance are limitations of this study that should be considered when interpreting the results.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial Registration<\/jats:italic>\n                      : The trial was retrospectively registered at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">www.clinicaltrials.gov<\/jats:ext-link>\n                      (NCT04283240) February 2nd 2020,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04283240?term=NCT04283240&amp;draw=2&amp;rank=1\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04283240?term=NCT04283240&amp;draw=2&amp;rank=1<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-021-01440-7","type":"journal-article","created":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T23:34:49Z","timestamp":1614468889000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Pulmonary vasodilation by sildenafil in acute intermediate-high risk pulmonary embolism: a randomized explorative trial"],"prefix":"10.1186","volume":"21","clinical-trial-number":[{"clinical-trial-number":"nct04283240","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9102-3130","authenticated-orcid":false,"given":"Asger","family":"Andersen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhad","family":"Waziri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob Gammelgaard","family":"Schultz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Holmboe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f8ren Warberg","family":"Becker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tage","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanne Maare","family":"S\u00f8ndergaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen Kaae","family":"Dodt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole","family":"May","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrik Markus","family":"Mortensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Won Yong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f8ren","family":"Mellemkj\u00e6r","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Erik","family":"Nielsen-Kudsk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,28]]},"reference":[{"issue":"4","key":"1440_CR1","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1161\/CIRCULATIONAHA.105.592592","volume":"113","author":"N Kucher","year":"2006","unstructured":"Kucher N, Rossi E, De Rosa M, Goldhaber SZ. 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All patients gave informed written consent before inclusion. The study was retrospectively registered February 2nd 2020 at\n                      \n                      (NCT04283240).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AA have received travel grants and lecturing fees from MSD, Medtronic, Abbot, Astra Zenica, Boehringer Ingelheim. JS has received lecturing fees from MSD. SB have received travel grants from Pfizer\/BMS and Boehringer Ingelheim. HMS have received travel grants and lecturing fees from Astra Zeneca. SM, WYK, OM, SH, KKD, FW, JENK, TJ, UMM report no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"72"}}