Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism

Abstract

for the PROTECT and the RIETE investigators. Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism. J Thromb Haemost 2014; 12: 1020-7.Summary. Background: Tricuspid annular plane systolic excursion (TAPSE) is an emerging prognostic indicator in patients with acute symptomatic pulmonary embolism (PE). Methods and Results: We prospectively examined 782 normotensive patients with PE who underwent echocardiography in a multicenter study. As compared with patients with a TAPSE of > 1.6 cm, those with a TAPSE of ≤ 1.6 cm had increased systolic pulmonary artery pressure (53.7 AE 16.7 mmHg vs. 40.0 AE 15.5 mmHg, P < 0.001), right ventricle (RV) end-diastolic diameter (3.5 AE 0.8 cm vs. 3.0 AE 0.6 cm, P < 0.001), and RV to left ventricle end-diastolic diameter ratio (1.0 AE 0.3 vs. 0.8 AE 0.2, P < 0.001), and a higher prevalence of RV free wall hypokinesis (68% vs. 11%, P < 0.001). Patients with a TAPSE of ≤ 1.6 cm at the time of PE diagnosis were significantly more likely to die from any cause (hazard ratio [HR] 2.3; 95% confidence interval [CI] 1.2-4.7; P = 0.02) and from PE (HR 4.4; 95% CI 1.3-15.3; P = 0.02) during follow-up. In an external validation cohort of 1326 patients with acute PE enrolled in the international multicenter Registro Informatizado de la Enfermedad TromboEmb olica, a TAPSE of ≤ 1.6 cm remained a significant predictor of all-cause mortality (HR 2.1; 95% CI 1.3-3.2; P = 0.001) and PE-specific mortality (HR 2.5; 95% CI 1.2-5.2; P = 0.01). Conclusions: In normotensive patients with PE, TAPSE reflects right ventricular function. For these patients, TAPSE is independently predictive of survival.

Interobserver reliability of echocardiography for prognostication of normotensive patients with pulmonary embolism

“…Moreover, RV dimensions are highly dependent on probe rotation by the user, which can result in an underestimation of RV width [20]. For normotensive patients with acute symptomatic PE, TAPSE is independently predictive of survival [21]; however no studies had previously assessed interobserver reliability for this parameter in these patients. In the initial validation study by Kaul et al [22], TAPSE correlated strongly with radionuclide angiography, with low interobserver variability.…”

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

“…41 TAPSE is a technique for assessing RV function that is well described in the cardiology literature, but to our knowledge only described once in the EP literature. [42][43][44][45] In our experience it is easily measured when an adequate A4C view is present and has been described as reproducible and perhaps better than RV size as a predictor of PE severity. 41,43,45 Right ventricle systolic pressure may be estimated quantitatively when tricuspid regurgitation is present.…”

“…[42][43][44][45] In our experience it is easily measured when an adequate A4C view is present and has been described as reproducible and perhaps better than RV size as a predictor of PE severity. 41,43,45 Right ventricle systolic pressure may be estimated quantitatively when tricuspid regurgitation is present. The peak velocity of the tricuspid regurgitant jet should be measured using continuous wave spectral Doppler with the Doppler signal in line with the jet (typically in an A4C view).…”

Tricuspid annular plane of systolic excursion to prognosticate acute pulmonary symptomatic embolism (TAPSEPAPSE study)

“…The tricuspid annular plane systolic excursion (TAPSE) has been studied as a surrogate measure for the assessment of RV function. This technique consists of using M‐mode echocardiography, which can be used to measure the movement of the tricuspid annulus of the right ventricle between the end of systole and end of diastole . Previous studies done on healthy individuals without an acute PE estimate the normal TAPSE value to be between 2.4 cm and 2.6 cm .…”