Subcostal echocardiographic assessment of tricuspid annular kick (SEATAK): A novel independent predictor of 30-day mortality in patients with acute pulmonary embolism

Abstract

Background:The most commonly used parameter of right ventricular (RV) systolic function -tricuspid annular plane systolic excursion (TAPSE) -is unavailable for some patients. Subcostal echocardiographic assessment of tricuspid annular kick (SEATAK) has been proposed as its alternative. Aim:The study aimed to assess the feasibility of SEATAK use in patients with acute pulmonary embolism (PE) and its value in prognosis after PE. Methods:The observational study included 164 consecutive patients (45.7% men; average age, 70 years) with a high clinical probability of PE referred for computed tomography pulmonary angiography.Results: SEATAK was unavailable due to inadequate quality of echocardiogram in 2.8% of patients, whereas TAPSE could not be calculated in 4.9%, both parameters were not estimated only in 0.6%. SEATAK and TAPSE values did not differ between groups of patients with PE (n = 82) and without (n = 82). In the whole study, SEATAK correlated positively with TAPSE (r = 0.71; 95% confidence interval [CI], 0.62-0.78; P <0.001), fractional area change of the RV, left ventricular ejection fraction, and peak systolic tricuspid annular velocity assessed with tissue Doppler imaging. There were only 3 echocardiographic predictors of 30-day all-cause mortality in patients with with PE (n = 10): SEATAK, pulmonary acceleration time, and the 60/60 sign. SEATAK predicted 30-day all-cause mortality with AUC (area under the curve) 0.726 (95% CI, 0.594-0.858; P = 0.01) and 30-day PE-related mortality (n = 4) with AUC, 0.772 (95% CI, 0.506-0.998; P = 0.03).Conclusions: SEATAK is a promising practicable echocardiographic parameter reflecting RV systolic function and might be an accurate alternative to TAPSE. Moreover, SEATAK could be an independent predictor of all-cause and PE-related 30-day mortality in patients with acute PE.

Echocardiographic parameters as adjuncts to the Pulmonary Embolism Severity Index in predicting 30-day mortality in acute pulmonary embolism patients

“…In our study AUC of TTE parameters with prognostic value (TAPSE, RVFWLS, RVGLS and AcT) only in case of AcT AUC exceeded 0.7 and showed only acceptable discrimination. Similar conclusions come from previous studies which included these echocardiographic markers [14,16,[24][25][26].…”

“…The study group included consecutive patients of the Internal Medicine Department and the Special Care Cardiac Unit with acute PE confirmed in computed tomography pulmonary angiography between August 1, 2018 and April 30 2021. The treatment regimen followed the guidelines on PE management of European Society of Cardiology and was described thoroughly previously [1,10,14].…”

“…A standard diagnostic protocol comprised determination in all patients on the day of admission to the ward the laboratory parameters including serum concentrations of troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP) and D-dimer with laboratory methods summarized formerly [14]. TTE was performed within 24 hours after admission to the ward by an experienced sonographer cardiologist (JW) using echocardiographic systems of Vivid S60N or Vivid S6 (General Electric Company, Boston, MA, US) according to the unified protocol [14][15][16]. The measurements were made based on the current guidelines of European Association of Cardiovascular Imaging with real-time electrocardiographic recording executed in order to accurately define the heart cycle phases [17].…”

“…The study endpoint was 30-day overall mortality. Data collection during the follow-up of the study was described in detail in the earlier publication [14].…”

Role of catheter-directed therapies in the treatment of acute pulmonary embolism. Expert opinion of the Polish PERT Initiative, Working Group on Pulmonary Circulation, Association of Cardiovascular Interventions, and Association of Intensive Cardiac Care of the Polish Cardiac Society

“…Indicators of RV dysfunction whose prognostic significance for acute PE was confirmed in numerous studies and which are simple to measure on TTE are as follows: an increased RV/LV ratio greater than 1 (measurement in the apical 4-chamber view) and decreased tricuspid annular plane systolic excursion (TAPSE) of 16 mm or less [5,23,24]. The prognostic role of other echocardiographic parameters is currently being investigated [25,26].…”