Tricuspid annulus plane systolic excursion (TAPSE) has superior predictive value compared to right ventricular to left ventricular ratio in normotensive patients with acute pulmonary embolism

Abstract

IntroductionRight ventricular dysfunction (RVD) is an indicator of poor prognosis in normotensive patients with acute pulmonary embolism (APE). The aim of this study was to compare right ventricular (RV)/left ventricular (LV) ratio measured by echocardiography and multidetector computed tomography (MDCT) with tricuspid annulus plane systolic excursion (TAPSE) as a prognostic factor of APE-related 30-day mortality.Material and methodsWe examined 76 patients with confirmed APE, hemodynamically stable at admission. We evaluated the prognostic value of RV/LV ratio in the apical 4-chamber view and TAPSE measured at echocardiography and the MDCT RV/LV ratio.ResultsThirty-day APE-related mortality was 10.5% (8 patients). The area under the curve (AUC) for TAPSE in the prediction of APE-related mortality was higher (p < 0.00001) (0.905, 95% CI: 0.828–0.983) than the AUC of the echo RV/LV ratio (0.427, 95% CI: 0.183–0.672) and MDCT RV/LV ratio (0.371, 95% CI: 0.145–0.598). In univariable Cox analysis, TAPSE was the only significant mortality predictor, with hazard ratio (HR) 0.73 (95% CI: 0.62–0.87, p = 0.0004). In multivariable Cox analysis TAPSE was the only significant mortality predictor, with HR 0.62 (95% CI: 0.46–0.85; p = 0.003), while age, heart rate, and RV/LV ratio in echo or MDCT were non-significant. TAPSE ≤ 15 mm was a significant predictor of APE-related mortality, with HR 26.2 (95% CI: 3.2–214.1; p = 0.002), PPV 44% and NPV 98%.ConclusionsThe TAPSE is preferable to echo and MDCT RV/LV ratio for risk stratification in initially normotensive patients with APE. The TAPSE ≤ 15 mm identifies patients with an increased risk of 30-day APE-related mortality.

Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography‐based study

“…In addition, they revealed the relationship between RV dysfunction and short-and long-term mortality. [21][22][23][24][25][26][27][28] These findings are associated with our results.…”

“…Great numbers of clinical studies using STE and conventional echocardiography demonstrated the RV dysfunction in patients with APE. In addition, they revealed the relationship between RV dysfunction and short‐ and long‐term mortality . These findings are associated with our results.…”

Tricuspid Regurgitation Peak Gradient (TRPG)/Tricuspid Annulus Plane Systolic Excursion (TAPSE) ― A Novel Parameter for Stepwise Echocardiographic Risk Stratification in Normotensive Patients With Acute Pulmonary Embolism ―

“…12 Our group has already reported that TAPSE is a useful parameter for risk stratification in normotensive APE patients, and TAPSE >20 mm can be used for identification of very low-risk patients. 8, 11 In the current study we tried to more precisely riskstratify normotensive APE patients using a stepwise echocardiographic approach. As the first step, we propose TAPSE assessment.…”

“…Predefined RV dysfunction criteria have been published previously. 8, 11 The TRPG/TAPSE parameter was also calculated.…”

Expanding our FoCUS: the utility of advanced echocardiography in the emergency department

“…Multiple studies have assessed the optimal management for patients with submassive PE, yet uncertainty remains. In a normotensive patient with sub‐massive PE confirmed on CTPA, the use of advanced echo to evaluate the Tricuspid Annular Plane Systolic Excursion (TAPSE) allows prognostication of clinical course and can influence the difficult decision regarding use of thrombolysis . In addition, a finding of clot‐in‐transit is associated with increased mortality, and endovascular techniques or thrombolysis should be carefully considered in a normotensive patient with this finding.…”