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 ―

Abstract

which is estimated at more than 15%. 4,5 Fortunately most APE patients are hemodynamically stable at admission but the early mortality risk is different in this population. Risk stratification of non-high-risk APE patients is based on clinical presentation, cardiac laboratory biomarkers, and signs of right ventricular (RV) dysfunction on echocardiography or computed tomography. 4,6 Low-risk patients require a short hospital stay and can be early discharged home or even treated as outpatients. 7 Intermediate-risk subjects comprise a very heterogeneous group in which the early mortality ranges between 2% and 15%. 4 More of A cute pulmonary embolism (APE) is the most serious clinical presentation of venous thromboembolism (VTE). According to registries and hospital discharge databases of unselected patients with APE and VTE, 30-day all-cause mortality rates are between 9% and 10%. 1-3 According to the recent European Society of Cardiology (ESC) guidelines on the diagnosis and treatment of APE patients, clinical classification of the severity of an episode of APE is based on the estimated 30-day APErelated mortality risk. 4 Patients with cardiogenic shock caused by APE comprise a high-risk group for early death, Background: Patients with intermediate-risk acute pulmonary embolism (APE) are a heterogeneous group with an early mortality rate of 2-15%. The tricuspid annulus plane systolic excursion (TAPSE) and tricuspid regurgitation peak gradient (TRPG) can be used for risk stratification, so we analyzed the prognostic value of a new echo parameter (TRPG/TAPSE) for prediction of APE-related 30-day death or need for rescue thrombolysis in initially normotensive APE patients.

Right Ventricular Early Inflow‐Outflow Index—A new method for echocardiographic evaluation of right ventricle dysfunction in acute pulmonary embolism

“…RV variables evaluated by echo include RV size, RV/LV basal diameter ratio, RV eccentricity index/interventricular septal shift, RV fractional area of change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), RV Tei index, Doppler tissue imaging(DTI)‐derived tricuspid lateral annular systolic velocity(S’), isovolumetric acceleration (IVA), right ventricular E/e’, RV global longitudinal strain (GLS) . Recently, tricuspid regurgitation peak gradient(TRPG)/TAPSE ratio has been described as a possible, more accurate marker of RV function . More recently, the addition of 3DRVEF has also improved the quantitative examination of the RV …”

“…Lobo et al reported that TAPSE was an independent predictor of survival in patients with APE . RV Tei index clues about both systolic and diastolic RV function . In a study, it has been shown that the RV Tei index might be handled for both the diagnosis of RV dysfunction and mortality .…”

“…16 The evaluation of the RV function has changed over time, and many advancements have 17 Recently, tricuspid regurgitation peak gradient(TRPG)/TAPSE ratio has been described as a possible, more accurate marker of RV function. 18 More recently, the addition of 3DRVEF has also improved the quantitative examination of the RV. 19 Many studies have shown that the changes in these above-mentioned parameters used to evaluate RV functions are also associated with mortality in APE.…”

“…25 S' is one of the most trustable and reproducible values to examine RV systolic function, and it correlates positively with RV ejection fraction (RVEF) as estimated by cardiac magnetic resonance. 18,26 There is a study demonstrating that the value of S' is associated with mortality. 26 FAC is a reflection of RV systolic function, and there has been a strong correlation with RV EF by magnetic resonance imaging.…”

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

“…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.…”