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Predictor identified for outcomes in patients with acute PE
Tricuspid annulus plane systolic excursion appears to be an independent predictor of pulmonary embolism-related death or thrombolysis in normotensive patients with acute pulmonary embolism.
Researchers found that tricuspid annulus plane systolic excursion, or TAPSE, was a better predictor of events in patients with acute pulmonary embolism (PE) than right ventricular/left ventricular (RV/LV) ratio, which is the most frequently used parameter for right ventricular dysfunction.
Piotr Pruszczyk, MD, PhD, of the Medical College of Warsaw, Poland, and colleagues found that patients with TAPSE ≤15 mm had an increased risk for 30-day mortality related to acute PE, whereas those with TAPSE >20 mm had a low risk.
The researchers studied the prognostic value of several echocardiographic parameters in 411 patients with acute PE (234 women; mean age, 64 years) who were hemodynamically stable at hospital admission. The researchers undertook the study because there is no standard echocardiographic definition of right ventricular dysfunction used for prognosis in acute PE, they wrote.
The clinical endpoint was a composite of 30-day acute PE-related mortality and/or rescue thrombolysis. The latter was defined as the need for cardiopulmonary resuscitation, systolic BP <90 mm Hg for at least 15 minutes with signs of end-organ hyperfusion, or the need for IV catecholamines in vasopressor doses.
The rate of the clinical endpoint was 5%, the rate of 30-day acute PE-related mortality was 3% and the rate of all-cause mortality was 5%, the researchers found.
The HR for the clinical endpoint of the RV/LV ratio was 7.3 (95% CI, 2-27.3). However, multivariable analysis revealed that TAPSE was the only independent predictor for the clinical endpoint (HR=0.64; 95% CI, 0.54-0.7).
In addition, the area under the curve (AUC) in receiver-operating characteristic analysis for TAPSE (0.91; 95% CI, 0.856-0.935) was significantly higher than that for RV/LV ratio (0.638; 95% CI, 0.589-0.686).
Patients with TAPSE ≤15 mm had an elevated risk for the clinical endpoint (HR=27.9; 95% CI, 6.2-124.6), and TAPSE ≤15 mm was associated with a positive predictive value of 20.9% and a negative predictive value of 99% for the clinical endpoint. TAPSE ≤20 mm was associated with a positive predictive value of 9.2% and a negative predictive value of 100% for the clinical endpoint, according to the results. In comparison, RV/LV ratio >0.9 had a positive predictive value of 13.2% and a negative predictive value of 97%, and RV/LV ratio >1 had a positive predictive value of 14.4% and a negative predictive value of 94.3%.
“TAPSE reflects global systolic RV function,” Pruszczyk and colleagues wrote. “TAPSE is a well-known, easy to measure and reproducible parameter that does not require sophisticated equipment or prolonged image analysis, with a proven prognostic value in congestive [HF].”
Disclosure: The researchers report no relevant financial disclosures.