Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism.
BACKGROUND
Tricuspid annular plane systolic excursion (TAPSE) is an emerging prognostic indicator in patients with acute symptomatic pulmonary embolism (PE).


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 ± 16.7 mmHg vs. 40.0 ± 15.5 mmHg, P < 0.001), right ventricle (RV) end-diastolic diameter (3.5 ± 0.8 cm vs. 3.0 ± 0.6 cm, P < 0.001), and RV to left ventricle end-diastolic diameter ratio (1.0 ± 0.3 vs. 0.8 ± 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 TromboEmbólica, 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.
Respiratory Department, Txagorritxu Hospital, Vitoria, Spain.
J L
JL
Lobo
A
A
Holley
V
V
Tapson
L
L
Moores
M
M
Oribe
M
M
Barrón
R
R
Otero
D
D
Nauffal
R
R
Valle
M
M
Monreal
R D
RD
Yusen
D
D
Jiménez
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality; D015203:Reproducibility of Results; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology; D016278:Ventricular Function, Right
echocardiography; prognosis; pulmonary embolism; right ventricular dysfunction; survival