title: Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy.
abstract: BACKGROUND
  Right ventricular failure remains a major cause of mortality during acute pulmonary embolism. Right ventricular function can be assessed with transesophageal echocardiography. However, due to the complex right ventricular anatomy, only a few echocardiographic parameters are reliable and easily obtainable intraoperatively. Tricuspid annular plane systolic excursion is a validated parameter of global right ventricular function.
  
  
  METHODS
  Data from 81 patients with acute pulmonary embolus undergoing pulmonary embolectomy were evaluated. Transesophageal echocardiography derived parameters of right ventricular function were obtained and compared to tricuspid annular plane systolic excursion measurements. Patients were then divided into two groups (TAPSE < 18 mm and ≥18 mm).
  
  
  RESULTS
  The patient population consisted of 46 males and 35 females, mean age 61.0 ± 12.9 years. Patients in the TAPSE <18 mm group had significantly larger diastolic (p=0.0015) and systolic (p=0.0031) right ventricular diameters, lower right ventricular fractional area change  (p=0.0065) and greater degrees of tricuspid regurgitation (p=0.0001) compared to patients with TAPSE ≥18 mm. In addition, all patients who needed intraoperative cardiopulmonary resuscitation (11/81) or died intraoperatively (8/81) belonged to the TAPSE <18 mm group. Logistic regression analysis confirmed TAPSE <18 mm as an independent risk factor for intraoperative cardiopulmonary resuscitation and death.
  
  
  CONCLUSIONS
  Transesophageal echocardiography derived TAPSE is easily obtainable and correlates well with other standardized parameters of right ventricular function. TAPSE <18 mm is an independent predictor of intraoperative cardiopulmonary resuscitation and death in patients undergoing emergent pulmonary embolectomy.
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Schmid
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
authors.forename: Jan N
authors.initials: JN
authors.lastname: Hilberath
authors.affiliation: Department of Medical Biometry, Eberhard Karls Universität Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Prem S
authors.initials: PS
authors.lastname: Shekar
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Kling
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberger
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Nowak-Machen
keywords: TAPSE; cardiopulmonary resuscitation; pulmonary embolism; right ventricle; transesophageal echocardiography