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.
BACKGROUND
Right 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.


METHODS
We 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.


RESULTS
Thirty-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%.


CONCLUSIONS
The 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.
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Marzanna
M
Paczyńska
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Piotr
P
Sobieraj
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Łukasz
Ł
Burzyński
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Maciej
M
Kostrubiec
Department of Radiology, Medical University of Warsaw, Warsaw, Poland.
Małgorzata
M
Wiśniewska
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Piotr
P
Bienias
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Katarzyna
K
Kurnicka
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Barbara
B
Lichodziejewska
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Piotr
P
Pruszczyk
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Michał
M
Ciurzyński
acute pulmonary embolism; computed tomography; echocardiography; mortality risk; tricuspid annulus plane systolic excursion
N Engl J Med. 2008 Dec 25;359(26):2804-13
19109575
Eur Heart J. 2008 Sep;29(18):2276-315
18757870
Thromb Res. 2014 Feb;133(2):182-6
24321418
Circulation. 2004 May 25;109 (20):2401-4
15148278
Circulation. 2004 Nov 16;110(20):3276-80
15533868
J Am Soc Echocardiogr. 2010 Jul;23 (7):685-713; quiz 786-8
20620859
Arch Intern Med. 2004 Aug 9-23;164(15):1685-9
15302640
Radiology. 2005 Jun;235(3):798-803
15845793
Arch Med Sci. 2012 Dec 20;8(6):957-69
23319967
Eur Respir J. 2014 Jun;43(6):1678-90
24603813
Chest. 2012 Dec;142(6):1417-24
22628491
Circulation. 2007 Jul 24;116(4):427-33
17606843
Arch Intern Med. 2005 Aug 8-22;165(15):1777-81
16087827
BMJ. 2005 Jul 30;331(7511):259
16052017
JACC Cardiovasc Imaging. 2014 Jun;7(6):553-60
24412192
Circulation. 2011 Apr 26;123(16):1788-830
21422387
Biometrics. 1988 Sep;44(3):837-45
3203132
Eur Heart J. 2008 Jun;29(12):1569-77
18495689
Circulation. 2000 Jun 20;101(24):2817-22
10859287
Eur Heart J. 2011 Jul;32(13):1657-63
21504936
Chest. 2008 Feb;133(2):358-62
17951624
Radiology. 2007 Mar;242(3):889-97
17325073
J Am Soc Echocardiogr. 2004 Nov;17 (11):1210-2
15502801
Chest. 2004 Apr;125(4):1539-45
15078772