title: Emergency physician performed tricuspid annular plane systolic excursion in the evaluation of suspected pulmonary embolism.
abstract: OBJECTIVE
  The primary objectives were to describe the diagnostic characteristics tricuspid annular plane systolic excursion (TAPSE) for pulmonary embolism (PE) and to optimize the measurement cutoff of TAPSE for the diagnosis of PE. Secondary objectives included assessment of interrater reliability and the quantitative visual estimation of TAPSE.
  
  
  METHODS
  This is a prospective observational cohort study involving a convenience sample of patients at an urban academic emergency department. Patients underwent focused right heart echocardiogram (FOCUS) before computed tomographic angiography (CTA) for suspected PE.
  
  
  RESULTS
  A total of 150 patients were enrolled, 32 of whom (21.3%) were diagnosed as having a PE. A receiver operating characteristic curve analysis yielded 2.0 cm as the optimal cutoff for TAPSE in the diagnosis of PE, with a sensitivity of 72% (95% confidence interval [CI], 53-86), a specificity of 66% (95% CI, 57-75), and an area under the curve of 0.73 (95% CI, 0.65-0.83). In patients with tachycardia or hypotension, post hoc analysis demonstrated that FOCUS is 100% (95% CI, 80-100) sensitive for PE, whereas TAPSE is 94% (95% CI, 71-99) sensitive for PE. The intraclass correlation coefficient was 0.87 (95% CI, 0.79-0.93). Emergency physicians with training in echocardiography accurately visually estimated TAPSE, with a κ statistic of 0.94 (95% CI, 0.87-0.98).
  
  
  CONCLUSIONS
  Emergency physicians with training in echocardiography can reliably measure TAPSE and are able to accurately visually estimate TAPSE as either normal or abnormal. When using an abnormal cutoff of less than 2.0 cm, TAPSE has moderate diagnostic value in patients with suspected PE. On post hoc analysis, TAPSE and FOCUS appear to be highly sensitive for PE in patients with tachycardia or hypotension.
authors: Department of Emergency Medicine, Yale New Haven Hospital, New Haven, CT. Electronic address: james.i.daley@yale.edu.
authors: James
authors: J
authors: Daley
authors: Yale School of Medicine, New Haven, CT.
authors: John
authors: J
authors: Grotberg
authors: Department of Emergency Medicine, Yale New Haven Hospital, New Haven, CT.
authors: Joseph
authors: J
authors: Pare
authors: Department of Emergency Medicine, Yale New Haven Hospital, New Haven, CT.
authors: Amanda
authors: A
authors: Medoro
authors: Department of Emergency Medicine, Yale New Haven Hospital, New Haven, CT.
authors: Rachel
authors: R
authors: Liu
authors: Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA.
authors: Michael Kennedy
authors: MK
authors: Hall
authors: Department of Emergency Medicine, Yale New Haven Hospital, New Haven, CT.
authors: Andrew
authors: A
authors: Taylor
authors: Department of Emergency Medicine, Yale New Haven Hospital, New Haven, CT.
authors: Christopher L
authors: CL
authors: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D004452:Echocardiography; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010820:Physicians; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013599:Systole; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology; D055815:Young Adult