The echocardiographic ratio tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure predicts short-term adverse outcomes in acute pulmonary embolism

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  • Mads D Lyhne
  • Christopher Kabrhel, Center for Vascular Emergencies, Emergency Medicine, Massachusetts General Hospital, Boston, MA
  • ,
  • Nicholas Giordano, Center for Vascular Emergencies, Emergency Medicine, Massachusetts General Hospital, Boston, MA
  • ,
  • Asger Andersen
  • Jens Erik Nielsen-Kudsk
  • Hui Zheng, Biostatistics Center, Massachusetts General Hospital
  • ,
  • David M Dudzinski, Center for Vascular Emergencies, Emergency Medicine, Massachusetts General Hospital, Boston, MA

AIMS: Right ventricular (RV) failure causes death from acute pulmonary embolism (PE), due to a mismatch between RV systolic function and increased RV afterload. We hypothesized that an echocardiographic ratio of this mismatch [RV systolic function by tricuspid annular plane systolic excursion (TAPSE) divided by pulmonary arterial systolic pressure (PASP)] would predict adverse outcomes better than each measurement individually, and would be useful for risk stratification in intermediate-risk PE.

METHODS AND RESULTS: This was a retrospective analysis of a single academic centre Pulmonary Embolism Response Team registry from 2012 to 2019. All patients with confirmed PE and a formal transthoracic echocardiogram performed within 2 days were included. All echocardiograms were analysed by an observer blinded to the outcome. The primary endpoint was a 7-day composite outcome of death or haemodynamic deterioration. Secondary outcomes were 7- and 30-day all-cause mortality. A total of 627 patients were included; 135 met the primary composite outcome. In univariate analysis, the TAPSE/PASP was associated with our primary outcome [odds ratio = 0.028, 95% confidence interval (CI) 0.010-0.087; P < 0.0001], which was significantly better than either TAPSE or PASP alone (P = 0.017 and P < 0.0001, respectively). A TAPSE/PASP cut-off value of 0.4 was identified as the optimal value for predicting adverse outcome in PE. TAPSE/PASP predicted both 7- and 30-day all-cause mortality, while TAPSE and PASP did not.

CONCLUSION: A combined echocardiographic ratio of RV function to afterload is superior in prediction of adverse outcome in acute intermediate-risk PE. This ratio may improve risk stratification and identification of the patients that will suffer short-term deterioration after intermediate-risk PE.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal Cardiovascular Imaging
Vol/bind22
Nummer3
Sider (fra-til)285–294
Antal sider10
ISSN1525-2167
DOI
StatusUdgivet - mar. 2021

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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.

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