| Related Articles |
Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism.
J Thromb Haemost. 2014 Apr 26;
Authors: Lobo JL, Holley A, Tapson V, Moores L, Oribe M, Barrón M, Otero R, Nauffal D, Valle R, Monreal M, Yusen RD, Jiménez D, The PROTECT and the RIETE investigators
Abstract
BACKGROUND: The tricuspid annular plane systolic excursion (TAPSE) is an emerging prognostic indicator in patients with acute symptomatic pulmonary embolism (PE).
METHODS AND RESULTS: We prospectively examined 782 normotensive patients with PE who underwent echocardiography in a multicenter study. Compared with patients with a TAPSE greater than 1.6 cm, those with a TAPSE of 1.6 cm or less had higher systolic pulmonary artery pressure (53.7 + 16.7 mm Hg vs. 40.0 + 15.5 mm Hg, P < 0.001), right ventricle (RV) end-diastolic diameter (3.5 + 0.8 cm vs. 3.0 + 0.6 cm, P < 0.001), RV to left ventricle end-diastolic diameter (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 or less at the time of PE diagnosis were significantly more likely to die from any cause (hazard ratio [HR] 2.3; 95% CI, 1.2 to 4.7; P = 0.02) and from PE (HR 4.4; 95% CI, 1.3 to 15.3; P = 0.02) during follow-up. In an external validation cohort of 1,326 patients with acute PE enrolled in the international multicenter RIETE registry, a TAPSE of 1.6 cm or less remained a significant predictor of all-cause (HR 2.1; 95% CI, 1.3 to 3.2; P = 0.001) and PE-specific mortality (HR 2.5; 95% CI, 1.2 to 5.2; P = 0.01).
CONCLUSIONS: In normotensive patients with PE, TAPSE reflects RV function. For these patients, TAPSE is independently predictive of survival. This article is protected by copyright. All rights reserved.
PMID: 24766779 [PubMed - as supplied by publisher]