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Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy.

Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, Rosenberger P, Nowak-Machen M - Heart Lung Vessel (2015)

Bottom Line: 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.Logistic regression analysis confirmed TAPSE <18 mm as an independent risk factor for intraoperative cardiopulmonary resuscitation and death.TAPSE <18 mm is an independent predictor of intraoperative cardiopulmonary resuscitation and death in patients undergoing emergent pulmonary embolectomy.

View Article: PubMed Central - PubMed

Affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.

ABSTRACT

Introduction: 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.

No MeSH data available.


Related in: MedlinePlus

Logistic regression analysis  predicting death and CPR from TAPSE measurements (n=81 patients).R2 (Nagelkerke), †adjusted for age, sex, BMI, and CPB time.CPR = cardio-pulmonary resuscitation; TAPSE = Tricuspid Annular Plane Systolic Excursion, OR = odds ratio; CI = confidence interval; CPB = cardiopulmonary bypass.
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Figure 003: Logistic regression analysis  predicting death and CPR from TAPSE measurements (n=81 patients).R2 (Nagelkerke), †adjusted for age, sex, BMI, and CPB time.CPR = cardio-pulmonary resuscitation; TAPSE = Tricuspid Annular Plane Systolic Excursion, OR = odds ratio; CI = confidence interval; CPB = cardiopulmonary bypass.


Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy.

Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, Rosenberger P, Nowak-Machen M - Heart Lung Vessel (2015)

Logistic regression analysis  predicting death and CPR from TAPSE measurements (n=81 patients).R2 (Nagelkerke), †adjusted for age, sex, BMI, and CPB time.CPR = cardio-pulmonary resuscitation; TAPSE = Tricuspid Annular Plane Systolic Excursion, OR = odds ratio; CI = confidence interval; CPB = cardiopulmonary bypass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476769&req=5

Figure 003: Logistic regression analysis  predicting death and CPR from TAPSE measurements (n=81 patients).R2 (Nagelkerke), †adjusted for age, sex, BMI, and CPB time.CPR = cardio-pulmonary resuscitation; TAPSE = Tricuspid Annular Plane Systolic Excursion, OR = odds ratio; CI = confidence interval; CPB = cardiopulmonary bypass.
Bottom Line: 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.Logistic regression analysis confirmed TAPSE <18 mm as an independent risk factor for intraoperative cardiopulmonary resuscitation and death.TAPSE <18 mm is an independent predictor of intraoperative cardiopulmonary resuscitation and death in patients undergoing emergent pulmonary embolectomy.

View Article: PubMed Central - PubMed

Affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.

ABSTRACT

Introduction: 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.

No MeSH data available.


Related in: MedlinePlus