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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

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: 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.

Material and 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.

No MeSH data available.


Kaplan-Meier survival analysis according to TAPSE in 76 initially normotensive patients with APE
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Figure 0003: Kaplan-Meier survival analysis according to TAPSE in 76 initially normotensive patients with APE

Mentions: In order to determine prognostic value, we defined two cut-off values of TAPSE. The TAPSE ≤ 15 mm (21% of subjects) showed a PPV of 43.75% for APE-related mortality with NPV 98.3%. The TAPSE ≥ 18 mm had a PPV of 25.8% with a 100% NPV. All patients with TAPSE ≥ 18 were in the low-risk group with good prognosis. In initially normotensive patients, TAPSE ≤ 15 mm was associated with a 43.75% risk of APE-related death. Figure 2 shows individual TAPSE values in APE patients according to clinical course, whereas Figure 3 presents the survival analysis according to TAPSE.


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
Kaplan-Meier survival analysis according to TAPSE in 76 initially normotensive patients with APE
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016574&req=5

Figure 0003: Kaplan-Meier survival analysis according to TAPSE in 76 initially normotensive patients with APE
Mentions: In order to determine prognostic value, we defined two cut-off values of TAPSE. The TAPSE ≤ 15 mm (21% of subjects) showed a PPV of 43.75% for APE-related mortality with NPV 98.3%. The TAPSE ≥ 18 mm had a PPV of 25.8% with a 100% NPV. All patients with TAPSE ≥ 18 were in the low-risk group with good prognosis. In initially normotensive patients, TAPSE ≤ 15 mm was associated with a 43.75% risk of APE-related death. Figure 2 shows individual TAPSE values in APE patients according to clinical course, whereas Figure 3 presents the survival analysis according to TAPSE.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: 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.

Material and 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.

No MeSH data available.