Prognostic Role of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure Ratio for the Identification of Early Clinical Deterioration in Intermediate-High–Risk Pulmonary Embolism Patients

• Published in: The American journal of cardiology 2024-03, Vol.214, p.40-46
• Main Authors: Zuin, Marco, Piazza, Gregory, Rigatelli, Gianluca, Bilato, Claudio, Bongarzoni, Amedeo, Henkin, Stanislav, Zonzin, Pietro, Casazza, Franco, Roncon, Loris
• Format: Article
• Language: English
• Subjects: Blood pressure; Cardiology; Clinical deterioration; Confidence intervals; Doppler effect; Echocardiography; Embolism; Embolisms; Hemodynamics; intermediate-high risk; Medical imaging; Mortality; Patients; Pressure ratio; pulmonary arterial pressure; Pulmonary arteries; Pulmonary artery; pulmonary embolism; Pulmonary embolisms; Regression analysis; Statistical analysis; TAPSE
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2023.12.053

The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate-high–risk patients with pulmonary embolism (PE). A post hoc analysis of intermediate-high–risk patients with PE enrolled in the Italian Pulmonary Embolism Registry (ClinicalTrials.gov: NCT01604538) was performed. All patients underwent transthoracic echocardiography at admission. The primary and secondary outcomes were clinical deterioration within 48 hours from admission and 30-day all-cause mortality, respectively. In 422 intermediate-high–risk patients with PE (mean age 71.2 ± 5.3 years, 238 men), 37 (8.7%) experienced clinical deterioration within 48 hours of admission. The 30-day mortality rate was 6.6% (n = 28). The receiver operating characteristic analysis established 0.33 as the optimal cut-off value for the TAPSE/PASP in predicting 48-hour clinical deterioration (area under the curve 0.79 ± 0.1). The sensitivity, specificity, positive predictive value, and negative predictive value were 81%, 88.5%, 40.5%, and 97.9%, respectively. The multivariate Cox regression analysis showed that a TAPSE/PASP ≤0.33 was an independent predictor of 48-hour clinical deterioration (hazard ratio 2.06, 95% confidence interval 1.98 to 2.11, p