Abstract 15621: Improved Risk Stratification of Pulmonary Embolism With Combining the Simplified Pulmonary Embolism Severity Index With Echocardiography-Derived Tricuspid Annular Planar Systolic Excursion

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A15621-A15621
• Main Authors: Ghahramani, Mehrdad, domaradzki, lisa, Ruzieh, Mohammed, Wilson, Ryan, Peterson, Brandon
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.15621

IntroductionA variety of approaches have been investigated for predicting major adverse events with pulmonary embolism (PE). The purpose of this study was to determine whether combining TAPSE (Tricuspid Annular Planar Systolic Excursion) measurement with the Simplified Pulmonary Embolism Severity Index (sPESI) clinical risk predictor tool could improve risk stratification for major adverse events following PE.MethodsWe reviewed hospital records from January 1 2010 through March 31 2018 to identify normotensive adult patients with PE who had echocardiography performed within 48 hours of PE diagnosis. Major adverse events were defined as in-hospital mortality, thrombolysis, or pulmonary embolectomy. A TAPSE measurement > 15 mm and sPESI = 0 were considered low risk. Fisher exact testing was used to determine relative risk for major adverse events.ResultsAmong 258 patients identified with PE, 51 (19.8%) experienced a major adverse event. When defining low risk patients as sPESI=0 and TAPSE > 15 mm, the negative predictive value (NPV) for major adverse events was 97.4%, compared with use of only sPESI=0 (84.6%) or TAPSE > 15 mm (89.6%) to define low risk (see table for relative risk of adverse events).ConclusionsCombining sPESI, a clinical risk factor tool, with TAPSE measurement provides improved risk stratification of major adverse outcomes following PE, including identifying patients at low risk for major adverse events. With use of focused cardiac ultrasound, integrating TAPSE into the early clinical assessment of PE patients may improve risk stratification and clinical decision making in patients with PE.