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Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism
Author(s) -
Lobo J. L.,
Holley A.,
Tapson V.,
Moores L.,
Oribe M.,
Barrón M.,
Otero R.,
Nauffal D.,
Valle R.,
Monreal M.,
Yusen R. D.,
Jiménez D.
Publication year - 2014
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12589
Subject(s) - medicine , cardiology , ventricle , hazard ratio , pulmonary artery , pulmonary embolism , confidence interval , diastole , pulmonary hypertension , heart failure , blood pressure
Summary Background 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. As compared with patients with a TAPSE of > 1.6 cm, those with a TAPSE of ≤ 1.6 cm had increased systolic pulmonary artery pressure (53.7 ± 16.7 mmHg vs. 40.0 ± 15.5 mmHg, P < 0.001), right ventricle ( RV ) end‐diastolic diameter (3.5 ± 0.8 cm vs. 3.0 ± 0.6 cm, P < 0.001), and RV to left ventricle end‐diastolic diameter ratio (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 at the time of PE diagnosis were significantly more likely to die from any cause (hazard ratio [ HR ] 2.3; 95% confidence interval [ CI ] 1.2–4.7; P = 0.02) and from PE ( HR 4.4; 95% CI 1.3–15.3; P = 0.02) during follow‐up. In an external validation cohort of 1326 patients with acute PE enrolled in the international multicenter Registro Informatizado de la Enfermedad TromboEmbólica, a TAPSE of ≤ 1.6 cm remained a significant predictor of all‐cause mortality ( HR 2.1; 95% CI 1.3–3.2; P = 0.001) and PE ‐specific mortality ( HR 2.5; 95% CI 1.2–5.2; P = 0.01). Conclusions In normotensive patients with PE , TAPSE reflects right ventricular function. For these patients, TAPSE is independently predictive of survival.