Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism. (19th June 2014)

• Record Type: Journal Article
• Authors: 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.; the PROTECT and the RIETE investigators
• Is Part Of: Journal of thrombosis and haemostasis. Volume 12:Number 7(2014:Jul.)
• Page Start: 1020
• Page End: 1027
• Publication Date: 2014-06-19
• Subjects: Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.12589
• Languages: English
• ISSNs: 1538-7933

Abstract

<abstract abstract-type="main" id="jth12589-abs-0001"> <title>Summary</title> <sec id="jth12589-sec-0001" sec-type="section"> <title>Background</title> <p>Tricuspid annular plane systolic excursion (TAPSE) is an emerging prognostic indicator in patients with acute symptomatic pulmonary embolism (PE).</p> </sec> <sec id="jth12589-sec-0002" sec-type="section"> <title>Methods and Results</title> <p>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, <italic>P</italic> < 0.001), right ventricle (RV) end‐diastolic diameter (3.5 ± 0.8 cm vs. 3.0 ± 0.6 cm, <italic>P </italic><<italic> </italic>0.001), and RV to left ventricle end‐diastolic diameter ratio (1.0 ± 0.3 vs. 0.8 ± 0.2, <italic>P </italic><<italic> </italic>0.001), and a higher prevalence of RV free wall hypokinesis (68% vs. 11%, <italic>P </italic><<italic> </italic>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; <italic>P </italic>=<italic> </italic>0.02) and from PE (HR 4.4; 95% CI 1.3–15.3; <italic>P </italic>=<italic> </italic>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; <italic>P </italic>=<italic> </italic>0.001) and PE‐specific mortality (HR 2.5; 95% CI 1.2–5.2; <italic>P </italic>=<italic> </italic>0.01).</p> </sec> <sec id="jth12589-sec-0003" sec-type="section"> <title>Conclusions</title> <p>In normotensive patients with PE, TAPSE reflects right ventricular function. For these patients, TAPSE is independently predictive of survival.</p> </sec> </abstract>