Prognostic value of the echocardiographic ratio tricuspid annular plane systolic excursion / pulmonary arterial systolic pressure in acute pulmonary embolism

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Published May 12, 2024
https://doi.org/10.62438/tunismed.v102i5.4860
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Vol. 102 No. 5 (2024): Tunis med may 2024

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Saoussen Antit
Department of Cardiology, Internal Security Forces Hospital of Marsa, Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia
Skander Iddir
Department of Pneumology, Internal Security Forces Hospital of Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Mariem Triki
Department of Pneumology, Internal Security Forces Hospital of Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ridha Fekih
Department of Cardiology, Internal Security Forces Hospital of Marsa, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
Khalil Bahri
Department of Cardiology, Internal Security Forces Hospital of Marsa, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
Sabrine Bousnina
Department of Cardiology, Internal Security Forces Hospital of Marsa, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
Elhem Boussabeh
Department of Cardiology, Internal Security Forces Hospital of Marsa, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
Lilia Zakhama
Department of Cardiology, Internal Security Forces Hospital of Marsa, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia

Abstract

Background: The occurrence of death from acute pulmonary embolism (PE) is often linked to right ventricular (RV) failure, arising from an imbalance between RV systolic function and heightened RV afterload. In our study, we posited that an echocardiographic ratio derived from this disparity [RV systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) divided by pulmonary arterial systolic pressure (PASP)] could offer superior predictive value for adverse outcomes compared to individual measurements of TAPSE and PASP alone.


Methods:  We conducted a retrospective analysis using data from a University Hospital Centre spanning from 2017 to 2023. All individuals with confirmed PE and a formal transthoracic echocardiogram within 7 days of diagnosis were included. The primary endpoint was a composite outcome of death, hemodynamic deterioration needing introduction of inotropes or thrombolysis within 30 days. Secondary endpoints included 6 months all-cause mortality and onset of right-sided heart failure.


Results: Thirty-eight patients were included. Mean age was 58 ±15 years old. A male predominance was noted: 23 male patients (60.5%) and 15 female patients (39.5%). Eight patients met the primary composite endpoint while nine patients met the secondary composite endpoint.


In multivariate analysis, the TAPSE/PASP ratio was independently associated with the primary outcome (OR=2.77, 95% CI 1.101–10.23, P=0.042). A TAPSE/PASP ratio <0.3 was independently associated with the secondary outcome (OR=3.07, 95% CI 1.185–10.18, P=0.034).


Conclusion: This study suggests that a combined echocardiographic ratio of RV function to afterload is effective in predicting adverse outcomes in acute PE.

Keywords:

acute pulmonary embolism , echocardiography, right ventricular afterload, right ventricular function, outcome

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