Novel quantitative echocardiographic parameters in acute PE

Abstract

The tricuspid annular plane systolic excursion (TAPSE) and the right ventricular performance index (RVPI) are quantitative measurements that are valid predictors of clinical outcomes in CHF, MI, PAH, and chronic pulmonary disease. We sought to measure TAPSE and RVPI in patients diagnosed with acute pulmonary embolism (APE) to assess for correlation with known predictors of clinical outcomes. Patients admitted with APE had echocardiograms performed within 24 h of diagnosis and B-type natriuretic peptide (BNP) drawn on admission. Serial troponins were measured for the first 48 h of the hospital stay, and clinical course was followed until discharge. A total of 29 patients were enrolled in the study. Compared to those with a normal study, significantly more patients with an abnormal TAPSE had an elevated BNP (60% vs. 5%; P = 0.004) and troponin (50% vs. 11.1%; P = 0.042). The mean TAPSE was 22.3 mm when BNP was normal and 17.4 mm when elevated (P = 0.003). TAPSE values were significantly lower in patients with abnormal RV function by echocardiogram graded by a blinded cardiologist (17.6 mm vs. 21.7 mm; P = 0.03). Both TAPSE and RVPI correlated significantly with septal flattening, RVEDD, and RVEDD/LVEDD by echo. TAPSE has good correlation with surrogate markers for morbidity and mortality in APE, and both TAPSE and RVPI seem to perform as well as the standard echo parameters used to assess RV function. Both are objective and easy to measure, and therefore warrant prospective study in larger patient groups, with assessment of clinical outcomes.