Prognostic Role of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure Ratio for the Identification of Early Clinical Deterioration in Intermediate-High–Risk Pulmonary Embolism Patients

Abstract

The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate high-risk PE patients. A post-hoc analysis of intermediate-high risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (ClinicalTrials.gov: NCT01604538) was performed. All patients underwent a transthoracic echocardiography (TTE) at admission. The primary and secondary outcomes were clinical deterioration within 48 hours from admission and 30-day all-cause mortality, respectively. Among 422 intermediate high-risk PE patients (mean age 71.2±5.3 years, 238 males), 37 (8.7%) experienced clinical deterioration within 48 hours of admission. The 30-day mortality rate was 6.6% (n=28). Receiver operating characteristic analysis established 0.33 as the optimal cut-off value for the TAPSE/PASP in predicting 48-h clinical deterioration (AUC of 0.79 ± 0.1). Sensitivity, specificity, PPV and NPV were 81%, 88.5%, 40.5% and 97.9%, respectively. Multivariate Cox regression analysis showed that a TAPSE/PASP≤0.33 was an independent predictor of 48-h clinical deterioration (HR: 2.06, 95% CI 1.98-2.11, p<0.0001) and 30-day mortality (HR: 2.28, 95% CI: 2.25-2.33, p<0.001). TAPSE/PASP shows promise as a non-invasive prognostic predictor to identify intermediate-high risk PE patients at higher risk of early clinical deterioration and short-term mortality.