Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism

Abstract

Tricuspid annular plane systolic excursion (TAPSE) is an emerging prognostic indicator in patients with acute symptomatic pulmonary embolism (PE). We prospectively examined 782 normotensive patients with PE who underwent echocardiography in a multicenter study. As compared with patients with a TAPSE of >1.6cm, those with a TAPSE of ≤1.6cm had increased systolic pulmonary artery pressure (53.7±16.7mmHg vs. 40.0±15.5mmHg, P < 0.001), right ventricle (RV) end-diastolic diameter (3.5 ± 0.8cm vs. 3.0±0.6cm, 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 ≤1.6cm 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 (HR4.4; 95%CI1.3-15.3; 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 ≤1.6cm remained a significant predictor of all-cause mortality (HR2.1; 95%CI1.3-3.2; P=0.001) and PE-specific mortality (HR2.5; 95%CI1.2-5.2; P=0.01). In normotensive patients with PE, TAPSE reflects right ventricular function. For these patients, TAPSE is independently predictive of survival.