Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism
Abstract
Background: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S’), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients.
Methods: One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis.
Results: Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4–80.0; p = 0.02); TAPSE and TV S’ showed HR 0.77 (0.67–0.89), p < 0.001, and 0.71 (0.52–0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812–0.932, p = 0.0001, for TV S’ was 0.751; 95% CI 0.670–0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83–0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52–0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S’ was only of borderline statistical significance.
Conclusions: It seems that TV S’ is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.
Keywords: transthoracic echocardiographyright ventricular functiontricuspid valveDoppler tissue imagingprognosispulmonary embolism
References
- Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014; 35(43): 3033–3069.
- Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000; 101(24): 2817–2822.
- Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123(16): 1788–1830.
- Becattini C, Agnelli G, Vedovati MC, et al. Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J. 2011; 32(13): 1657–1663.
- Pruszczyk P, Goliszek S, Lichodziejewska B, et al. Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism. JACC: Cardiovascular Imaging. 2014; 7(6): 553–560.
- Lobo JL, Holley A, Tapson V, et al. Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism. J Thromb Haemost. 2014; 12(7): 1020–1027.
- Saxena N, Rajagopalan N, Edelman K, et al. Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures. Echocardiography. 2006; 23(9): 750–755.
- Kim H, Jung C, Yoon HJ, et al. Prognostic value of tricuspid annular tissue Doppler velocity in heart failure with atrial fibrillation. J Am Soc Echocardiogr. 2012; 25(4): 436–443.
- Kwon DA, Park JS, Chang HJ, et al. Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity. Am J Cardiol. 2006; 98(5): 659–661.
- Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23(7): 685–713; quiz 786.
- Lang R, Badano L, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233–271.
- Meluzín J, Spinarová L, Bakala J, et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J. 2001; 22(4): 340–348.
- Rodrigues AC, Cordovil A, Monaco C, et al. Right ventricular assessment by tissue-Doppler echocardiography in acute pulmonary embolism. Arq Bras Cardiol. 2013; 100(6): 524–530.
- Park JH, Kim JH, Lee JH, et al. Evaluation of right ventricular systolic function by the analysis of tricuspid annular motion in patients with acute pulmonary embolism. J Cardiovasc Ultrasound. 2012; 20(4): 181–188.
- Rydman R, Larsen F, Caidahl K, et al. Right ventricular function in patients with pulmonary embolism: early and late findings using Doppler tissue imaging. J Am Soc Echocardiogr. 2010; 23(5): 531–537.
- Rodrigues AC, Cordovil A, Mônaco CG, et al. Assessing prognosis of pulmonary embolism using tissue-Doppler echocardiography and brain natriuretic peptide. Einstein (Sao Paulo). 2013; 11(3): 338–344.
- Petkov R, Yamakova Y, Petkova E. Prognostic value of TDI assessment of right ventricular function in patients with acute pulmonary embolism. Eur Respir J. 2014; 44: P2303.
- Kurnicka K, Lichodziejewska B, Goliszek S, et al. Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients. J Am Soc Echocardiogr. 2016; 29(9): 907–913.
- McConnell MV, Solomon SD, Rayan ME, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996; 78(4): 469–473.
- Smarz K, Zaborska B, Jaxa-Chamiec T, et al. Right ventricular systolic function as a marker of prognosis after ST-elevation inferior myocardial infarction 5-year follow-up. Int J Cardiol. 2016; 221: 549–553.
- Kjaergaard J, Schaadt BK, Lund JO, et al. Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects. Eur J Echocardiogr. 2008; 9(5): 641–645.
- Hamilton-Craig CR, Stedman K, Maxwell R, et al. Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance. Int J Cardiol Heart Vasc. 2016; 12: 38–44.
