University of Tunis El Manar, Faculty of medicine of Tunis, cardiology department, Internal Security Forces hospital of Marsa, Tunisia.
University of Tunis El Manar, Faculty of medicine of Tunis, Pneumology department, Internal Security Forces hospital of Marsa, Tunisia.
Tunis Med. 2024 May 5;102(5):315-320. doi: 10.62438/tunismed.v102i5.4860.
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.
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.
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).
This study suggests that a combined echocardiographic ratio of RV function to afterload is effective in predicting adverse outcomes in acute PE.
急性肺栓塞（PE）导致的死亡通常与右心室（RV）衰竭有关，这是由于 RV 收缩功能与 RV 后负荷增加之间的不平衡引起的。在我们的研究中，我们假设这种差异衍生的超声心动图比值[通过三尖瓣环平面收缩期位移（TAPSE）评估的 RV 收缩功能除以肺动脉收缩压（PASP）]与单独测量 TAPSE 和 PASP 相比，对不良结局具有更高的预测价值。
我们对 2017 年至 2023 年期间一家大学医院中心的数据进行了回顾性分析。所有确诊为 PE 并在诊断后 7 天内进行正式经胸超声心动图检查的患者均被纳入研究。主要终点是 30 天内死亡、血流动力学恶化需要使用正性肌力药或溶栓的复合结局。次要终点包括 6 个月全因死亡率和右侧心力衰竭的发生。
共纳入 38 例患者。平均年龄为 58 ±15 岁。男性占优势：23 例男性（60.5%）和 15 例女性（39.5%）。8 例患者符合主要复合终点，9 例患者符合次要复合终点。多变量分析显示，TAPSE/PASP 比值与主要结局独立相关（OR=2.77，95%CI 1.101-10.23，P=0.042）。TAPSE/PASP 比值<0.3 与次要结局独立相关（OR=3.07，95%CI 1.185-10.18，P=0.034）。
本研究表明，RV 功能与后负荷的联合超声心动图比值可有效预测急性 PE 的不良结局。
