Mostafa Amir, Medhat Mahmoud, Alhosary Hossam, Amin Wassim
Cardiovascular Department, Cairo University, Cairo, Egypt.
National Heart Institute, Cairo, Egypt.
Egypt Heart J. 2024 Sep 9;76(1):122. doi: 10.1186/s43044-024-00554-7.
Pulmonary embolism (PE) is a lethal type of venous thromboembolic disease. Right ventricular (RV) failure is not an uncommon complication of PE leading to higher adverse outcomes. The tricuspid annular peak systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio as a surrogate for RV-pulmonary artery coupling has proven to be among the predictor of clinical outcomes in multiple patient groups. We evaluated in this study the role of TAPSE/PASP ratio in predicting adverse clinical outcomes in patients with acute PE.
Among patients with established diagnosis of acute PE admitted to the coronary care unit, echocardiography was done within 12 h of admission and TAPSE/PASP ratio was calculated. The patients were followed during hospitalization and after discharge for 3 months for development of adverse outcomes including rehospitalization due to heart failure, recurrent PE and mortality. A total of fifty-five consecutive patients were recruited with mean age 58.3 ± 6.9 years and nearly equal male-to-female ratio. The mean ratio of TAPSE/PASP was 0.479 ± 0.206. In-hospital and 3-month follow-up showed that 10.9% needed rehospitalization with heart failure, 14.5% developed recurrent pulmonary embolism, and mortality was 9.1%. TAPSE/PASP ratio was significantly lower among the patients who developed adverse outcomes. TAPSE/PASP ratio was among the independent predictors of rehospitalization with heart failure, recurrent pulmonary embolism but not mortality at 3-month follow-up. TAPSE/PASP ratio predicted rehospitalization with heart failure at a cutoff point ≤ 0.325, with 100% sensitivity and 79.6% specificity, and predicted recurrent pulmonary embolism at a cutoff point ≤ 0.325, with 75% sensitivity and 78.7% specificity.
TAPSE/PASP ratio is a noninvasive tool that can predict the development of early adverse outcomes in patients with acute PE including rehospitalization with heart failure and recurrent pulmonary embolism.
肺栓塞（PE）是一种致命的静脉血栓栓塞性疾病。右心室（RV）衰竭是PE常见的并发症，会导致更高的不良后果。三尖瓣环收缩期峰值位移/肺动脉收缩压（TAPSE/PASP）比值作为右心室-肺动脉耦合的替代指标，已被证明是多个患者群体临床结局的预测指标之一。我们在本研究中评估了TAPSE/PASP比值在预测急性PE患者不良临床结局中的作用。
在入住冠心病监护病房且确诊为急性PE的患者中，入院12小时内进行了超声心动图检查并计算了TAPSE/PASP比值。对患者在住院期间及出院后3个月进行随访，观察不良结局的发生情况，包括因心力衰竭再次住院、复发性PE和死亡率。共纳入55例连续患者，平均年龄58.3±6.9岁，男女比例接近。TAPSE/PASP的平均比值为0.479±0.206。住院期间及3个月随访显示，10.9%的患者因心力衰竭需要再次住院，14.5%的患者发生复发性肺栓塞，死亡率为9.1%。发生不良结局的患者中TAPSE/PASP比值显著更低。TAPSE/PASP比值是心力衰竭再次住院、复发性肺栓塞的独立预测指标，但不是3个月随访时死亡率的独立预测指标。TAPSE/PASP比值在截断点≤0.325时可预测因心力衰竭再次住院，敏感性为100%，特异性为79.6%；在截断点≤0.325时可预测复发性肺栓塞，敏感性为75%，特异性为78.7%。
TAPSE/PASP比值是一种无创工具，可预测急性PE患者早期不良结局的发生，包括因心力衰竭再次住院和复发性肺栓塞。
