Lyhne Mads Dam, Bikdeli Behnood, Jiménez David, Kabrhel Christopher, Dudzinski David M, Moisés Jorge, Lobo José Luis, Armestar Fernando, Guirado Leticia, Ballaz Aitor, Monreal Manuel
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Eur Heart J Acute Cardiovasc Care. 2024 Dec 24;13(12):817-825. doi: 10.1093/ehjacc/zuae120.
Acute pulmonary embolism (PE) increases pulmonary pressure and impair right ventricular (RV) function. Echocardiographic investigation can quantify this mismatch as the tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) ratio. The aim of the study was to investigate the prognostic capabilities of TAPSE/PASP ratio in patients with acute PE.
We utilized the Registro Informatizado Enfermedad TromboEmbolica registry to analyse consecutive haemodynamically stable PE patients. We used multi-variable logistic regression analyses to assess the association between the TAPSE/PASP ratio and 30-day all-cause mortality across the strata of European Society of Cardiology (ESC) risk categories. We included 4478 patients, of whom 1326 (30%) had low-risk, 2425 (54%) intermediate-low risk and 727 (16%) intermediate-high risk PE. Thirty-day mortality rates were 0.7%, 2.3% and 3.4%, respectively. Mean TAPSE/PASP ratio was 0.65 ± 0.29 in low-risk patients, 0.46 ± 0.30 in intermediate-low risk and 0.33 ± 0.19 in intermediate-high risk patients. In multi-variable analyses, there was an inverse association between TAPSE/PASP ratio and 30-day mortality (adjusted OR 1.32 [95% CI 1.14-1.52] per 0.1 decrease in TAPSE/PASP). TAPSE/PASP ratio below optimal cut-points was associated with increased mortality in low- (<0.40, aOR: 5.88; 95% CI: 1.63-21.2), intermediate-low (<0.43, aOR: 2.96; 95% CI: 1.54-5.71) and intermediate-high risk patients (<0.34, aOR: 4.37; 95% CI: 1.27-15.0). TAPSE/PASP <0.44 showed net reclassification improvement of 18.2% (95% CI: 0.61-35.8) vs. RV/LV ratio >1, and 27.7% (95% CI: 10.2-45.1) vs. ESC risk strata.
Decreased TAPSE/PASP ratio was associated with increased mortality. The ratio may aid in clinical decision-making, particularly for intermediate-risk patients for whom the discriminatory capability of the current risk stratification tools is limited.
急性肺栓塞（PE）会增加肺动脉压力并损害右心室（RV）功能。超声心动图检查可将这种不匹配量化为三尖瓣环平面收缩期位移（TAPSE）与肺动脉收缩压（PASP）之比。本研究的目的是探讨TAPSE/PASP比值对急性PE患者的预后评估能力。
我们利用血栓栓塞性疾病信息登记系统分析连续的血流动力学稳定的PE患者。我们使用多变量逻辑回归分析来评估TAPSE/PASP比值与欧洲心脏病学会（ESC）风险类别各分层中30天全因死亡率之间的关联。我们纳入了4478例患者，其中1326例（30%）为低风险，2425例（54%）为中低风险，727例（16%）为中高风险PE。30天死亡率分别为0.7%、2.3%和3.4%。低风险患者的平均TAPSE/PASP比值为0.65±0.29，中低风险患者为0.46±0.30，中高风险患者为0.33±0.19。在多变量分析中，TAPSE/PASP比值与30天死亡率呈负相关（TAPSE/PASP每降低0.1，调整后的OR为1.32[95%CI 1.14 - 1.52]）。低于最佳切点的TAPSE/PASP比值与低风险（<0.40，aOR：5.88；95%CI：1.63 - 21.2）、中低风险（<0.43，aOR：2.96；95%CI：1.54 - 5.71）和中高风险患者（<0.34，aOR：4.37；95%CI：1.27 - 15.0）的死亡率增加相关。与RV/LV比值>1相比，TAPSE/PASP<0.44显示净重新分类改善为18.2%（95%CI：0.61 - 35.8），与ESC风险分层相比为27.7%（95%CI：10.2 - 45.1）。
TAPSE/PASP比值降低与死亡率增加相关。该比值可能有助于临床决策，特别是对于当前风险分层工具鉴别能力有限的中风险患者。
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