Yuriditsky Eugene, Zhang Robert S, Zhang Peter, Postelnicu Radu, Greco Allison A, Horowitz James M, Bernard Samuel, Leiva Orly, Mukherjee Vikramjit, Hena Kerry, Elbaum Lindsay, Alviar Carlos L, Keller Norma M, Bangalore Sripal
Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York.
Division of Cardiology, Weill Cornell Medicine, New York, New York.
Am J Cardiol. 2025 Feb 1;236:1-7. doi: 10.1016/j.amjcard.2024.10.036. Epub 2024 Nov 4.
Right ventricular-pulmonary arterial coupling describes the relation between right ventricular contractility and its afterload and is estimated as the ratio of the tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) by way of echocardiography. Whether TAPSE/PASP is reflective of invasive hemodynamics or occult shock in acute pulmonary embolism (PE) is unknown. This was a single-center retrospective study over a 3-year period of consecutive patients with PE who underwent mechanical thrombectomy and simultaneous pulmonary artery catheterization with echocardiograms performed within 24 hours before the procedure. A total of 70 patients (81% intermediate risk) had complete invasive hemodynamic profiles and echocardiograms, with TAPSE/PASP calculated. The optimal cutoff for TAPSE/PASP as a predictor of a reduced cardiac index (CI) (CI ≤2.2 L/min/m) was 0.34 mm/mm Hg, with an area under the curve of 0.97 and sensitivity, specificity, positive predictive value, and negative predictive value of 97.3%, 90.9%, 92.3%, and 96.8%, respectively. Every 0.1 mm/mm Hg decrease in TAPSE/PASP was associated with a 0.24-L/min/m decrease in the CI. This relation was similar when restricted to intermediate-risk PE. The TAPSE/PASP ratio was predictive of normotensive shock with an odds ratio of 2.63 (95% confidence interval 1.42 to 4.76, p = 0.002) per unit decrease in the ratio. In conclusion, in patients with acute PE who underwent mechanical thrombectomy, TAPSE/PASP was a strong predictor of a reduced CI and normotensive shock. This means that noninvasive point-of-care assessment of hemodynamics may have added value in PE risk stratification.
右心室-肺动脉耦合描述了右心室收缩力与其后负荷之间的关系，通过超声心动图将三尖瓣环平面收缩期位移（TAPSE）与肺动脉收缩压（PASP）的比值作为评估指标。在急性肺栓塞（PE）中，TAPSE/PASP是否反映有创血流动力学或隐匿性休克尚不清楚。这是一项单中心回顾性研究，对连续3年接受机械血栓切除术并在术前24小时内同时进行肺动脉导管插入术及超声心动图检查的PE患者进行研究。共有70例患者（81%为中度风险）有完整的有创血流动力学资料和超声心动图，并计算了TAPSE/PASP。TAPSE/PASP作为预测心脏指数（CI）降低（CI≤2.2 L/min/m²）的最佳截断值为0.34 mm/mm Hg，曲线下面积为0.97，敏感性、特异性、阳性预测值和阴性预测值分别为97.3%、90.9%、92.3%和96.8%。TAPSE/PASP每降低0.1 mm/mm Hg，CI降低0.24 L/min/m²。当仅限于中度风险的PE时，这种关系相似。TAPSE/PASP比值可预测血压正常的休克，比值每降低一个单位，优势比为2.63（95%置信区间1.42至4.76，p = 0.002）。总之，在接受机械血栓切除术的急性PE患者中，TAPSE/PASP是CI降低和血压正常的休克的有力预测指标。这意味着血流动力学的无创床旁评估在PE风险分层中可能具有附加价值。
