Prognostic Role of TAPSE-to-PASP ratio for the identification of early clinical deterioration in intermediate-high risk pulmonary embolism patients.

The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate high-risk PE patients. A post-hoc analysis of intermediate-high risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (ClinicalTrials.gov: NCT01604538) was performed. All patients underwent a transthoracic echocardiography (TTE) at admission. The primary and secondary outcomes were clinical deterioration within 48 hours from admission and 30-day all-cause mortality, respectively. Among 422 intermediate high-risk PE patients (mean age 71.2±5.3 years, 238 males), 37 (8.7%) experienced clinical deterioration within 48 hours of admission. The 30-day mortality rate was 6.6% (n=28). Receiver operating characteristic analysis established 0.33 as the optimal cut-off value for the TAPSE/PASP in predicting 48-h clinical deterioration (AUC of 0.79 ± 0.1). Sensitivity, specificity, PPV and NPV were 81%, 88.5%, 40.5% and 97.9%, respectively. Multivariate Cox regression analysis showed that a TAPSE/PASP≤0.33 was an independent predictor of 48-h clinical deterioration (HR: 2.06, 95% CI 1.98-2.11, p<0.0001) and 30-day mortality (HR: 2.28, 95% CI: 2.25-2.33, p<0.001). TAPSE/PASP shows promise as a non-invasive prognostic predictor to identify intermediate-high risk PE patients at higher risk of early clinical deterioration and short-term mortality.

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gregory Piazza reports a relationship with Bristol Myers Squibb Co that includes: consulting or advisory and funding grants. Gregory Piazza reports a relationship with Bayer Corporation that includes: funding grants. Gregory Piazza reports a relationship with Janssen Pharmaceuticals Inc that includes: consulting or advisory and funding grants. Gregory Piazza reports a relationship with Alexion that includes: funding grants. Gregory Piazza reports a relationship with Amgen that includes: consulting or advisory and non-financial support. Gregory Piazza reports a relationship with Boston Scientific Corp that includes: consulting or advisory and funding grants. Gregory Piazza reports a relationship with NAMSA that includes: consulting or advisory. Gregory Piazza reports a relationship with Prairie Educatin and Research Cooperative that includes: consulting or advisory. Gregory Piazza reports a relationship with Boston Clinical research Institute that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.