Right ventricular-pulmonary artery coupling for prognostication in acute pulmonary embolism.
TAPSE
echocardiography
pulmonary pressure
right ventricular function
risk stratification
Journal
European heart journal. Acute cardiovascular care
ISSN: 2048-8734
Titre abrégé: Eur Heart J Acute Cardiovasc Care
Pays: England
ID NLM: 101591369
Informations de publication
Date de publication:
24 Oct 2024
24 Oct 2024
Historique:
received:
15
08
2024
revised:
12
10
2024
accepted:
22
10
2024
medline:
24
10
2024
pubmed:
24
10
2024
entrez:
23
10
2024
Statut:
aheadofprint
Résumé
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 RIETE registry to analyze consecutive hemodynamically stable PE patients. We used multivariable 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 4,478 patients, of whom 1,326 (30%) had low-risk, 2,425 (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 multivariable 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.
Sections du résumé
BACKGROUND
BACKGROUND
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.
METHODS
METHODS
We utilized the RIETE registry to analyze consecutive hemodynamically stable PE patients. We used multivariable 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.
RESULTS
RESULTS
We included 4,478 patients, of whom 1,326 (30%) had low-risk, 2,425 (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 multivariable 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.
CONCLUSIONS
CONCLUSIONS
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.
Identifiants
pubmed: 39442929
pii: 7833492
doi: 10.1093/ehjacc/zuae120
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Paolo Prandoni
(P)
Benjamin Brenner
(B)
Dominique Farge-Bancel
(D)
Raquel Barba
(R)
Pierpaolo Di Micco
(P)
Laurent Bertoletti
(L)
Sebastian Schellong
(S)
Inna Tzoran
(I)
Abilio Reis
(A)
Marijan Bosevski
(M)
Henri Bounameaux
(H)
Radovan Malý
(R)
Peter Verhamme
(P)
Joseph A Caprini
(JA)
Hanh My Bui
(H)
J Aibar
(J)
A Alberich-Conesa
(A)
A Alda-Lozano
(A)
J Alfonso
(J)
J Alonso-Carrillo
(J)
C Amado
(C)
M Angelina-García
(M)
J I Arcelus
(JI)
A Ballaz
(A)
R Barba
(R)
C Barbagelata
(C)
B Barreiro
(B)
M Barrón
(M)
B Barrón-Andrés
(B)
J Bascuñana
(J)
F Beddar-Chaib
(F)
A Blanco-Molina
(A)
J C Caballero
(JC)
I Cañas
(I)
R Carrero-Arribas
(R)
G Castellanos
(G)
L Chasco
(L)
G Claver
(G)
J Criado
(J)
C De Juana-Izquierdo
(C)
J Del Toro
(J)
P Demelo-Rodríguez
(P)
M C Díaz-Pedroche
(MC)
J A Díaz-Peromingo
(JA)
A Dubois-Silva
(A)
J C Escribano
(JC)
C Falgá
(C)
C Fernández-Aracil
(C)
C Fernández-Capitán
(C)
B Fernández-Jiménez
(B)
J L Fernández-Reyes
(JL)
M A Fidalgo
(MA)
I Francisco
(I)
C Gabara
(C)
F Galeano-Valle
(F)
F García-Bragado
(F)
A García-Ortega
(A)
O Gavín-Sebastián
(O)
A Gil-Díaz
(A)
C Gómez-Cuervo
(C)
A González-Munera
(A)
E Grau
(E)
L Guirado
(L)
J Gutiérrez-Guisado
(J)
L Hernández-Blasco
(L)
M J Hernández-Vidal
(MJ)
L Jara-Palomares
(L)
D Jiménez
(D)
I Jou
(I)
M D Joya
(MD)
R Lecumberri
(R)
P Llamas
(P)
J L Lobo
(JL)
H López-Brull
(H)
M López-De la Fuente
(M)
L López-Jiménez
(L)
P López-Miguel
(P)
J J López-Núñez
(JJ)
A López-Ruiz
(A)
J B López-Sáez
(JB)
M A Lorente
(MA)
A Lorenzo
(A)
M Lumbierres
(M)
O Madridano
(O)
A Maestre
(A)
P J Marchena
(PJ)
M Marcos
(M)
M Martín Del Pozo
(M)
F Martín-Martos
(F)
R Martínez-Prado
(R)
J M Maza
(JM)
M I Mercado
(MI)
J Moisés
(J)
A Molino
(A)
M Monreal
(M)
L Monzón
(L)
M V Morales
(MV)
G Muñoz-Gamito
(G)
M S Navas
(MS)
J A Nieto
(JA)
M J Núñez-Fernández
(MJ)
M Olid
(M)
L Ordieres-Ortega
(L)
M Ortiz
(M)
J Osorio
(J)
S Otálora
(S)
R Otero
(R)
N Pacheco-Gómez
(N)
J Pagán
(J)
A C Palomeque
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E Paredes
(E)
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M Pérez-Pinar
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T Sancho
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(JF)
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(A)
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C Ay
(C)
S Nopp
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I Pabinger
(I)
T Vanassche
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P Verhamme
(P)
A Verstraete
(A)
H H B Yoo
(HHB)
A C Montenegro
(AC)
S N Morales
(SN)
J Roa
(J)
J Hirmerova
(J)
R Malý
(R)
L Bertoletti
(L)
A Bura-Riviere
(A)
J Catella
(J)
R Chopard
(R)
F Couturaud
(F)
O Espitia
(O)
R Le Mao
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B Leclerq
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I Mahé
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F Moustafa
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L Plaisance
(L)
G Sarlon-Bartoli
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P Suchon
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E Versini
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S Schellong
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F Rashidi
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P Sadeghipour
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B Brenner
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N Dally
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G Kenet
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J Meireles
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S Pinto
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M Bosevski
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T Stankovski
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M Zdraveska
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H Bounameaux
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L Mazzolai
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A Aujayeb
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B Bikdeli
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J A Caprini
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A Khalil
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J Tafur
(J)
I Weinberg
(I)
H M Bui
(HM)
S T Nguyen
(ST)
K Q Pham
(KQ)
G B Tran
(GB)
Informations de copyright
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