Utility of TAPSE/sPAP Ratio in Acute Pulmonary Embolism as Valuable Prognostic Marker as PESI Score

Abstract

Introduction: The pulmonary embolism severity index (PESI) score is used to determine the risk of mortality and severity of complications in acute pulmonary embolism (APE). Tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio has been recently shown to predict poor 30-day clinical outcome in APE. We aimed to analyze the prognostic value of the TAPSE/sPAP ratio for prediction of 30-day adverse clinical outcomes in APE patients, similar to PESI score.

Patients and Methods: This study enrolled 203 retrospectively evaluated patients (female 108, mean age= 57.4 ± 15.5 years) with the diagnosis of APE between 2010 and 2020. All patients underwent transthoracic echocardiography before specific APE treatment. Primary endpoints were 30-day mortality, thrombolytic therapy requirement, mechanical ventilation requirement, mental status deterioration, and persistent hypotension (systolic blood pressure <90 mmHg). The study population was divided into two groups according to the TAPSE/sPAP ratio= 114 patients in group 1 with a low TAPSE/sPAP ratio (<0.494) and 89 patients in group 2 with a high TAPSE/sPAP ratio (>0.494).

Results: The incidence of in-hospital mortality (4.4 vs. 0%, p= 0.045], 30-day mortality [n= 8 (7.0%); 0 (0%), p= 0.009] and primary adverse outcomes (35.1 vs. 0%, p< 0.001) were higher in group 1. The TAPSE/sPAP ratio was negatively correlated with PESI (r= -0.716, p< 0.001). In multivariate logistic regression analyses revealed that the TAPSE/sPAP ratio [OR= 0.001, 95C% CI= 0.000-0.476, p= 0.028] was an independent predictor of 30-day mortality in APE.

Conclusion: The present study showed that the TAPSE/sPAP ratio may be used in clinical practice for the prediction of short-term adverse outcome risk estimation in APE patients, similar to PESI score.

Cite this article as: Çizgici AY, Gülmez R, Kahraman S, Gültekin Güner E, Güler A, Kalkan AK, et al. Predictive value of the naples score Utility of TAPSE/sPAP ratio in acute pulmonary embolism as valuable prognostic marker as PESI score. Koşuyolu Heart J 2023;26(3):128-138.

This study was approved by the İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Clinical Research Ethics Committee (Decision no: 10678112-514.10-03, Date: 11.02.2021).

This is retrospective study, we could not obtain written informed consent from the participants.

Externally peer-reviewed.

Concept/Design - AYÇ, SK, EGG, AKK; Analysis/Interpretation - SK; Data Collection - AG, RG; Writing - AYÇ, RG; Critical Revision - ME, MY, FU; Final Approval - AYÇ, AKK; Statistical Analysis -SK; Overall Responsibility - AYÇ.

The authors have no conflicts of interest to declare.

The authors declare that this study has received no financial support.