Ahmet Yaşar Çizgici, Recep Gülmez, Serkan Kahraman, Ezgi Gültekin Güner, Arda Güler, Ali Kemal Kalkan, Fatih Uzun, Mustafa Yıldız, Mehmet Ertürk

Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye

Keywords: Acute pulmonary embolism; echocardiography; hypotension; death; single center


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.

Ethics Committee Approval

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).

Peer Review

Externally peer-reviewed.

Author Contributions

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.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

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