Assessment of acute pulmonary embolism outcome in hospital through Tricuspid Annular Plane Systolic Excursion versus Pulmonary Embolism Severity Index score

Abstract

Background: In-hospital mortality of acute pulmonary embolism ranging from 0 to 50%, depending upon hemodynamic status and right ventricular dysfunction. RV enlargement, in normotensive PE patients is considered as a predictor of poor clinical outcome, even in initially stable patients. Aim of the study: Evaluations of Tricuspid Annular Plane Systolic Excursion (TAPSE) as the prognostic tool for prediction of in hospital mortality in relation to the Pulmonary Embolism Severity Index (PESI) clinical risk score. Patients and methods: This study was carried out in Dallah hospital Riyadh – Saudi Arabia including 50 patients diagnosed with APE. Those patients classified into three groups, Group I (20 patients) hemodynamically unstable, Group II (15 patients) hemodynamically stable with RV dysfunction and Group III (15 patients) hemodynamically stable with normal RV function. For all included patients TAPSE was measured, PESI risk score was calculated and recorded in the 1st day, 3rd day and 7th day of admission. Results: Receiver operating characteristic (ROC) curve analysis of TAPSE determine that 14 mm was the optimal cutoff value (AUC) 0.994, p < 0.001 and for PESI determine that 124 points was the optimal cutoff value (AUC) 0.983, p < 0.001. Conclusion: TAPSE and PESI can be used as a good prognostic tool in acute PE during hospital course and TAPSE has higher accuracy than PESI in mortality prediction. TAPSE value ≤14 mm can be used in judgment of thrombolytic therapy decision in hemodynamically stable APE patients.

Keywords

• Acute pulmonary embolism
• TAPSE
• PESI