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Right ventricular-pulmonary artery coupling for prognostication in acute pulmonary embolism

2024; Oxford University Press; Linguagem: Inglês

10.1093/ehjacc/zuae120

2048-8734

Mads Dam Lyhne, Behnood Bikdeli, David Jiménez, Christopher Kabrhel, David M. Dudzinski, Jorge Moisés, J.L. Lobo, Fernándo Arméstar, Leticia Guirado, Aitor Ballaz, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Peter Verhamme, Joseph A. Caprini, My Bui, Jesús Aibar, A. Alberich-Conesa, Alicia Alda-Lozano, J Alfonso, Jesús Alonso‐Carrillo, Cristina Amado, M. Angelina-García, Juan I. Arcelus, Aitor Ballaz, Raquel Barba, C. Barbagelata, Bienvenido Barreiro, M. Barrón, B. Barrón‐Andrés, José Bascuñana, Fahd Beddar-Chaib, Á. Blanco-Molina, Jesús Caballero Caballero, I. Cañas, R. Carrero-Arribas, G. Castellanos, Leyre Chasco, Gisela Claver, Juan Criado, C. De Juana-Izquierdo, Jorg Del Toro, Pablo Demelo‐Rodríguez, Carmen Díaz‐Pedroche, J.A. Díaz‐Peromingo, Álvaro Dubois-Silva, José Carlos Escribano, C. Falgá, C. Fernández‐Aracil, Carmen Fernández‐Capitán, B. Fernández-Jiménez, JL Fernández‐Reyes, María Ángeles Fidalgo, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, F García‐Bragado, Alberto García‐Ortega, Olga Gavín‐Sebastián, A. Gil-Díaz, Covadonga Gómez‐Cuervo, A. González-Munera, E Grau, L. Guirado, Javier Gutiérrez-Guisado, Luis Blasco, M J Hernández-Vidal, Luis Jara‐Palomares, David Jiménez, I. Jou, M.D. Joya, Ramón Lecumberri, Pilar Llamas, J.L. Lobo, Helena López-Brull, M. López-De la Fuente, Luciano López‐Jiménez, Patricia López-Miguel, JJ López‐Núñez, Antonio López‐Ruiz, J.B. López‐Sáez, M.A. Lorente, A. García de Lorenzo, M Lumbierres, Olga Madridano, Ana Maestre, P.J. Marchena, Miguel Marcos, M. Martín del Pozo, F. Martín‐Martos, R Martínez-Prado, Jesús Morales Maza, María Inés Mercado, Jorge Moisés, Antonio Molino, Manuel Monreal, Leon Monzon, M.V. Morales, Gema Muñoz, Mónica Navas, José Antonio Nieto, Manuel Jesús Núñez‐Fernández, M. Olid, Lucía Ordieres‐Ortega, María José Ortiz, Jorge Osorio, S. Otálora, Ronny Otero, Nazaret Pacheco-Gómez, Juan Carlos García–Pagán, Andrea Palomeque, E. Paredes, J M Pedrajas, Cristina Pérez-Ductor, Montserrat Pérez‐Pinar, ML Peris, M.L. Pesce, José Antonio Porras, Rosa Puchades, A. Rivas, F. Rivera-Cívico, Alberto Rivera-Gallego, A. Rodríguez-Cobo, M Romero-Bruguera, Pedro Ruiz‐Artacho, G. Salgueiro, Marina Sánchez-Serrano, Teresa Sancho, Vanesa Sendín, Patricia Sigüenza, S. Soler, Adrián Steinherr, S. Suárez-Fernández, Raimundo Tirado, A. Torrents-Vilar, Marı́a Isabel Torres, Javier Trujillo-Santos, Fernando Uresandi, Raquel Del Valle, José F. Varona, Alexander Villalobos, Paula Villares, Cihan Ay, Stephan Nopp, Ingrid Pabinger, Thomas Vanassche, Peter Verhamme, Alain Verstraete, H H B Yoo, Ana Cristina de Albuquerque Montenegro, Shyrlei Morales, Jorge A. Roa, Jana Hirmerová, Radován Malý, L Bertoletti, A. Bura-Rivière, Judith Catella, Romain Chopard, Françis Couturaud, O. Espitia, Raphaël Le Mao, B Leclerq, Isabelle Mahé, Farès Moustafa, L Plaisance, G. Sarlon-Bartoli, Pierre Suchon, E. Versini, Sebastian Schellong, Farid Rashidi, Parham Sadeghipour, Barry E. Brenner, Najib Dally, Gili Kenet, Inna Tzoran, Alessia Abenante, Giovanni Barillari, Manuela Basaglia, Franca Bilora, Daniele Bissacco, B. Brandolin, Renato Casana, Maurizio Ciammaichella, Francesco Dentali, P. Di Micco, Matteo Giorgi‐Pierfranceschi, Egidio Imbalzano, D. Lambertenghi-Deliliers, César Marcon, Romeo Martini, Francesco Negro, Alessandra Poz, Paolo Prandoni, Paolo Simioni, Carmine Siniscalchi, B. Taflaj, A Tufano, A. Visonà, Beniamino Zalunardo, Ričards Kauliņš, A Skride, Z. Tazi-Mezalek, S. Fonseca, Rui Marques, J. Meireles, S. Pinto, Marijan Bosevski, Tomislav Stankovski, Marija Zdraveska, H Bounameaux, L Mazzolai, A Aujayeb, Behnood Bikdeli, J A Caprini, Azza Ali Khalil, Jose Tafur Soto, Ido Weinberg, Hà Mạnh Bùi, S. Nguyen, Khanh Quoc Pham, George Tran,

Cardiovascular Function and Risk Factors

Abstract 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 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 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 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.