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

Area of Science:

• Cardiology
• Pulmonology
• Echocardiography

Background:

• Acute pulmonary embolism (PE) significantly impacts right ventricular (RV) function and pulmonary hemodynamics.
• Echocardiography offers a method to assess RV function and pulmonary pressure, with the TAPSE/PASP ratio being a key metric.

Purpose of the Study:

• To evaluate the prognostic value of the TAPSE/PASP ratio in predicting 30-day mortality in patients diagnosed with acute PE.
• To determine if the TAPSE/PASP ratio enhances risk stratification beyond existing European Society of Cardiology (ESC) guidelines.

Main Methods:

• Analysis of a large cohort (4478 patients) from the Registro Informatizado Enfermedad TromboEmbolica registry.
• Utilized multivariable logistic regression to assess the association between TAPSE/PASP ratio and 30-day mortality across different ESC risk categories.
• Evaluated the ratio's ability to reclassify risk compared to RV/LV ratio and ESC risk strata.

Main Results:

• A decreased TAPSE/PASP ratio was inversely associated with 30-day mortality (adjusted OR 1.32 per 0.1 decrease).
• Specific TAPSE/PASP ratio cut-points were linked to significantly increased mortality across low, intermediate-low, and intermediate-high risk PE groups.
• The TAPSE/PASP ratio demonstrated significant net reclassification improvement for mortality prediction.

Conclusions:

• The TAPSE/PASP ratio is a valuable prognostic marker in acute PE, correlating with increased mortality.
• This echocardiographic ratio can assist clinicians in decision-making, particularly for intermediate-risk PE patients who often have limited discriminatory power with current tools.