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Novel quantitative echocardiographic parameters in acute PE

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Abstract

Background The tricuspid annular plane systolic excursion (TAPSE) and the right ventricular performance index (RVPI) are quantitative measurements that are valid predictors of clinical outcomes in CHF, MI, PAH, and chronic pulmonary disease. We sought to measure TAPSE and RVPI in patients diagnosed with acute pulmonary embolism (APE) to assess for correlation with known predictors of clinical outcomes. Methods Patients admitted with APE had echocardiograms performed within 24 h of diagnosis and B-type natriuretic peptide (BNP) drawn on admission. Serial troponins were measured for the first 48 h of the hospital stay, and clinical course was followed until discharge. Results A total of 29 patients were enrolled in the study. Compared to those with a normal study, significantly more patients with an abnormal TAPSE had an elevated BNP (60% vs. 5%; P = 0.004) and troponin (50% vs. 11.1%; P = 0.042). The mean TAPSE was 22.3 mm when BNP was normal and 17.4 mm when elevated (P = 0.003). TAPSE values were significantly lower in patients with abnormal RV function by echocardiogram graded by a blinded cardiologist (17.6 mm vs. 21.7 mm; P = 0.03). Both TAPSE and RVPI correlated significantly with septal flattening, RVEDD, and RVEDD/LVEDD by echo. Conclusions TAPSE has good correlation with surrogate markers for morbidity and mortality in APE, and both TAPSE and RVPI seem to perform as well as the standard echo parameters used to assess RV function. Both are objective and easy to measure, and therefore warrant prospective study in larger patient groups, with assessment of clinical outcomes.

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Abbreviations

APE:

Acute pulmonary embolism

BNP:

Brain natriuretic peptide

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

ET:

Ejection time

ICOPER:

International Cooperative Pulmonary Embolism Registry

ICT:

Isovolumetric contraction time

ICU:

Intensive care unit

IRT:

Isvolumetric relaxation time

IVC:

Inferior vena cava

LV:

Left ventricle

LVEDD:

Left ventricular end diastolic diameter

MI:

Myocardial infarction

MPI:

Myocardial performance index

NT:

proBNP n-terminal pro-brain natriuretic peptide

PAH:

Pulmonary arterial hypertension

PE:

Pulmonary embolism

RV:

Right ventricle

RVEDD:

Right ventricular end diastolic diameter

RVPI:

Right ventricular performance index

sPAP:

Systolic pulmonary arterial pressure

TAPSE:

Tricuspid annular plane systolic excursion

Trop T:

Troponin T

VQ:

Ventilation perfusion

VTE:

Venous thromboembolism

WRAMC:

Walter Reed Army Medical Center

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Acknowledgments

Funding was not provided for this study. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

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Authors and Affiliations

  1. Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC, 20307, USA

    Aaron B. Holley, Joseph G. Cheatham, Jeffrey L. Jackson, Lisa K. Moores & Todd C. Villines

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  1. Aaron B. Holley
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  2. Joseph G. Cheatham
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  3. Jeffrey L. Jackson
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  4. Lisa K. Moores
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  5. Todd C. Villines
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Correspondence to Aaron B. Holley.

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Holley, A.B., Cheatham, J.G., Jackson, J.L. et al. Novel quantitative echocardiographic parameters in acute PE. J Thromb Thrombolysis 28, 506–512 (2009). https://doi.org/10.1007/s11239-009-0322-6

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  • DOI: https://doi.org/10.1007/s11239-009-0322-6

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