Association and discrimination of TAPSE and S’ for short-term outcomes in acute pulmonary embolism

One important component of normal right ventricular (RV) function is longitudinal myocardial contraction, which can be evaluated echocardiographically by distance of excursion (tricuspid annular plane systolic excursion [TAPSE]) or speed (tissue Doppler imaging systolic [S’] velocity).1 RV dysfunction is central to the clinical risk stratification in patients with acute pulmonary embolism (PE)2 but it remains unknown if TAPSE or S’ is a better predictor of outcomes. In this study, we sought to assess the correlation of TAPSE and RV S’ and outcomes in patients with acute PE. This was a retrospective analysis of a prospectively maintained Pulmonary Embolism Response Team (PERT) registry at Massachusetts General Hospital.3 We measured TAPSE and S’. Our primary outcome was a 7-day composite of clinical deterioration. See Supplementary. We included 540 patients with measurable TAPSE and S’. Mean age was 61 ± 16 years, and 51.3% (277/540) were male. Dyspnoea was the most common presenting symptom. One-hundred-and-eight (20.0%) patients experienced the primary outcome including systemic thrombolysis (1.5%, 8/540), catheter-directed therapy (9.1%, 49/540), extra-corporal membrane oxygenation (0.9%, 5/540), surgical embolectomy (2.8%, 15/540), mechanical ventilation (5.2%, 28/540), need for vasopressor (2.6%, 14/540) or death within seven days (3.5%, 19/540). Forty-seven (8.7%, 47/540) died within 30 days.