Key result
Higher admission TAPSE is linked to ~16% lower in-hospital mortality in women with PE.
Why the study?
Does TAPSE measured at admission predict all-cause in-hospital mortality differently in men versus women with acute pulmonary embolism?
Cohort (n=2,408)
Yes
Does TAPSE measured at admission predict all-cause in-hospital mortality differently in men versus women with acute pulmonary embolism?
Hazard Ratio: 0.84 (95% CI 0.77–0.9)
p-value: p=<0.001
TAPSE is a strong, independent predictor of in-hospital mortality in women with acute pulmonary embolism, with a cutoff of >19 mm identifying a very low-risk subgroup.
TAPSE may support sex-specific risk stratification in acute PE; hypothesis-generating and requires prospective validation before practice change.
BackgroundRisk stratification of acute pulmonary embolism (PE) is primarily based on systolic arterial pressure, right ventricular (RV) function, and cardiac troponin levels.ObjectivesTo investigate sex-related differences in simple RV echocardiographic parameters for predicting all-cause in-hospital mortality in acute PE.DesignMulticenter, observational, retrospective, registry-based cohort study.MethodsWe analyzed data from the Regional Pulmonary Embolism Registry, including consecutive patients with acute PE confirmed by computed tomography pulmonary angiography between January 2015 and January 2026. Of 2776 patients, 2408 had at least one RV echocardiographic parameter measured at admission (RV diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion [TAPSE], and ratio TAPSE/RV systolic pressure). Multivariable Cox regression adjusted for age, sex-specific differences, and shock at admission (systolic arterial pressure <90 mmHg), was used to identify predictors of all-cause in-hospital mortality. Sex-specific cutoffs of echocardiographic parameters with the strongest predictive value for all-cause mortality were determined using a decision tree.ResultsAll-cause in-hospital mortality rates were similar between men (7.6%, 83/1125) and women (9.2%, 118/1283; p=0.107). TAPSE was the only echocardiographic parameter independently associated with all-cause in-hospital mortality in women (adjusted hazard ratio [95% confidence interval] 0.84 [0.77-0.90], p<0.001), but not in men (0.92 [0.85-1.01], p=0.075). Decision-tree analyses identified TAPSE cutoffs of >19 mm for women and >16 mm for men, enabling discrimination between low- and high-risk patients. Mortality was 10.2% versus 0.9% in women (≤19 vs. >19 mm, p<0.001) and 9.0% versus 2.5% in men (≤16 vs. >16 mm, p=0.001). In women, TAPSE >19 mm identified a subgroup with very low in-hospital mortality (1.4%) and an excellent negative predictive value (98.6%).ConclusionIn patients with acute PE, TAPSE measured at admission in women, but not in men, was the only echocardiographic parameter independently associated with all-cause in-hospital mortality.
No takes yet. Share an insight, caveat, or question.
Kos et al. (2026) conducted a cohort in acute pulmonary embolism (n=2,408). TAPSE (tricuspid annular plane systolic excursion) was evaluated on all-cause in-hospital mortality (HR 0.84, 95% CI 0.77-0.90, p=<0.001). In women with acute pulmonary embolism, TAPSE measured at admission was independently associated with all-cause in-hospital mortality (adjusted HR 0.84), whereas this association was not significant in men.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: