Prognostic Performance of TAPSE/sPAP Versus RV/LV Ratio in Normotensive Acute Pulmonary Embolism

Background: Normotensive patients with acute pulmonary embolism (APE) represent a heterogeneous population with variable early mortality. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (TAPSE/sPAP), an echocardiographic marker of right ventricular–pulmonary arterial coupling, has shown prognostic value in APE, but comparisons with established indices of right ventricular dysfunction remain limited. Objectives: To assess and compare the prognostic value of TAPSE/sPAP and the right-to-left ventricular diameter ratio (RV/LV) for predicting in-hospital all-cause mortality or hemodynamic deterioration in initially normotensive patients with APE. Methods: We retrospectively analyzed prospectively collected registry data from 401 initially normotensive patients with APE who underwent echocardiography within 24 h of admission and had an available TAPSE/sPAP measurement. The clinical endpoint was a composite of in-hospital all-cause mortality and a complicated in-hospital course. TAPSE/sPAP was first evaluated in the full cohort; head-to-head comparisons with RV/LV used the complete-case cohort. Results: The clinical endpoint occurred in 25 patients (6.2%). In the full cohort, lower TAPSE/sPAP was associated with the endpoint (HR: 3.77; 95% CI: 1.78–7.99 per 1-SD decrease). Head-to-head analyses included 354 patients and 23 events; the C-index was 0.721 for TAPSE/sPAP and 0.731 for RV/LV. In the mutually adjusted model, TAPSE/sPAP remained associated with the endpoint (HR: 1.36; 95% CI: 1.06–1.75 per 0.1 decrease; p = 0.017), whereas RV/LV was not (HR: 1.09; 95% CI: 0.95–1.26 per 0.1 increase; p = 0.206). Conclusions: TAPSE/sPAP is associated with adverse in-hospital outcomes in normotensive patients with APE but does not provide superior prognostic discrimination compared with RV/LV.