April 6th, 2016

Prognostic significance of tricuspid annular displacement in normotensive patients with acute symptomatic pulmonary embolism

Journal of Thrombosis and Haemostasis 12:1020-1027


Have you ever gotten push back for admitting a very stable looking PE patient. I mean really stable…like normal troponin, normal vitals, no RV strain on your bedside PoCUS. Is there something you can use to convince your colleagues that this patient should be admitted? Well yes there is! TAPSE!!! TAPSE is Tricuspid Annular Plane Systolic Excursion. This is a fairly simple thing to learn to do. The reason we are talking about it is this paper published in the Journal of Thrombosis and Haemostasis.


What this study aimed to answer is there a relationship between TAPSE and clinical outcomes in patients with hemodynamically stable PE’s. This study was well designed, and involved a prospective cohort study and then a retrospective external validation. Patients were eligible to be enrolled is the had a CT confirmed PE within 14 days of symptom onset. Patients were excluded from the study if they received thrombolytic therapy, are pregnant, cannot follow up, have a life expectancy less than 3months, renal insufficiency, or hemodynamic instability.


What the study showed was that a TAPSE that is normal (ie. greater than 1.6cm), was indicative of normal RV function. The main outcome studied in both patient populations, showed that an abnormal TAPSE of less than 1.6cm was predictive of 30 day mortality in these patients that was statistically significant.


In this well done study showing a mortality difference in stable patients with CT confirmed PE with an abnormal TAPSE measurement. TAPSE is a relatively simple measurement to obtain and definitely is in the scope of EM or critical care PoCUS practice. While and ED based study would be great to confirm these findings in an ED patient population, I feel that we should start assessing, particularly if an admitting service is giving any push back for admitting the patient.

Tom Jelic and Judith Alain

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