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Observational Study
. 2019 Mar;38(3):695-702.
doi: 10.1002/jum.14753. Epub 2018 Sep 4.

Tricuspid Annular Plane of Systolic Excursion to Prognosticate Acute Pulmonary Symptomatic Embolism (TAPSEPAPSE Study)

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Free PMC article
Observational Study

Tricuspid Annular Plane of Systolic Excursion to Prognosticate Acute Pulmonary Symptomatic Embolism (TAPSEPAPSE Study)

Shadi Lahham et al. J Ultrasound Med. .
Free PMC article

Abstract

Introduction: The imaging standard for evaluation of acute pulmonary embolism (PE) includes a computed tomography pulmonary angiogram. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. The objective of this study is to evaluate the diagnostic capability of TAPSE measurements for patients with suspicion for acute PE.

Methods: We prospectively enrolled patients who came to the emergency department with suspicion of acute PE. Each patient underwent a point-of-care sonogram where a TAPSE measurement was obtained, followed by computed tomography pulmonary angiogram. Based on the computed tomography pulmonary angiogram findings, patients were grouped into 3 categories: no acute PE, clinically insignificant acute PE, or clinically significant acute PE.

Results: We enrolled 87 patients in this study. Twenty-three (26.4%) of these patients were diagnosed with PE. Of patients with PE, 15 (65%) were found to have a clinically significant acute PE. Analysis of mean TAPSE measurements between patients with clinically significant acute PE and those with insignificant or no PE was 15.2 mm and 22.7 mm, respectively (P ≤ .0001). Following receiver operating characteristic curve analysis, optimum TAPSE measurement to identify clinically significant acute PE is 18.2 mm. A cutoff TAPSE measurement of 15.2 mm shows a sensitivity of 53.3% (95% confidence interval, 26.7%-80%) and a specificity of 100% (95% confidence interval, 100%-100%) for the diagnosis of a clinically significant PE.

Conclusions: Our data suggest that TAPSE measurements less than 15.2 mm have a high specificity for identifying clinically significant acute PE.

Keywords: TAPSE; cardiac sonogram; point-of-care sonography; pulmonary embolism; right heart strain.

Figures

Figure 1:
Figure 1:
Image of M-mode ultrasound with measurement of TAPSE value.
Figure 2.
Figure 2.
Boxplot of TAPSE between PE and Non-PE.
Figure 3.
Figure 3.
Boxplot of TAPSE among non-PE, clinically insignificant PE and clinically significant PE.
Figure 4.
Figure 4.
Boxplot of TAPSE between Non-PE, insignificant PE vs significant PE.
Figure 5.
Figure 5.
ROC curve of TAPSE for PE vs. Non-PE
Figure 6.
Figure 6.
ROC curve of TAPSE for significant PE, insignificant PE and non-PE.

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