Last week we posted an article on acute pulmonary embolism in echocardiography. In that post we discussed how echo is good for ruling-in pulmonary embolism but not for ruling-out a pulmonary embolism. After diagnosing a pulmonary embolism what is the role of echo? Many studies have demonstrated the prognostic value of echo in determining short term mortality, prolonged hospital stay and/or survival. This week we will explore TAPSE in pulmonary embolism.
If you need to refresh your memory on your right heart quantification measurements you can review past blog articles here:
First, lets review TAPSE with McConnell’s sign. Last week we reviewed how the McConnell’s Sign is one echo finding in the setting of acute pulmonary embolism. The classic distinction of McConnell’s sign is normal RV apex wall motion (RV apex is tethered to the LV apex) and the mid free wall buldging out due to akinesis. Remember the sudden pressure overload of the RV causes stress on the RV and this stress is not uniform causing localized mid free wall buldging.
One of our readers asked if TAPSE with McConnell’s Sign is normal. With the mid wall being akinetic the basal wall may appear “normal” to the eye. Although the basal wall moves better than the akinetic mid section of the RV – there is still dysfunction therefore TAPSE would not be normal.
To avoid confusion we updated our image from last week’s blog by removing arrows from the basal RV segment.
So how does echo help as a prognostic tool in pulmonary embolism? “Right ventricular failure remains a major cause of mortality during acute pulmonary embolism” (Schmid et al, 2015). Through the use of echo and quantification measurements like TAPSE we have the ability to assess RV function. If we can identify patients with RV dysfunction we can make better decisions on how best to treat them.
Read 8 Tips to Correct RV Function Assessment with TAPSE and S’ Wave for a step by step guide.
Right ventricular hypokinesia and abnormal TAPSE are independent predictors of increased risk (double) for 30-day mortality in patients with acute pulmonary embolism. Abnormal TAPSE is also predictive or poor pericoperative outcomes. TAPSE is easy to perorm and is reproducable between users and readers. Please review how to correctly perform TAPSE.
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