Comparison of TAPSE to the the Gold Standard in the Diagnosis of Patients with Acute Pulmonary Embolisms

Author: Shannon Lee

Introduction: Acute pulmonary embolism (aPE) is a fatal condition that can lead to death if not quickly identified and treated. The current standard of care in patients with suspicion for pulmonary embolism consists of a Computed Tomography scan of the Pulmonary Arteries (CTPA). Despite the accuracy of CTPA, many patients are unable to undergo this test due to renal disease, pregnancy or risk of radiation. Recently, ultrasonography has shown some promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements to help make the diagnosis of aPE. We assessed the right ventricular outflow tract (RVOT) by using cardiac point-of-care ultrasound (POCUS) in the evaluation of patients with suspicion for aPE. Methods: We prospectively enrolled patients who presented to the Emergency Department with a clinical suspicion of aPE and were ordered a CTPA between November 2015 and September 2016. This study consists of a comparative analysis of two cohorts of patients based on the results from the gold standard (CTPA scan). Results: We enrolled a total of 41 patients. Of the 41 patients with a suspicion of aPE based on the CTPA scan, 10 patients had an aPE (24.39%) and 31 patients did not have an aPE (75.61%). We performed an un-paired t-test to calculate the significance of TAPSE in identifying patients with aPE. Based on preliminary data, our study shows that there is statistical significance (p=0.0176) in the identification of patients with pulmonary embolisms. Results from this study can be useful not only in the prognosis in hospitals where CTPAs are readily available, but also in underdeveloped countries where easily transportable ultrasound machines can be used.

Co Author/Co-Investigator Names/Professional Title: John Christian Fox, MD; Shadi Lahham, MD, MS