Subcostal echocardiographic assessment of tricuspid annular kick (SEATAK) - a novel independent predictor of 30-day mortality in patients with acute pulmonary embolism.

BACKGROUND The most commonly used parameter of right ventricular (RV) systolic function - tricuspid annular plane systolic excursion (TAPSE) is unavailable in some patients. Subcostal echocardiographic assessment of tricuspid annular kick (SEATAK) has been proposed as its alternative. AIM The aim of the study was to assess the feasibility of SEATAK use in patients with acute pulmonary embolism (PE) and its value in prognosis after PE. METHODS The observational study included 164 consecutive patients (45.7% men; average age, 70 years) with high clinical probability of PE referred for computed tomography pulmonary angiography. RESULTS SEATAK was unavailable due to inadequate quality of echocardiograph in 2.8% of patients, whereas TAPSE in 4.9%, both parameters only in 0.6%. SEATAK and TAPSE values did not differ between groups of patients with (n = 82) and without PE (n = 82). In the whole study SEATAK correlated positively with TAPSE (r = 0.71; 95% confidence interval [CI], 0.62-0.78; P <0.001), fractional area change of RV, left ventricular ejection fraction and peak systolic tricuspid annular velocity assessed with tissue Doppler imaging. There were only 3 echocardiographic predictors of 30-day all-cause mortality (n = 10) in patients with PE: SEATAK, pulmonary acceleration time and 60/60 sign. SEATAK predicted 30-day all-cause mortality with AUC (area under the curve) 0.726 (95% CI, 0.594-0.858; P = 0.01) and 30-day PE-related mortality (n = 4) with AUC, 0.772 (95% CI, 0.506-0.998; P = 0.03). CONCLUSIONS SEATAK is a promising feasible echocardiographic parameter reflecting RV systolic function and might be an accurate alternative to TAPSE. Moreover, SEATAK could be an independent predictor of all-cause and PE-related 30-day mortality in patients with acute PE.