Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS: a more objective approach

Subeer Kanwar Wadia, Trushil G. Shah, Grady Hedstrom, Julie A. Kovach, Rajive Tandon

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Purpose: Right ventricular (RV) dysfunction is an independent predictor of morbidity and mortality in acute respiratory distress syndrome (ARDS). Our goal was to describe morphologic changes in the RV using objective measures on transthoracic echocardiography (TTE) that occur following ARDS. Methods: We retrospectively measured changes in the following RV parameters from a pre-ARDS TTE to an ARDS TTE: tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), fractional area change (FAC), systolic pulmonary artery pressure (SPAP), peak tricuspid regurgitant (TR) velocity, and septal shift. Results: Over 24 months, 14 patients met inclusion/exclusion criteria. Mean TAPSE decreased from 22.4 mm pre-ARDS to 16.3 mm during ARDS, P<.001. Mean MPI increased from 0.19 to 0.38, P=.001. Mean FAC decreased from 60.8% to 41.2%, P=.003. Peak TR velocity increased from 2.67 m/s pre-ARDS to 3.31 m/s during ARDS, P=.02. SPAP and septal shift demonstrated trends but not statistically different between pre-ARDS and ARDS states. TAPSE correlated with ARDS severity (PaO2/FiO2 ratios), P=.004, and was lower among 30-day nonsurvivors compared with survivors, P=.002. Conclusions: Mild RV dysfunction is common after ARDS onset. RV morphologic changes coupled with dysfunction can be detected noninvasively through TTE changes with TAPSE, MPI, and FAC. Mild RV dysfunction by TAPSE is associated with ARDS severity and mortality.

Original languageEnglish (US)
Pages (from-to)1874-1879
Number of pages6
JournalEchocardiography
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • acute respiratory distress syndrome
  • dysfunction
  • right ventricle
  • TAPSE
  • transthoracic echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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