TY - JOUR
T1 - Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS
T2 - a more objective approach
AU - Wadia, Subeer Kanwar
AU - Shah, Trushil G.
AU - Hedstrom, Grady
AU - Kovach, Julie A.
AU - Tandon, Rajive
N1 - Publisher Copyright:
© 2016, Wiley Periodicals, Inc.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - TAPSE
KW - acute respiratory distress syndrome
KW - dysfunction
KW - right ventricle
KW - transthoracic echocardiography
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U2 - 10.1111/echo.13350
DO - 10.1111/echo.13350
M3 - Article
C2 - 27558525
AN - SCOPUS:84992025923
SN - 0742-2822
VL - 33
SP - 1874
EP - 1879
JO - Echocardiography
JF - Echocardiography
IS - 12
ER -