Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients.
OBJECTIVE
Echocardiographic recording of the tricuspid annular plane systolic excursion (TAPSE) has been recommended for assessing right ventricular function in cardiac patients. The ability of TAPSE to reflect right ventricular function at baseline and to monitor acute changes in right ventricular function was tested in critically ill patients.


METHODS
Prospective study.


METHODS
A 24-bed medical intensive care unit.


METHODS
Eighty-six patients admitted for acute respiratory failure, circulatory failure, or coma.


METHODS
In 40 patients, the examination was repeated after volume expansion (n = 15), passive leg raising (n = 5), or dobutamine infusion (n = 20).


RESULTS
The right ventricular fractional area change, TAPSE, the left ventricular ejection fraction, and the ratio of right to left ventricular end-diastolic area were measured using Doppler echocardiography. In the overall population, TAPSE (19+/-5 mm) was positively related to left ventricular ejection fraction (r2 = 0.31, p < 0.001) and right ventricular fractional area change and was negatively related to age and to the ratio of right to left ventricular end-diastolic area. Multivariate analysis indicated that only left ventricular ejection fraction and age were independently related to TAPSE (multiple r2 = 0.36, p < 0.001). Following dynamic interventions, the changes in TAPSE were linearly related to changes in left ventricular ejection fraction (r2 = 0.65, p < 0.01) but notto changes in the right ventricular fractional area change.


CONCLUSIONS
Unexpectedly, TAPSE was more strongly related to left ventricular ejection fraction than to indices of right ventricular function in critically ill patients. The potential interest of TAPSE as a dynamic marker of left ventricular systolic function deserves further study.
Lamia
Bouchra
B
AP-HP, Service de Réanimation Médicale, 94275 Le Kremlin-Bicêtre, France.
Teboul
Jean-Louis
JL
Monnet
Xavier
X
Richard
Christian
C
Chemla
Denis
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013599:Systole / Q000502:physiology*; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*