Tricuspid Annular Plane Systolic Excursion and Its Association with Mortality in Critically Ill Patients.
BACKGROUND
Transient left ventricular dysfunction can occur under conditions of extreme emotional or physiological stress. There is little data on right ventricular function in such situations.


METHODS
One hundred twenty patients admitted to an ICU with a noncardiac illness were studied. Those with documented coronary disease, ejection fraction <40%, sepsis, or intracranial hemorrhage were excluded. Echocardiograms were performed within 24 hours of admission. Tricuspid annular plane systolic excursion (TAPSE) was measured to assess right ventricular systolic function. Plasma catecholamines (norepinephrine, epinephrine, dopamine) were measured on admission. Clinical and demographic data were collected, along with data on ICU length of stay (LOS), hospital LOS, and in-hospital and long-term mortality. TAPSE was tested for correlation with adverse outcomes and length of stay.


RESULTS
Mean TAPSE for the group was 2.05 ± 0.66 cm. Based on area under the ROC curve analysis, TAPSE <2.4 cm was the best cutoff for predicting in-hospital and long-term mortality. There were 13 in-hospital deaths, 12 in the group with TAPSE <2.4 cm and one among those with TAPSE ≥2.4 cm. On multivariate analysis, TAPSE <2.4 cm was a significant predictor of in-hospital mortality (χ(2)  = 4.6, P = 0.03). When tested against hospital LOS, an inverse correlation was found (P = 0.04). No association was found between TAPSE and catecholamine levels.


CONCLUSIONS
Right ventricular systolic function, as assessed by TAPSE, has important prognostic value in critically ill patients. Mean values were lower in patients who died in-hospital versus those who survived to discharge. In addition, patients with TAPSE <2.4 cm had a longer hospital length of stay.
The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania.
Deepakraj
D
Gajanana
The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania.
Harish
H
Seetha Rammohan
Division of Cardiovascular disease, UAB School of Medicine, Birmingham, Alabama.
Oluseun
O
Alli
The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania.
Abel
A
Romero-Corral
Zena & Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
Bhaskar
B
Purushottam
Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota.
Shiva
S
Ponamgi
The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania.
Vincent M
VM
Figueredo
The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania.
Gregg S
GS
Pressman
D000293:Adolescent; D015984:Causality; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D015994:Incidence; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016019:Survival Analysis; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014481:United States / Q000453:epidemiology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality*
critically ill patients; length of stay; right ventricular systolic dysfunction; tricuspid annular plane systolic excursion