title: Echocardiographic parameters of right ventricular function predict mortality in acute respiratory distress syndrome: a pilot study.
abstract: Right ventricular (RV) dysfunction in acute respiratory distress syndrome (ARDS) contributes to increased mortality. Our aim is to identify reproducible transthoracic echocardiography (TTE) parameters of RV dysfunction that can be used to predict outcomes in ARDS. We performed a retrospective single-center cohort pilot study measuring tricuspid annular plane systolic excursion (TAPSE), Tei index, RV-fractional area change (RV-FAC), pulmonary artery systolic pressure (PASP), and septal shift, reevaluated by an independent blinded cardiologist (JK). Thirty-eight patients were included. Patients were divided on the basis of 30-day survival. Thirty-day mortality was 47%. Survivors were younger than nonsurvivors. Survivors had a higher pH, PaO2∶FiO2 ratio, and TAPSE. Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) scores were lower in survivors. TAPSE has the strongest association with increased 30-day mortality from date of TTE. Accordingly, TAPSE has a strong positive correlation with PaO2∶FiO2 ratios, and Tei index has a strong negative correlation with PaO2∶FiO2 ratios. Septal shift was associated with lower PaO2∶FiO2 ratios. Decrease in TAPSE, increase in Tei index, and septal shift were seen in the severe ARDS group. In multivariate logistic regression models, TAPSE maintained a significant association with mortality independent of age, pH, PaO2∶FiO2 ratios, positive end expiratory pressure, PCO2, serum bicarbonate, plateau pressures, driving pressures, APACHE II, SAPS II, and SOFA scores. In conclusion, TAPSE and other TTE parameters should be used as novel predictive indicators for RV dysfunction in ARDS. These parameters can be used as surrogate noninvasive RV hemodynamic measurements to be manipulated to improve mortality in patients with ARDS and contributory RV dysfunction.
authors.affiliation: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Trushil G
authors.initials: TG
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Subeer K
authors.initials: SK
authors.lastname: Wadia
authors.affiliation: Department of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Kovach
authors.affiliation: Rush University College of Nursing, Rush University, Chicago, Illinois, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.affiliation: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Rajive
authors.initials: R
authors.lastname: Tandon
keywords: pulmonary hypertension; transthoracic echocardiography; tricuspid annular plane systolic excursion