title: Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS: a more objective approach.
abstract: OBJECTIVE
  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/FiO2ratios), 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.
authors: Rush University Medical Center, Chicago, Illinois.
authors: Subeer Kanwar
authors: SK
authors: Wadia
authors: Rush University Medical Center, Chicago, Illinois.
authors: Trushil G
authors: TG
authors: Shah
authors: Rush University Medical Center, Chicago, Illinois.
authors: Grady
authors: G
authors: Hedstrom
authors: Rush University Medical Center, Chicago, Illinois.
authors: Julie A
authors: JA
authors: Kovach
authors: Rush University Medical Center, Chicago, Illinois.
authors: Rajive
authors: R
authors: Tandon
mesh_terms: D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology
keywords: 
  TAPSE
  ; acute respiratory distress syndrome; dysfunction; right ventricle; transthoracic echocardiography