The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy
Abstract Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-01-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-024-01242-0 |
| _version_ | 1827377138969346048 |
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| author | Emma Bowcock Stephen Huang Rachel Yeo Deshani Walisundara Chris F. Duncan Faraz Pathan Geoffrey Strange David Playford Sam Orde |
| author_facet | Emma Bowcock Stephen Huang Rachel Yeo Deshani Walisundara Chris F. Duncan Faraz Pathan Geoffrey Strange David Playford Sam Orde |
| author_sort | Emma Bowcock |
| collection | DOAJ |
| description | Abstract Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. Methods We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (< 5.9 mm.(m/s)−1), middle (≥ 5.9–8.02 mm.(m/s)−1), and high (≥ 8.03 mm.(m/s)−1). The distribution of the TAPSE/TRV ratio across ventricular function subtypes of normal, isolated left ventricular (LV), isolated RV, and biventricular dysfunction was explored. The overall prognostic relevance of the TAPSE/TRV ratio was tested, including distribution across septic, cardiovascular, respiratory, and neurological subgroups. Results Higher proportions of ventricular dysfunctions were seen in low TAPSE/TRV tertiles. TAPSE/TRV ratio is impacted by LV systolic function but to a lesser extent than RV dysfunction or biventricular dysfunction. There was a strong inverse relationship between TAPSE/TRV ratio and survival. After multivariate analysis, higher TAPSE/TRV ratios (indicating better RV-PA coupling) were independently associated with lower risk of death in ICU (HR 0.927 [0.872–0.985], p < 0.05). Kaplan–Meier analysis demonstrated higher overall survival in middle and high tertiles compared to low tertiles (log rank p < 0.0001). The prognostic relevance of TAPSE/TRV ratio was strongest in respiratory and sepsis subgroups. Patients with TAPSE/TRV < 5.9 mm (m/s)−1 had a significantly worse prognosis than those with higher TAPSE/TRV ratios. Conclusion The TAPSE/TRV ratio has prognostic relevance in critically ill patients. The prognostic power may be stronger in respiratory and septic subgroups. Larger prospective studies are needed to investigate the role of TAPSE/TRV in pre-specified subgroups including its role in clinical decision-making. |
| first_indexed | 2024-03-08T12:34:36Z |
| format | Article |
| id | doaj.art-96da1f8dc5af416f966f0add64ca46a1 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-08T12:34:36Z |
| publishDate | 2024-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-96da1f8dc5af416f966f0add64ca46a12024-01-21T12:35:15ZengSpringerOpenAnnals of Intensive Care2110-58202024-01-0114111410.1186/s13613-024-01242-0The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudyEmma Bowcock0Stephen Huang1Rachel Yeo2Deshani Walisundara3Chris F. Duncan4Faraz Pathan5Geoffrey Strange6David Playford7Sam Orde8Intensive Care Medicine, Nepean HospitalIntensive Care Medicine, Nepean HospitalIntensive Care Medicine, Nepean HospitalIntensive Care Medicine, John Hunter HospitalIntensive Care Medicine, Nepean HospitalUniversity of SydneyUniversity of SydneyThe University of Notre DameIntensive Care Medicine, Nepean HospitalAbstract Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. Methods We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (< 5.9 mm.(m/s)−1), middle (≥ 5.9–8.02 mm.(m/s)−1), and high (≥ 8.03 mm.(m/s)−1). The distribution of the TAPSE/TRV ratio across ventricular function subtypes of normal, isolated left ventricular (LV), isolated RV, and biventricular dysfunction was explored. The overall prognostic relevance of the TAPSE/TRV ratio was tested, including distribution across septic, cardiovascular, respiratory, and neurological subgroups. Results Higher proportions of ventricular dysfunctions were seen in low TAPSE/TRV tertiles. TAPSE/TRV ratio is impacted by LV systolic function but to a lesser extent than RV dysfunction or biventricular dysfunction. There was a strong inverse relationship between TAPSE/TRV ratio and survival. After multivariate analysis, higher TAPSE/TRV ratios (indicating better RV-PA coupling) were independently associated with lower risk of death in ICU (HR 0.927 [0.872–0.985], p < 0.05). Kaplan–Meier analysis demonstrated higher overall survival in middle and high tertiles compared to low tertiles (log rank p < 0.0001). The prognostic relevance of TAPSE/TRV ratio was strongest in respiratory and sepsis subgroups. Patients with TAPSE/TRV < 5.9 mm (m/s)−1 had a significantly worse prognosis than those with higher TAPSE/TRV ratios. Conclusion The TAPSE/TRV ratio has prognostic relevance in critically ill patients. The prognostic power may be stronger in respiratory and septic subgroups. Larger prospective studies are needed to investigate the role of TAPSE/TRV in pre-specified subgroups including its role in clinical decision-making.https://doi.org/10.1186/s13613-024-01242-0TAPSEPulmonary hypertensionEchocardiographyVentriculo-arterial couplingVentricular dysfunctionCritical illness |
| spellingShingle | Emma Bowcock Stephen Huang Rachel Yeo Deshani Walisundara Chris F. Duncan Faraz Pathan Geoffrey Strange David Playford Sam Orde The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy Annals of Intensive Care TAPSE Pulmonary hypertension Echocardiography Ventriculo-arterial coupling Ventricular dysfunction Critical illness |
| title | The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy |
| title_full | The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy |
| title_fullStr | The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy |
| title_full_unstemmed | The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy |
| title_short | The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy |
| title_sort | value of right ventricular to pulmonary arterial coupling in the critically ill a national echocardiography database of australia neda substudy |
| topic | TAPSE Pulmonary hypertension Echocardiography Ventriculo-arterial coupling Ventricular dysfunction Critical illness |
| url | https://doi.org/10.1186/s13613-024-01242-0 |
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