Prognostic Value of Tricuspid Annular Plane Systolic Excursion and Right Ventricular Outflow Tract Fractional Shortening in Mechanically Ventilated Septic Patients

Hongmin Zhang; Xiukai Chen; Hui Lian; Qing Zhang; Xiaoting Wang; Min Zheng; Dawei Liu; Chinese Critical Ultrasound Study Group

doi:10.1053/j.jvca.2020.10.002

Prognostic Value of Tricuspid Annular Plane Systolic Excursion and Right Ventricular Outflow Tract Fractional Shortening in Mechanically Ventilated Septic Patients

J Cardiothorac Vasc Anesth. 2020 Oct 8:S1053-0770(20)31059-4. doi: 10.1053/j.jvca.2020.10.002. Online ahead of print.

Authors

Hongmin Zhang¹, Xiukai Chen², Hui Lian³, Qing Zhang¹, Xiaoting Wang¹, Min Zheng¹, Dawei Liu⁴; Chinese Critical Ultrasound Study Group

Affiliations

¹ Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
² Pittsburgh Heart, Lung, Blood, and Vascular Institute, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
³ Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. Electronic address: dwliu2015@sina.com.

PMID: 34756352
DOI: 10.1053/j.jvca.2020.10.002

Abstract

Objective: The authors aimed to explore whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow fractional shortening (RVOT-FS) were associated with long-term prognosis in mechanically ventilated septic patients.

Design: A prospective observational study.

Setting: A tertiary hospital intensive care unit (ICU).

Participants: One hundred eighty-one septic patients who were on mechanical ventilation.

Interventions: Echocardiography was performed within 24 hours of ICU admission.

Measurements and main results: Several echocardiographic parameters, including TAPSE and RVOT-FS, as well as prognostic information, were collected. A Cox regression survival analysis showed that TAPSE was independently associated with one-year all-cause mortality (hazard ratio [HR] 0.407, 95% confidence interval [CI]: 0.200-0.827, p = 0.013), but ROVT-FS was not (HR 0.997, 95% CI: 0.970-1.025, p = 0.828). ROC analysis showed that the optimal cutoff value for TAPSE and RVOT-FS to determine one-year mortality was TAPSE <18 mm and RVOT-FS <40%. The one-year mortality in patients with low TAPSE (n = 88) and in patients with both low TAPSE and low RVOT-FS (n = 60) was 45.5% and 48.3%, respectively; p = 0.724. In a multivariate analysis, RVOT-FS did not add significant prognostic information to that provided by TAPSE <18 mm (p = 0.197).

Conclusions: TAPSE was an independent predictor of one-year all-cause mortality in mechanically ventilated septic patients. RVOT-FS was not associated with one-year mortality and added no prognostic value to TAPSE in these patients.

Keywords: echocardiography; right ventricular outflow tract fractional shortening; sepsis; septic shock; tricuspid annular plane systolic excursion.