Abstract 14753: Prognostic Value of TAPSE in Critically Ill Patients
Background: Transient left ventricular dysfunction (e.g. Takotsubo cardiomyopathy) can occur under conditions of extreme emotional or physiological stress. There is little data on right ventricular function in such situations.
Methods: Eligible subjects included patients admitted to a medical or surgical ICU with a non-cardiac illness. Those with a history of MI or documented coronary disease, ejection fraction known to be < 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 (lower limit of normal = 1.8 cm). Blood samples were drawn on admission for measurement of serum catecholamines (norepinephrine, epinephrine). Clinical and demographic data were collected, along with data on ICU length of stay (LOS), total hospital LOS, and in-hospital mortality.
Results: 103 consecutive patients with technically adequate echocardiograms were studied. Mean TAPSE for the group was 2.1 ± 0.6 cm (range 0.4-3.5). There was a significant, inverse correlation between the TAPSE and total LOS (r= -0.22, p=0.03); similar results were observed with ICU LOS (r= -0.21, p=0.05). There were 11 in-hospital deaths. TAPSE in that group ranged from 0.4-2.4 cm, with 5 (45%) patients having values <1.8 cm. Among hospital survivors TAPSE ranged from 0.4-3.5 cm with 27 (29%) having values <1.8 cm. Mean TAPSE in those who died was 1.6 ± 0.8 cm vs. 2.1 ± 0.6 cm in survivors, p=0.01. Neither serum norepinephrine or epinephrine levels showed an association with TAPSE.
Conclusions: Right ventricular systolic function, as assessed by TAPSE, may have important prognostic value in critically ill patients. Mean values were lower in patients who died in-hospital vs. those who survived to discharge. In addition, both ICU LOS and total LOS were inversely correlated with TAPSE.
- © 2013 by American Heart Association, Inc.