PMID- 38228991
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240119
IS  - 2110-5820 (Print)
IS  - 2110-5820 (Electronic)
IS  - 2110-5820 (Linking)
VI  - 14
IP  - 1
DP  - 2024 Jan 16
TI  - The value of right ventricular to pulmonary arterial coupling in the critically 
      ill: a National Echocardiography Database of Australia (NEDA) substudy.
PG  - 10
LID - 10.1186/s13613-024-01242-0 [doi]
LID - 10
AB  - 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.
CI  - (c) 2024. Crown.
FAU - Bowcock, Emma
AU  - Bowcock E
AUID- ORCID: 0000-0002-3567-6655
AD  - Intensive Care Medicine, Nepean Hospital, Sydney, Australia. 
      Emma.bowcock@health.nsw.gov.au.
AD  - University of Sydney, Sydney, Australia. Emma.bowcock@health.nsw.gov.au.
FAU - Huang, Stephen
AU  - Huang S
AD  - Intensive Care Medicine, Nepean Hospital, Sydney, Australia.
AD  - University of Sydney, Sydney, Australia.
FAU - Yeo, Rachel
AU  - Yeo R
AD  - Intensive Care Medicine, Nepean Hospital, Sydney, Australia.
FAU - Walisundara, Deshani
AU  - Walisundara D
AD  - Intensive Care Medicine, John Hunter Hospital, Newcastle, Australia.
FAU - Duncan, Chris F
AU  - Duncan CF
AD  - Intensive Care Medicine, Nepean Hospital, Sydney, Australia.
FAU - Pathan, Faraz
AU  - Pathan F
AD  - University of Sydney, Sydney, Australia.
AD  - Department of Cardiology, Nepean Hospital, Sydney, Australia.
FAU - Strange, Geoffrey
AU  - Strange G
AD  - University of Sydney, Sydney, Australia.
AD  - The University of Notre Dame, Fremantle, Australia.
FAU - Playford, David
AU  - Playford D
AD  - The University of Notre Dame, Fremantle, Australia.
FAU - Orde, Sam
AU  - Orde S
AD  - Intensive Care Medicine, Nepean Hospital, Sydney, Australia.
AD  - University of Sydney, Sydney, Australia.
LA  - eng
PT  - Journal Article
DEP - 20240116
PL  - Germany
TA  - Ann Intensive Care
JT  - Annals of intensive care
JID - 101562873
PMC - PMC10792157
OTO - NOTNLM
OT  - Critical illness
OT  - Echocardiography
OT  - Intensive care units
OT  - Pulmonary hypertension
OT  - Survival
OT  - TAPSE
OT  - Ventricular dysfunction
OT  - Ventriculo-arterial coupling
COIS- The authors declare they have no competing interests.
EDAT- 2024/01/17 00:42
MHDA- 2024/01/17 00:43
PMCR- 2024/01/16
CRDT- 2024/01/16 23:33
PHST- 2023/09/13 00:00 [received]
PHST- 2024/01/02 00:00 [accepted]
PHST- 2024/01/17 00:43 [medline]
PHST- 2024/01/17 00:42 [pubmed]
PHST- 2024/01/16 23:33 [entrez]
PHST- 2024/01/16 00:00 [pmc-release]
AID - 10.1186/s13613-024-01242-0 [pii]
AID - 1242 [pii]
AID - 10.1186/s13613-024-01242-0 [doi]
PST - epublish
SO  - Ann Intensive Care. 2024 Jan 16;14(1):10. doi: 10.1186/s13613-024-01242-0.