Key result
Subcostal TAPSE correlated well with conventional apical four-chamber TAPSE with a mean difference of 1.2 mm, accurately discriminating abnormal right ventricular function with 97.8% sensitivity.
Why the study?
TAPSE is often difficult to obtain in critically ill patients, prompting evaluation of the feasibility and accuracy of a subcostal TAPSE measurement for right-ventricular dysfunction.
Does subcostal TAPSE accurately measure right ventricular function compared to apical four-chamber TAPSE in critically ill patients with sepsis?
Observational (n=56)
Single-blind
No
Does subcostal TAPSE accurately measure right ventricular function compared to apical four-chamber TAPSE in critically ill patients with sepsis?
Mean Difference: 1.2 (95% CI 0.04–2.36)
Subcostal TAPSE is a feasible and accurate alternative to conventional apical TAPSE for assessing right ventricular function in critically ill patients with sepsis.
May enable RV assessment when apical views are inadequate; leaves open need for prospective validation before clinical adoption.
BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE) is frequently used as an objective measure of right-ventricular dysfunction. Abnormal TAPSE values are associated with poor prognosis in a number of disease states; however, the measure is not always easy to obtain in the critically ill. The purpose of this study is to assess the feasibility and accuracy of using a subcostal view and TAPSE measurement as a measure of right-ventricular dysfunction. A secondary aim was to perform a pilot study to assess whether right-ventricular dysfunction was associated with adverse outcomes including mortality. RESULTS: Subcostal TAPSE corresponds well with TAPSE obtained from the apical window at low and moderate TAPSE values (mean difference 1.2 mm (CI 0.04-2.36; 100% data pairs < 3-mm difference for TAPSE < 19 mm; 92% had < 3 mm difference at TAPDE < 24 mm). Subcostal TAPSE is able to accurately discriminate between abnormal and normal TAPSE results (sensitivity 97.8%, specificity 87.5%). There was no association between right-ventricular (RV) dysfunction and 90-day mortality. CONCLUSIONS: Subcostal TAPSE is a feasible and accurate alternative to conventional TAPSE from the apical view in critically ill patients. Further research is required to elucidate the relationship between RV dysfunction and outcomes in sepsis.
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Main et al. (2019) conducted an observational in Sepsis (n=56). Subcostal TAPSE vs. Apical four-chamber TAPSE was evaluated on Mean difference between subcostal and apical four-chamber TAPSE (MD 1.2, 95% CI 0.04-2.36). Subcostal TAPSE correlated well with conventional apical four-chamber TAPSE with a mean difference of 1.2 mm, accurately discriminating abnormal right ventricular function with 97.8% sensitivity.
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