Key result
Acute fluid challenge increases TAPSE ~20% and decreases RV strain in preload responders.
Why the study?
Few data are available regarding 2D-STE parameters and their dependency on RV preload.
Does an acute fluid challenge alter 2D-STE parameters of right ventricular systolic function in healthy volunteers?
Does an acute fluid challenge alter 2D-STE parameters of right ventricular systolic function in healthy volunteers?
Absolute Event Rate: 24% vs 20%
p-value: p=0.018
RV strain parameters and TAPSE are preload-dependent in healthy volunteers, whereas tricuspid annular displacement parameters are not, indicating that loading conditions must be considered when assessing RV function.
RV strain and TAPSE require preload adjustment in echo interpretation; leaves open whether TAD parameters provide load-independent RV assessment in patients.
(1) Background: Right ventricular (RV) strain parameters derived from the analysis of the tricuspid annular displacement (TAD) are emergent two-dimensional speckle tracking echocardiography (2D-STE) parameter used for the quantitative assessment of RV systolic function. Few data are available regarding 2D-STE parameters and their dependency on RV preload. Our aim was to evaluate the effect of an acute change in RV preload on 2D-STE parameters in healthy volunteers. (2) Methods: Acute modification of RV preload was performed by a fluid challenge (FC): an infusion of 500 mL of 0.9% sodium chloride was given over 5 min in supine position. Preload dependency (responder group) was confirmed by a stroke volume increase of at least 10% measured by echocardiography. (3) Results: Among 32 healthy volunteers, 19 (59%) subjects were classified as non-responders and 13 (41%) as responders. In the responder group, the tricuspid annular plane systolic excursion (TAPSE) significantly increased (20 (20–23.5) mm to 24 (20.5–26.5) mm; p = 0.018), while RV strain parameters significantly decreased after FC: −23.5 ((−22.3)–(−27.3))% to −25 ((−24)–(29.6))%; p = 0.03) for RV free wall longitudinal strain and −22.8 ((−20.4)–(−30.7))% to −23.7 ((−21.2)–(−27))%; p = 0.02) for RV four-chamber longitudinal strain. 2D-STE parameters derived from the TAD analysis were not influenced by the FC (all p > 0.05). (4) Conclusions: In young, healthy volunteers, RV strain parameters and TAPSE are preload dependent, while TAD parameters were not. The loading conditions must be accounted for when evaluating RV systolic function by 2D-STE parameters.
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Beyls et al. (2021) studied Healthy volunteers (n=32). Fluid challenge (0.9% sodium chloride) vs. Baseline (pre-fluid challenge) was evaluated on Tricuspid annular plane systolic excursion (TAPSE) in the responder group (p=0.018). An acute fluid challenge significantly increased TAPSE (20 to 24 mm; p=0.018) and decreased RV strain parameters in preload responders, whereas TAD parameters were preload independent.
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