Tricuspid annular plane systolic excursion and central venous pressure in mechanically ventilated critically ill patients

Hongmin Zhang, Xiaoting Wang, Xiukai Chen, Qing Zhang, Dawei Liu, Hongmin Zhang, Xiaoting Wang, Xiukai Chen, Qing Zhang, Dawei Liu

Abstract

Background: The tricuspid annular plane systolic excursion (TAPSE) is commonly recommended for estimating the right ventricular systolic function. The central venous pressure (CVP), which is determined by venous return and right heart function, was found to be associated with right ventricular outflow fractional shortening. This study thus aimed to investigate the relationship between the TAPSE and CVP in mechanically ventilated critically ill patients.

Methods: This is a prospective observational study. From October 1 to December 31, 2017, patients admitted to the intensive care unit with CVP monitoring and controlled mechanical ventilation were screened for enrolment. Echocardiographic parameters, including the TAPSE, mitral annular plane systolic excursion (MAPSE), left ventricular ejection fraction (LVEF), and internal diameter of inferior vena cava (dIVC), and haemodynamic parameters, including the CVP, were collected.

Results: Seventy-four patients were included. Thirty-one were included in the low LVEF (< 55%) group, and 43 were included in the high LVEF (≥55%) group. In the high LVEF group, the TAPSE and CVP were not correlated (r = - 0.234, P = 0.151). In the low LVEF group, partial correlation analysis indicated that the TAPSE and CVP were correlated (r = - 0.516, P = 0.006), and multivariable linear regression analysis indicated that the TAPSE was independently associated with the CVP (standard coefficient: - 0.601, p < 0.001). Additionally, in the low LVEF group, a ROC analysis showed that the area under the curve of the TAPSE for the detection of CVP greater than 8 mmHg was 0.860 (95% confidence interval: 0.730-0.991; P = 0.001). The optimum cut-off value was 1.52 cm, which resulted in a sensitivity of 75.0%, a specificity of 86.7%, a positive predictive value of 84.6% and a negative predictive value of 77.8%.

Conclusions: The TAPSE is inversely correlated with the CVP in mechanically ventilated critically ill patients who have a LVEF less than 55%.

Keywords: Central venous pressure; Critically ill; Echocardiography; Tricuspid annulus plane systolic excursion.

Conflict of interest statement

This study was approved by the ethics committee of Peking Union Medical College Hospital, Beijing, China. Written informed consent was obtained from the next of kin of each patient.

Not applicable.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The measurement of TAPSE
Fig. 2
Fig. 2
Flow chart of patient enrollment
Fig. 3
Fig. 3
Correlation between TAPSE and CVP in patients with LVEF below 55%. CVP was negatively correlated with TAPSE, r = − 0.516, P = 0.006
Fig. 4
Fig. 4
ROC curve to detect CVP greater than 8 mmHg in patients with LVEF below 55%. The area under the curve for TAPSE to detect CVP >8 mmHg in patients with LVEF P = 0.001, TAPSE at 1.52, sensitivity 75.0%, specificity 86.7%. The area under the curve for dIVC to detect CVP >8 mmHg in patients with LVEF <55% is 0.723 (95%CI 0.533, 0.913), P = 0.034, dIVC at 1.8, sensitivity 68.8%, specificity73.3%. Area comparison, Z = − 1.162, P = 0.245

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