Subcostal TAPSE: a retrospective analysis of a novel right ventricle function assessment method from the subcostal position in patients with sepsis

Alison B Main, Rachel Braham, Daniel Campbell, Andrew J Inglis, Anthony McLean, Sam Orde, Alison B Main, Rachel Braham, Daniel Campbell, Andrew J Inglis, Anthony McLean, Sam Orde

Abstract

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.

Keywords: Apical four chamber; Right ventricle; Sepsis; Subcostal; Tricuspid annular plane systolic excursion.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
TAPSE measurement. a A4C TAPSE: standard method from the A4C window using M-mode. b Subcostal TAPSE: measured from subcostal window using B-mode imaging and marker
Fig. 2
Fig. 2
Study design: patients included in study
Fig. 3
Fig. 3
Bland–Altman plot demonstrating mean difference between A4C and Subcostal TAPSE

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Source: PubMed

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