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

• Published in: The ultrasound journal Vol. 11; no. 1; pp. 19 - 8
• Main Authors: Main, Alison B., Braham, Rachel, Campbell, Daniel, Inglis, Andrew J., McLean, Anthony, Orde, Sam
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 27-08-2019; Springer Nature B.V; SpringerOpen
• Subjects: Apical four chamber; Critical care; Critical Care Medicine; Diagnostic Radiology; Emergency Medicine; Feasibility; Heart; Imaging; Intensive; Interventional Radiology; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Patient assessment; Radiology; Right ventricle; Sepsis; Subcostal; Tricuspid annular plane systolic excursion; Ultrasound; Sepsis; Apical four chamber; Right ventricle; Subcostal; Tricuspid annular plane systolic excursion
• ISSN: 2524-8987; 2524-8987
• DOI: 10.1186/s13089-019-0134-7

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.