Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS : a more objective approach

Purpose Right ventricular ( RV ) dysfunction is an independent predictor of morbidity and mortality in acute respiratory distress syndrome ( ARDS ). Our goal was to describe morphologic changes in the RV using objective measures on transthoracic echocardiography ( TTE ) that occur following ARDS . Methods We retrospectively measured changes in the following RV parameters from a pre‐ ARDS TTE to an ARDS TTE : tricuspid annular plane systolic excursion ( TAPSE ), myocardial performance index ( MPI ), fractional area change ( FAC ), systolic pulmonary artery pressure ( SPAP ), peak tricuspid regurgitant ( TR ) velocity, and septal shift. Results Over 24 months, 14 patients met inclusion/exclusion criteria. Mean TAPSE decreased from 22.4 mm pre‐ ARDS to 16.3 mm during ARDS , P <.001. Mean MPI increased from 0.19 to 0.38, P =.001. Mean FAC decreased from 60.8% to 41.2%, P =.003. Peak TR velocity increased from 2.67 m/s pre‐ ARDS to 3.31 m/s during ARDS , P =.02. SPAP and septal shift demonstrated trends but not statistically different between pre‐ ARDS and ARDS states. TAPSE correlated with ARDS severity (PaO 2 /FiO 2 ratios), P =.004, and was lower among 30‐day nonsurvivors compared with survivors, P =.002. Conclusions Mild RV dysfunction is common after ARDS onset. RV morphologic changes coupled with dysfunction can be detected noninvasively through TTE changes with TAPSE , MPI , and FAC . Mild RV dysfunction by TAPSE is associated with ARDS severity and mortality.