TAPSE effective biomarker associated with high-risk of severe COVID-19

In a retrospective study, tricuspid annular plane systolic excursion (TAPSE) was associated with ICU admission or death in hospitalised patients with COVID-19.

The clinical course of COVID-19 is highly variable. Thus, the identification of biomarkers associated with severe disease might enable an effective risk stratification. Respiratory complications during the infection may lead to right ventricular (RV) failure. RV failure remains a major cause of mortality during acute pulmonary embolism. TAPSE has emerged as a simple RV longitudinal strain measure and a validated global RV function parameter [1]. Owing to its complex geometry, the RV is difficult to measure. Yet, it is still important to quantify the RV with echo. The basal diameter is a reproducible measure of RV size. In a retrospective, observational study, Dr Neil Bodagh (King´s College Hospital NHS Foundation Trust, UK) and colleagues assessed whether RV size and/or function were associated with worse outcomes in hospitalised patients with COVID-19 [2].

Enrolled were 119 patients (38% women and median age of 73 years), who were admitted to Princess Royal University Hospital between March and June 2020. RV basal diameter >41 mm was considered abnormal. TAPSE was used to assess RV function (abnormal values <17 mm). The primary outcome was ICU admission and/or death after 3 months of follow-up. Chi-squared tests were performed to assess associations between echocardiographic parameters and outcomes.

The association between RV size according to RV base diameter and admission to ICU and/or death was not statistically significant. In contrast, a significant association was found between abnormal TAPSE and either admission to ICU and/or death (chi-square 4.33; P<0.05). Thus, reduced TAPSE appears to correlate with admission to ICU and/or mortality in hospitalised patients with COVID-19. These results confirm a meta-analysis including 641 patients from 7 studies published this year [3]. In this analysis, every 1 mm decrease in TAPSE was associated with an increase in mortality of approximately 20%.

Although RV dilation was noticed in 27% of patients, it did not correlate with worse outcomes. Dr Bodagh pointed out that the retrospective design poses a limitation of the study. Interobserver variability in measurements cannot be excluded. However, these findings are in line with published data. An advantage of TAPSE is that it is simple to perform and easy to measure in a wide range of settings. Dr Bodagh concluded that TAPSE could be used to identify patients with severe disease.

1. 
   
   1. Schmid E, et al. Heart Lung Vessel 2015;7:151–8.
   2. Bodagh N. Association between right ventricle size and function on outcomes in COVID-19. Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.
   3. Martha JW, et al. Int J Infect Dis 2021;105:351–6.

 

Copyright ©2021 Medicom Medical Publishers



Posted on 19 August, 202120 August, 2021