The place of the TAPSE/PASP in the diagnosis of right heart dysfunction in critically ill patients.

OBJECTIVE

ICU patients with cardiac and chronic respiratory failure (CRF) often experience increased right heart load, necessitating reliable parameters to assess right heart dysfunction (RHD). This study evaluates the right ventriculo-pulmonary artery (RV-PA) uncoupling ratio's (TAPSE/PASP's) diagnostic role for RHD in ICU setting.

DESIGN

Single-center retrospective observational cohort study.

PATIENTS: One hundred and thirty-three adult ICU patients from a tertiary hospital.

INTERVENTIONS: None.

MAIN VARIABLES OF INTEREST: Echocardiographic and clinical data were analyzed. Patients were stratified by TAPSE/PASP tertiles (<0.30, 0.30-0.50, >0.50). TAPSE/PASP was compared with other RHD parameters. ROC curve analysis, decision curve analysis, net reclassification index and integrated discrimination improvement analysis were used to evaluate its diagnostic accuracy and place in clinical decision for treatment.

RESULTS

Lower TAPSE/PASP ratios correlated with enlarged right and left cardiac chambers, reduced left and right ventricular outflow tract velocity time integrals, stroke volume, cardiac output, and ejection fraction. TAPSE/PASP outperformed other RHD parameters in reflecting biventricular structural and functional changes, diagnosing more cases. Based on predefined echocardiographic criteria (TAPSE < 16 mm or RV-FAC < 35%), ROC analysis identified an optimal TAPSE/PASP cutoff of 0.48 mm/mmHg (AUC = 0.702, 95% CI: [0.579-0.825], P < .05)). Decision curve analysis demonstrated that using the TAPSE/PASP ratio provides a consistently higher net benefit across a clinically relevant range of threshold probabilities (approximately 10%-40%) compared to using TAPSE alone.

CONCLUSION

TAPSE/PASP effectively assesses RV-PA uncoupling and RHD in medical ICU patients. While the ratio does not offer superior diagnostic accuracy, it provides additional clinical decision support for treatment decisions compared to TAPSE alone.