Although right ventricular (RV) performance is often evaluated separately, its strong link to afterload suggests that a combined examination of RV-pulmonary arterial (RV-PA) coupling and RV-outflow tract (RVOT) Doppler may be more revealing than conventional assessment methods. This study sought to address the shortage of information available on the practicability and value of these measures in sepsis. About 131 patients with sepsis who were brought to the intensive care unit were analyzed retrospectively over a 3-year period using transthoracic echocardiography (TTE) and right ventricular outflow tract (RVOT) pulsed wave Doppler. In addition to conventional assessments of RV systolic function and pulmonary pressures, RVOT Doppler flow and RV-PA coupling were also assessed. Examining the RVOT Doppler, researchers looked at the pulmonary artery acceleration time (PAAT), the velocity time integral, and the existence of notching. RV-PA coupling was evaluated by measuring the tricuspid annular plane systolic excursion ratio to pulmonary artery systolic pressure (TAPSE/PASP) ratio. PAAT was measurable in 106 (81%) patients, and TAPSE/PASP was measurable in 77 (73%). About 73 (69%) patients had a PAAT of less than or equal to 100 ms suggesting raised pulmonary vascular resistance (PVR) is common. RVOT flow notching occurred in 15 (14%) of patients. TRV was unable to be assessed in 24 (23%) patients where measurement of PAAT was possible. RV dysfunction (RVD) was present in 28 (26%), 26 (25%), and 36 (34%) patients if subjective assessment, TAPSE less than 17 mm, and RV dilatation definitions were used, respectively. There was a trend towards shorter PAAT with increasing severity of RVD. RV–PA uncoupling, defined as a TAPSE/PASP less than 0.31 mm/mmHg, was present in 15 (19%) patients. TAPSE seemed more sensitive to changes in LV systolic function, while the RV-PA coupling ratio declined with increasing RV dilatation regardless of LV systolic function. A large percentage of sepsis patients exhibit an increased PVR and RV-PA uncoupling. TTE has the potential to provide a non-invasive evaluation. More research is needed to determine whether or not these factors can aid in more precise definitions of RVD and whether or not they can improve prognoses beyond the use of more conventional parameters.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04160-4
