No abstract

Background: This systematic review and meta-analysis aimed to assess whether tricuspid annular plane systolic excursion (TAPSE) could be used as a prognostic tool in patients with coronavirus disease 19 .Methods: Studies on the relationship between TAPSE and COVID-19 since February 2021. Standardized mean difference (SMD) and 95% confidence intervals were used to assess the effect size. The potential for publication bias was assessed using a contourenhanced funnel plot and Egger test. A meta-regression was performed to assess if the difference in TAPSE between survivors and nonsurvivors was affected by age, sex, hypertension or diabetes.Results: Sixteen studies comprising 1579 patients were included in this meta-analysis. TAPSE was lower in nonsurvivors (SMD À3.24 (À4.23, À2.26), P < .00001; I 2 = 71%), and a subgroup analysis indicated that TAPSE was also lower in critically ill patients (SMD À3.85 (À5.31, À2.38,), P < .00001; I 2 = 46%). Heterogeneity was also significantly reduced, I 2 < 50%. Pooled results showed that patients who developed right ventricular dysfunction had lower TAPSE (SMD À5.87 (À7.81, À3.92), P = .004; I 2 = 82%). There was no statistically significant difference in the TAPSE of patients who sustained a cardiac injury vs those who did not (SMD À1.36 (À3.98, 1.26), P = .31; I 2 = 88%). No significant publication bias was detected (P = .8147) but the heterogeneity of the included studies was significant. A meta-regression showed that heterogeneity was significantly greater when the incidence of hypertension was <50% (I 2 = 91%) and that of diabetes was <30% (I 2 = 85%). Conclusion:Low TAPSE levels are associated with poor COVID-19 disease outcomes. TAPSE levels are modulated by disease severity, and their prognostic utility may be skewed by pre-existing patient comorbidities.