Low tricuspid annular plane systolic excursion is associated with a poor outcome in patients with COVID-19

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.

The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis

“…In another systematic review and metaanalysis, it has been shown that TAPSE in COVID-19 patients is related to mortality, right ventricular dysfunction, cardiac injury, and COVID-19 nonsurvivors had lower TAPSE measurements compared with survivors, while every 1 mm decrease in TAPSE was associated with an increase of approximately 20% in mortality. 69 In another systematic review and meta-analysis of 16 studies with 1579 patients, Tian et al 70 illustrated that lower TAPSE and poor COVID-19 outcomes were independently associated with mortality and right ventricular dysfunction. Additionally, it has been demonstrated that lower GLS in patients with COVID-19 correlates with disease-related mortality.…”

Factors of Persistent Limited Exercise Tolerance in Patients after COVID-19 with Normal Left Ventricular Ejection Fraction

“…A total of 25% presented with a decreased GLS, and 8% had a reduced RV GLS [ 31 ]. The meta-analysis of Tian et al showed that lower TAPSE relates to poor COVID-19 disease outcomes [ 32 ]. Sex differences have been demonstrated in the acute phase of COVID-19.…”

Relationship between hyponatremia at hospital admission and cardiopulmonary profile at follow-up in patients with SARS-CoV-2 (COVID-19) infection

“…These findings suggest a greater involvement of right-sided heart at follow-up in patients with basal hypoNa. Indeed, several meta-analyses have indicated that worse indexes of right ventricular function are associated with a more unfavorable outcome in COVID-19 patients [37][38][39][40].…”