Tricuspid annular plane systolic excursion/mitral annular plane systolic excursion ratio in critically ill patients: an index of right- and left-ventricular function mismatch and a risk factor for cardiogenic pulmonary edema

BackgroundThis study aimed to explore whether the tricuspid annular systolic excursion (TAPSE)/mitral annular systolic excursion (MAPSE) ratio was associated with the occurrence of cardiogenic pulmonary edema (CPE) in critically ill patients.Materials and methodsThis was a prospective observational study conducted in a tertiary hospital. Adult patients admitted to the intensive care unit who were on mechanical ventilation or in need of oxygen therapy were prospectively screened for enrolment. The diagnosis of CPE was determined based on lung ultrasound and echocardiography findings. TAPSE >= 17 mm and MAPSE >= 11 mm were used as normal references.ResultsAmong the 290 patients enrolled in this study, 86 had CPE. In the logistic regression analysis, the TASPE/MAPSE ratio was independently associated with the occurrence of CPE (odds ratio 4.855, 95% CI: 2.215-10.641, p < 0.001). The patients' heart function could be categorized into four types: normal TAPSE in combination with normal MAPSE (TAPSE up arrow/MAPSE up arrow) (n = 157), abnormal TAPSE in combination with abnormal MAPSE (TAPSE down arrow/MAPSE down arrow) (n = 40), abnormal TAPSE in combination with normal MAPSE (TAPSE down arrow/MAPSE up arrow) (n = 50) and normal TAPSE in combination with abnormal MAPSE (TAPSE up arrow/MAPSE down arrow) (n = 43). The prevalence of CPE in patients with TAPSE up arrow/MAPSE down arrow (86.0%) was significantly higher than that in patients with TAPSE up arrow/MAPSE up arrow (15.3%), TAPSE down arrow/MAPSE down arrow (37.5%), or TAPSE down arrow/MAPSE up arrow (20.0%) (p < 0.001). The ROC analysis showed that the area under the curve for the TAPSE/MAPSE ratio was 0.761 (95% CI: 0.698-0.824, p < 0.001). A TAPSE/MAPSE ratio of 1.7 allowed the identification of patients at risk of CPE with a sensitivity of 62.8%, a specificity of 77.9%, a positive predictive value of 54.7% and a negative predictive value of 83.3%.ConclusionsThe TAPSE/MAPSE ratio can be used to identify critically ill patients at higher risk of CPE.