Prognostic Value of TAPSE/sPAP Ratio, RV S′ Velocity, and RV S′/sPAP Ratio in Hospitalized Patients with COVID-19: A Retrospective Echocardiographic Analysis
Abstract
Aim: This study aimed to evaluate the association between the tricuspid annular plane systolic excursion (TAPSE) systolic pulmonary artery pressure (sPAP) ratio, right ventricular (RV) S′ velocity, RV S′/sPAP ratio and, adverse clinical outcomes in hospitalized COVID-19 patients.
Materials and Methods: A retrospective cohort of 100 adult patients hospitalized with laboratory-confirmed COVID-19 who underwent transthoracic echocardiography (TTE) was analyzed. Patients were classified into two groups according to clinical outcomes: adverse outcome (ICU admission, mechanical ventilation, ARDS, or in-hospital mortality) and favorable outcome. Echocardiographic parameters (TAPSE, sPAP, RV S′, TAPSE/sPAP, and RV S′/sPAP) were compared between groups, and receiver operating characteristic (ROC) curve analysis was performed to assess discriminative performance in this exploratory analysis.
Results: Thirty-two patients experienced adverse outcomes. The TAPSE/sPAP ratio (0.44 ± 0.18 vs. 0.55 ± 0.22, p = 0.006), RV S′ velocity (9.17 ± 2.1 cm/s vs. 10.54 ± 2.1 cm/s, p = 0.004), and RV S′/sPAP ratio (0.28 ± 0.10 vs. 0.33 ± 0.08, p = 0.008) were significantly lower in the adverse outcome group. ROC analysis showed fair discriminative performance for TAPSE/sPAP, RV S′, and RV S′/sPAP with AUCs of 0.686, 0.691, and 0.753, respectively.
Conclusion: TAPSE/sPAP, RV S′, and RV S′/sPAP are non-invasive echocardiographic markers associated with adverse outcomes in hospitalized COVID-19 patients. Their combined use may contribute to early risk stratification in an exploratory, hypothesis-generating context.
Keywords
COVID-19, Echocardiography, Right ventricular function, Prognosis, TAPSE/sPAP, RV S′/sPAP
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References
- 1. Kim J, Volodarskiy A, Sultana R, Pollie MP, Yum B, Nambiar L et al. Prognostic Utility of Right Ventricular Remodeling Over Conventional Risk Stratification in Patients With COVID-19. J Am Coll Cardiol. 2020;76(17):1965-1977.
- 2. Karagodin I, Carvalho Singulane C, Woodward GM, Xie M, Tucay ES, Tude Rodrigues AC et al. Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study. J Am Soc Echocardiogr. 2021;34(8):819-830.
- 3. Li Y, Li H, Zhu S, Xie Y, Wang B, He L et al. Prognostic Value of Right Ventricular Longitudinal Strain in Patients With COVID-19. JACC Cardiovasc Imaging. 2020;13(11):2287-2299.
- 4. D'Alto M, Marra AM, Severino S, Salzano A, Romeo E, De Rosa R et al. Right ventricular-arterial uncoupling independently predicts survival in COVID-19 ARDS. Crit Care. 2020;24(1):670.
- 5. Bursi F, Santangelo G, Barbieri A, Vella AM, Toriello F, Valli F et al. Impact of Right Ventricular-Pulmonary Circulation Coupling on Mortality in SARS-CoV-2 Infection. J Am Heart Assoc. 2022;11(4):e023220.
- 6. Warpechowski J, Olichwier A, Golonko A, Warpechowski M, Milewski R. Literature Review-Transthoracic Echocardiography, Computed Tomography Angiography, and Their Value in Clinical Decision Making and Outcome Predictions in Patients with COVID-19 Associated Cardiovascular Complications. Int J Environ Res Public Health. 2023;20(12):6123.
- 7. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14.
- 8. Naeije R, Manes A. The right ventricle in pulmonary arterial hypertension. Eur Respir Rev. 2014;23(134):476-487.
- 9. Vanderpool RR, Pinsky MR, Naeije R, Deible C, Kosaraju V, Bunner C et al. RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension. Heart. 2015;101(1):37-43.
- 10. Guazzi M, Naeije R. Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives. J Am Coll Cardiol. 2017;69(13):1718-1734.