Low tricuspid annular plane systolic excursion is associated with a poor outcome in patients with COVID-19: A systematic review and meta-analysis

• Published in: Medicine (Baltimore) Vol. 101; no. 8; p. e28971
• Main Authors: Tian, Ye, Lu, Huaihai, Liu, Xuefang, Zhao, Yinlong, Zhang, Pei
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 25.02.2022
• Subjects: COVID-19; Echocardiography - methods; Humans; Hypertension - complications; SARS-CoV-2; Systematic Review and Meta-Analysis; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - physiopathology; Ventricular Dysfunction, Right - etiology; Ventricular Function, Right - physiology
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000028971

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 (COVID-19). 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 contour-enhanced 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. Sixteen studies comprising 1579 patients were included in this meta-analysis. TAPSE was lower in nonsurvivors (SMD -3.24 (-4.23, -2.26), P < .00001; I2 = 71%), and a subgroup analysis indicated that TAPSE was also lower in critically ill patients (SMD -3.85 (-5.31, -2.38,), P < .00001; I2 = 46%). Heterogeneity was also significantly reduced, I2 < 50%. Pooled results showed that patients who developed right ventricular dysfunction had lower TAPSE (SMD -5.87 (-7.81, -3.92), P = .004; I2 = 82%). There was no statistically significant difference in the TAPSE of patients who sustained a cardiac injury vs those who did not (SMD -1.36 (-3.98, 1.26), P = .31; I2 = 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% (I2 = 91%) and that of diabetes was <30% (I2 = 85%). 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. PROSPERO CRD42021236731.