Presentation Title

Tricuspid Annular Plane Systolic Excursion (TAPSE) Assessment in Septic Cardiomyopathy

Faculty Mentor

Shadi Lahham, MD, MS, Assistant Professor of Emergency Medicine, University of California, Irvine. John C. Fox, MD. John Moeller, MD. Chanel Fischetti, MD.

Start Date

17-11-2018 9:00 AM

End Date

17-11-2018 9:15 AM

Location

C304

Session

Oral 1

Type of Presentation

Oral Talk

Subject Area

health_nutrition_clinical_science

Abstract

The purpose of this study is to determine the association between right ventricular (RV) dysfunction and patient health outcomes in patients with severe sepsis and or septic shock in the Emergency Department (ED). The development of septic cardiomyopathy has been shown to lead to poor clinical outcomes. In addition, the effects of sepsis affecting the right ventricle is less studied than those of the left, despite resulting in poorer outcomes.

This prospective, longitudinal study aims to elucidate the specific relationship between RV dysfunction in severely septic patients and their clinical outcomes by recording a bedside ultrasound TAPSE measurement near the time of the diagnosis of sepsis in the ED. By assessing patients’ length of stay and final disposition, we hope to obtain a correlation between the tricuspid plane systolic excursion (TAPSE) measurement and patient outcome in order to help identify high risk patients more quickly using the TAPSE measurement. We hypothesize that patients with severe sepsis or septic shock and abnormal RV function, based on TAPSE values, will have poorer outcomes than septic patients with normal RV function.

At this time in our study, we have collected data from 20 patients, 4 of which were unable to be included due to exclusion criteria. Of the remaining 16 patients, 11 were male and 5 were female. Our data showed that these patients (n=16) were determined to have sepsis. None of the 16 patients had a prior known history of pulmonary hypertension or pulmonary embolism. The average age of the (n=16) was 53.3 years. The average temperature upon enrollment was 41.2 degrees Celsius, with an average heart rate of 106.6 beats per minute, an average respiratory rate of 19.3 breaths per minute, an average pulse oximetry read of 97.3%, and an average blood pressure of 115.2/60.9mmHg.

Summary of research results to be presented

Among the 16 severely septic patients enrolled by September 2018 at the University of California, Irvine Medical Center Emergency Department, the average TAPSE score was 22.1 mm compared to the normal reference range of 15-20 mm. We found that of the 11 patients that were admitted, 5 were transferred to the ICU. Additionally, 6 patients presented with heart conditions such as pericardial effusion and tachycardia. Out of the three patients that expired, one presented with addition heart problems. We also limited the enrollment time frame to within two hours to limit confounding factors such as additional treatment fluids and antibiotics. However since the sample size at September 2018 was small, no significant correlation was extracted. Further patient data collection will be performed to provide better analysis of the effects of septic cardiomyopathy on patient outcome.

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Nov 17th, 9:00 AM Nov 17th, 9:15 AM

Tricuspid Annular Plane Systolic Excursion (TAPSE) Assessment in Septic Cardiomyopathy

C304

The purpose of this study is to determine the association between right ventricular (RV) dysfunction and patient health outcomes in patients with severe sepsis and or septic shock in the Emergency Department (ED). The development of septic cardiomyopathy has been shown to lead to poor clinical outcomes. In addition, the effects of sepsis affecting the right ventricle is less studied than those of the left, despite resulting in poorer outcomes.

This prospective, longitudinal study aims to elucidate the specific relationship between RV dysfunction in severely septic patients and their clinical outcomes by recording a bedside ultrasound TAPSE measurement near the time of the diagnosis of sepsis in the ED. By assessing patients’ length of stay and final disposition, we hope to obtain a correlation between the tricuspid plane systolic excursion (TAPSE) measurement and patient outcome in order to help identify high risk patients more quickly using the TAPSE measurement. We hypothesize that patients with severe sepsis or septic shock and abnormal RV function, based on TAPSE values, will have poorer outcomes than septic patients with normal RV function.

At this time in our study, we have collected data from 20 patients, 4 of which were unable to be included due to exclusion criteria. Of the remaining 16 patients, 11 were male and 5 were female. Our data showed that these patients (n=16) were determined to have sepsis. None of the 16 patients had a prior known history of pulmonary hypertension or pulmonary embolism. The average age of the (n=16) was 53.3 years. The average temperature upon enrollment was 41.2 degrees Celsius, with an average heart rate of 106.6 beats per minute, an average respiratory rate of 19.3 breaths per minute, an average pulse oximetry read of 97.3%, and an average blood pressure of 115.2/60.9mmHg.