Tricuspid Annular Plane Systolic Excursion (TAPSE) Measured by Echocardiography and Mortality in COVID-19: A Systematic Review and Meta-analysis

Martha, Januar Wibawa; Pranata, Raymond; Wibowo, Arief; Lim, Michael Anthonius

BACKGROUND: This systematic review and meta-analysis aimed to assess the association between the tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography and mortality in COVID-19. METHODS: We performed a systematic literature search using PubMed, Embase, and Scopus databases with keywords "COVID-19" OR "SARS-CoV-2" OR “2019-nCoV” AND “Tricuspid annular plane systolic excursion” OR “TAPSE” up until 20 January 2021. The main outcome was mortality; the effect estimate was reported in hazard ratio (HR) which was pooled from the unadjusted and adjusted effect estimate retrieved from the included studies. Mean difference of the TAPSE (in mm) between non-survivors and survivors were pooled. RESULTS: There were 641 patients from 7 studies included in this systematic review and meta-analysis. TAPSE was lower in non-survivors compared to survivors (mean difference -3.74 [-5.22, -2.26], p < 0.001; I(2): 85.5%, p < 0.001). Each 1 mm decrease in TAPSE was associated with increased mortality (HR 1.24 [1.18, 1.31], p < 0.001; I(2): 0.0%, p = 0.491). In pooled adjusted model, each 1 mm decrease in TAPSE was associated with increased mortality (HR 1.21 [1.11, 1.33], p < 0.001; I(2): 45.1%, p = 0.156). Meta-regression indicates that the difference in TAPSE between the non-survivors and survivors were affected by COPD (-0.183, p < 0.001) and PASP (-0.344, p = 0.039). but not age (p = 0.668), male (p = 0.821), hypertension (p = 0.101), diabetes (p = 0.603), CAD (p = 0.564), smoking (p = 0.140), and LVEF (p = 0.452). CONCLUSION: Every 1 mm decrease in TAPSE was associated with approximately 20% increase in mortality. PROSPERO ID: CRD42021232194.