key: cord-0862887-axm7sc81
authors: Beyls, Christophe; Bohbot, Yohann; Huette, Pierre; Abou-Arab, Osama; Mahjoub, Yazine
title: Tricuspid longitudinal annular displacement for the assessment of right ventricular systolic dysfunction during prone positioning in COVID-19 patients
date: 2020-05-20
journal: J Am Soc Echocardiogr
DOI: 10.1016/j.echo.2020.05.016
sha: 623d3dacea803f6614e174df26cc843eab94dcea
doc_id: 862887
cord_uid: axm7sc81

nan

To the editors, During the COVID-19 outbreak pandemic, many patients developed severe acute respiratory distress syndrome (ARDS), often requiring prone positioning. Despite a "lung-protective" ventilation, the pulmonary vascular dysfunction associated with COVID-19 related ARDS [1] can lead to right ventricular (RV) dilatation and dysfunction, both associated with poor outcomes. RV global longitudinal strain (RVGLS) assessed by transthoracic echocardiography was recently found to predict mortality more accurately than RV fraction area change (RVFAC) in COVID-19 patients [2] . However, during prone positioning, the assessment of the RV function using transthoracic echocardiography can be very challenging [3] , and transesophageal echocardiography (TEE) is often necessary. To date, RVFAC is still considered as the best parameter for assessing RV systolic function by TEE [4] , but like RVGLS, it requires that the entire endocardium be clearly visible, which is sometimes difficult in the setting of acute cor pulmonale(ACP) related to mechanical ventilation.

Tricuspid longitudinal annular displacement (TMAD) is an emerging bidimensional strain echocardiographic parameter, tracking tricuspid annular tissue motion toward the RV apex, allowing an objective quantitative assessment of the RV systolic function [5] . TMAD is also angle-independent but its main advantage compared to RVGLS is to be unaffected by the endocardial definition.

Our objective was to assess the feasibility of TMAD and RVGLS and to evaluate their respective performance to diagnose a RV dysfunction (defined by a RVFAC<35%) during prone positioning for severe ARDS related to COVID-19 infection. TMAD measurements were performed on the apical four-chamber view as recommended. Three points were placed, and the software (QLAB CMQ software, Philips Medical Systems) automatically tracked and calculated the TMAD at the RV free wall (TMAD lat ) and at the interventricular septum (TMAD sep ). The RV longitudinal shortening (RVLS) was also calculated [5] . This was an ancillary study of a cohort of critical ill patients with COVID-19 infection (NCT04354558). 

Severe Covid-19 disease: rather AVDS* than ARDS. *Acute vascular distress syndrome

Prognostic Value of Right Ventricular Longitudinal Strain in Patients with COVID-19

DURING PRONE POSITION MECHANICAL VENTILATION IN COVID-19 PATIENTS: A PROPOSAL FOR A NEW APPROACH

Two-Dimensional Assessment of Right Ventricular Function: An Echocardiographic MRI Correlative Study

Tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography for predicting right ventricular function in pulmonary hypertension: A new approach to evaluating right ventricle dysfunction