Point-of-care echocardiographic assessment of right ventricle systolic function in infants with severe bronchiolitis: a prospective observational study

The aim of this study was to assess right ventricle (RV) systolic function in infants with severe bronchiolitis using tricuspid annular plane systolic excursion (TAPSE) and to explore its prognostic value. We hypothesized that lower TAPSE at pediatric intensive care unit (PICU) admission could be associated with prolonged length of stay (LOS) and duration of respiratory support. We conducted a prospective single-center observational pilot study in a tertiary general PICU during the 2022-2023 bronchiolitis season. All children < 12 months admitted to PICU for bronchiolitis were eligible. TAPSE was measured by transthoracic echocardiography at PICU admission. Patients were followed up until discharge. Forty-six patients were included, aged from 16 days to 9.5 months. TAPSE Z-score was within normal range (- 2 to + 2) in 36/46 (78%) patients and > + 2 in 10/46 (22%) patients. TAPSE Z-score was weakly associated with PICU LOS (Spearman ρ = - 0.38, p = 0.009) and moderately associated with the duration of respiratory support (Spearman ρ = - 0.45, p = 0.002). No significant association was found between other echocardiographic parameters and PICU LOS or duration of respiratory support. In post hoc exploratory multivariable analysis, TAPSE Z-score was independently associated with a duration of respiratory support < 3 days (OR = 2.29, 95% CI [1.25; 4.17], p = 0.007). Conclusion: TAPSE was within or above normal range in children with severe bronchiolitis, suggesting that RV systolic dysfunction is uncommon. Although its value may be associated with patients' clinical course, the pathophysiological basis and the clinical relevance of this association warrants further investigations.Trial registration: NCT07209956, date of registration October 7, 2025, retrospectively registered.