Lemarié Jérémie, Maigrat Charles-Henri, Kimmoun Antoine, Dumont Nathalie, Bollaert Pierre-Edouard, Selton-Suty Christine, Gibot Sébastien, Huttin Olivier
Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France.
Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France.
Ann Intensive Care. 2020 Feb 13;10(1):24. doi: 10.1186/s13613-020-0636-2.
Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients.
Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S', RV FAC). A RV global LSS value > - 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters.
Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT.
通过超声心动图评估右心室（RV）功能是重症监护病房（ICU）中急性呼吸窘迫综合征（ARDS）患者管理的关键，但仍具有挑战性。斑点追踪超声心动图（STE）对RV变形进行量化是一种新近可用且可重复的技术，可对RV进行综合分析。然而，关于其在危重症患者中的应用数据稀缺。本研究的目的是评估其在中重度ARDS患者中的可行性和临床实用性。
48例接受有创机械通气（MV）的ARDS患者连续纳入一项前瞻性观察性研究。在MV开始后36小时内进行完整的经胸超声心动图检查。记录STE衍生参数和传统参数。RV侧壁、下壁和室间隔壁的应变成像高度可行（47/48（98%）患者）。在ARDS患者中，RV应变值的观察者间可重复性显示出良好的可靠性（所有STE衍生参数的组内相关系数（ICC）>0.75）。ROC曲线分析表明，与几个传统指标（TAPSE、S'、RV FAC）相比，侧壁、下壁、整体（3个RV壁的平均值）纵向收缩期应变（LSS）和整体应变率具有显著的诊断价值。RV整体LSS值>-13.7%可区分TAPSE<与>12mm的患者，敏感性为88%，特异性为83%。关于临床结局，STE衍生参数正常与异常的患者在第28天的死亡率和脱机累积发生率无差异。
在接受MV的中重度ARDS患者中，对RV进行整体STE评估是高度可行且可重复的，并且还与RV功能的几个传统参数相关。在我们的队列中，STE衍生参数在生存或脱机预测方面未提供任何增量价值。需要进一步研究以评估其诊疗实用性。试验注册号NCT02638844：NCT。
