Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France.
Department of Cardiology, Amiens University Hospital, Amiens, France.
J Cardiothorac Vasc Anesth. 2021 Dec;35(12):3594-3603. doi: 10.1053/j.jvca.2021.01.025. Epub 2021 Jan 18.
To compare two-dimensional-speckle tracking echocardiographic parameters (2D-STE) and classic echocardiographic parameters of right ventricular (RV) systolic function in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (CARDS) complicated or not by acute cor pulmonale (ACP).
Prospective, between March 1, 2020 and April 15, 2020.
Intensive care unit of Amiens University Hospital (France).
Adult patients with moderate-to-severe CARDS under mechanical ventilation for fewer than 24 hours.
None.
Tricuspid annular displacement (TAD) parameters (TAD-septal, TAD-lateral, and RV longitudinal shortening fraction [RV-LSF]), RV global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RVFWLS) were measured using transesophageal echocardiography with a dedicated software and compared with classic RV systolic parameters (RV-FAC, S' wave, and tricuspid annular plane systolic excursion [TAPSE]). RV systolic dysfunction was defined as RV-FAC <35%. Twenty-nine consecutive patients with moderate-to-severe CARDS were included. ACP was diagnosed in 12 patients (41%). 2D-STE parameters were markedly altered in the ACP group, and no significant difference was found between patients with and without ACP for classic RV parameters (RV-FAC, S' wave, and TAPSE). In the ACP group, RV-LSF (17% [14%-22%]) had the best correlation with RV-FAC (r = 0.79, p < 0.001 v r = 0.27, p = 0.39 for RVGLS and r = 0.28, p = 0.39 for RVFWLS). A RV-LSF cut-off value of 17% had a sensitivity of 80% and a specificity of 86% to identify RV systolic dysfunction.
Classic RV function parameters were not altered by ACP in patients with CARDS, contrary to 2D-STE parameters. RV-LSF seems to be a valuable parameter to detect early RV systolic dysfunction in CARDS patients with ACP.
比较 2019 冠状病毒病（COVID-19）相关急性呼吸窘迫综合征（CARDS）合并或不合并急性肺心病（ACP）患者的二维斑点追踪超声心动图参数（2D-STE）和经典右心室（RV）收缩功能超声心动图参数。
前瞻性，2020 年 3 月 1 日至 2020 年 4 月 15 日。
法国亚眠大学医院重症监护病房。
机械通气时间少于 24 小时的中重度 CARDS 成年患者。
无。
使用经食管超声心动图和专用软件测量三尖瓣环位移（TAD）参数（TAD-间隔、TAD-侧壁和 RV 纵向缩短分数[RV-LSF]）、RV 整体纵向应变（RV-GLS）和 RV 游离壁纵向应变（RVFWLS），并与经典 RV 收缩参数（RV-FAC、S'波和三尖瓣环平面收缩期位移[TAPSE]）进行比较。RV 收缩功能障碍定义为 RV-FAC<35%。共纳入 29 例中重度 CARDS 患者。12 例（41%）患者诊断为 ACP。ACP 组 2D-STE 参数明显改变，而经典 RV 参数（RV-FAC、S'波和 TAPSE）在有无 ACP 的患者之间无显著差异。在 ACP 组，RV-LSF（17%[14%-22%]）与 RV-FAC 相关性最好（r=0.79，p<0.001 比 r=0.27，p=0.39 用于 RVGLS 和 r=0.28，p=0.39 用于 RVFWLS）。RV-LSF 截断值为 17%时，对识别 RV 收缩功能障碍的敏感性为 80%，特异性为 86%。
与 2D-STE 参数相反，在 CARDS 患者中，经典 RV 功能参数不受 ACP 影响。RV-LSF 似乎是一种有价值的参数，可用于检测 CARDS 合并 ACP 患者的早期 RV 收缩功能障碍。
