Simmons James, Haines Philip, Extein Jonathan, Bashir Zubair, Aliotta Jason, Ventetuolo Corey E
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI.
Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI.
Crit Care Explor. 2022 Jan 18;4(1):e0619. doi: 10.1097/CCE.0000000000000619. eCollection 2022 Jan.
Right ventricular (RV) dysfunction is common in acute respiratory failure and associated with worse outcomes, but it can be difficult to detect in the ICU setting. Speckle-tracking echocardiography (STE) can identify early changes in RV systolic function and be quantified as systolic strain. We measured the feasibility of RV global longitudinal systolic strain (RV GLS) in respiratory failure patients and its association with clinical outcomes.
Retrospective cohort.
Two tertiary hospital medical ICUs in Providence, RI, from March 2015 to January 2018.
Two hundred twenty-three patients with acute respiratory failure requiring mechanical ventilation (MV) with available echocardiograms.
Clinical data were extracted from medical records. RV GLS was measured via STE (TOMTEC, Chicago, IL), along with standard echocardiographic measurements by two independent readers blinded to outcomes. The average age was 65 years (range, 21-90 yr), 121 (54%) were men, and the most common etiology of respiratory failure was pneumonia ( = 83, 37%). The average RV GLS was -16% (sd ± 7). The intraobserver correlation coefficients were 0.78 and 0.94, whereas the interobserver correlation coefficient was 0.61 for RV GLS. In the majority of echocardiograms ( = 178, 80%), all wall segments were tracked appropriately by operator visual inspection. Worse RV GLS was associated with greater hospital mortality (odds ratio, 1.03; 95% CI, 1.00-1.07; = 0.03), such that every 1% decrement in RV GLS was associated with up to a 7% increase in the risk of death. RV GLS was 90% sensitive for the detection of RV dysfunction compared with tricuspid annular plane systolic excursion.
The measurement of RV GLS by STE in subjects on MV is feasible, reproducible, and sensitive for the detection of RV dysfunction. RV GLS may predict poor outcomes in acute respiratory failure.
右心室（RV）功能障碍在急性呼吸衰竭中很常见，且与更差的预后相关，但在重症监护病房（ICU）环境中可能难以检测到。斑点追踪超声心动图（STE）可以识别右心室收缩功能的早期变化，并量化为收缩期应变。我们测量了呼吸衰竭患者右心室整体纵向收缩期应变（RV GLS）的可行性及其与临床结局的关联。
回顾性队列研究。
罗德岛州普罗维登斯市的两家三级医院医疗ICU，时间为2015年3月至2018年1月。
223例需要机械通气（MV）且有可用超声心动图的急性呼吸衰竭患者。
从病历中提取临床数据。通过STE（TOMTEC，伊利诺伊州芝加哥）测量RV GLS，并由两名对结局不知情的独立读者进行标准超声心动图测量。平均年龄为65岁（范围21 - 90岁），121例（54%）为男性，呼吸衰竭最常见的病因是肺炎（n = 83，37%）。平均RV GLS为 - 16%（标准差±7）。观察者内相关系数分别为0.78和0.94，而RV GLS的观察者间相关系数为0.61。在大多数超声心动图（n = 178，80%）中，通过操作者目视检查所有壁段均被正确追踪。较差的RV GLS与更高的医院死亡率相关（比值比，1.03；95%置信区间，1.00 - 1.07；P = 0.03），即RV GLS每降低1%，死亡风险最多增加7%。与三尖瓣环平面收缩期位移相比，RV GLS对检测RV功能障碍的敏感性为90%。
在接受MV的受试者中，通过STE测量RV GLS是可行的、可重复的，并且对检测RV功能障碍敏感。RV GLS可能预测急性呼吸衰竭的不良结局。
