Lashin Hazem, Vasques Francesco, Bhattacharyya Sanjeev
Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK.
Egypt Heart J. 2024 Aug 23;76(1):110. doi: 10.1186/s43044-024-00544-9.
Transthoracic echocardiography (TTE) is the primary tool for assessing left ventricular (LV) function in cardiogenic shock (CS). However, inadequate image quality often hinders it. In this retrospective study, we investigated factors associated with LV image quality in patients admitted to the intensive care unit (ICU) with ischemic CS.
Two critical care physicians accredited in echocardiography independently reviewed the TTEs of 100 patients admitted to our tertiary cardiac ICU with ST-elevation myocardial infarction complicated by CS between October 2016 and September 2019. Endocardial border definition (EBD) was graded for each myocardial segment of the apical 4-chamber and 2-chamber views using a conventional scoring system (1 = good, 2 = suboptimal, 3 = poor, and 4 = not possible). The biplane EBD index (EBDi) was calculated by averaging all segments from both views. An average EBDi of both observers was correlated with clinical and echocardiographic parameters. The median age was 62 years [54, 73], and 78% were males. LV ejection fraction and cardiac index (CI) medians were 29% [20, 35] and 1.93 l/min/m [1.40, 2.51], respectively. The median biplane EBDi was nearly suboptimal (1.833 [1.542, 2.083]). There was no correlation between EBDi and age, sex, or body mass index. However, biplane EBDi demonstrated statistically significant correlations with PaO (r = 0.066, p = 0.01), mean arterial pressure (MAP, r = 0.055, p = 0.03), CI (r = 0.105, p < 0.01), tricuspid annulus systolic velocity (RV S', r = 0.092, p = 0.01), and tricuspid regurge maximum velocity (TR Vmax, r = 0.067, p = 0.01). In a multivariate model, only CI correlated independently with EBDi (r = 0.105, p < 0.01). The biplane EBDi predicted CI (area under the curve (AUC) 0.70, p = 0.001) with good sensitivity (71%) and reasonable specificity (61%).
The study suggests that in patients admitted to the ICU with ischemic CS, LV image quality by TTE deteriorates with the severity of shock, as indicated by CI.
经胸超声心动图（TTE）是评估心源性休克（CS）患者左心室（LV）功能的主要工具。然而，图像质量不佳常常会对其造成阻碍。在这项回顾性研究中，我们调查了入住重症监护病房（ICU）的缺血性CS患者中与LV图像质量相关的因素。
两名经认可的超声心动图重症监护医师独立回顾了2016年10月至2019年9月期间入住我们三级心脏ICU的100例ST段抬高型心肌梗死合并CS患者的TTE检查结果。使用传统评分系统（1 = 良好，2 = 次优，3 = 差，4 = 无法评估）对心尖四腔心和两腔心视图的每个心肌节段的心内膜边界清晰度（EBD）进行分级。双平面EBD指数（EBDi）通过平均两个视图的所有节段来计算。两位观察者的平均EBDi与临床和超声心动图参数相关。患者的中位年龄为62岁[54, 73]，78%为男性。LV射血分数和心脏指数（CI）的中位数分别为29%[20, 35]和1.93 l/min/m[1.40, 2.51]。双平面EBDi的中位数接近次优（1.833[1.542, 2.083]）。EBDi与年龄、性别或体重指数之间无相关性。然而，双平面EBDi与动脉血氧分压（r = 0.066，p = 0.01）、平均动脉压（MAP，r = 0.055，p = 0.03）、CI（r = 0.105，p < 0.01）、三尖瓣环收缩期速度（RV S'，r = 0.092，p = 0.01）和三尖瓣反流最大速度（TR Vmax，r = 0.067，p = 0.01）具有统计学显著相关性。在多变量模型中，只有CI与EBDi独立相关（r = 0.105，p < 0.01）。双平面EBDi对CI具有良好的预测能力（曲线下面积（AUC）为0.70，p = 0.001），敏感性良好（71%），特异性合理（61%）。
该研究表明，在入住ICU的缺血性CS患者中，如CI所示，TTE评估的LV图像质量会随着休克严重程度的增加而恶化。
