Bashir Zubair, Ataklte Feven, Wang Shuyuan, Chen Edward W, Kadiyala Vishnu, Sherrod Charles F, Has Phinnara, Song Christopher, Ventetuolo Corey E, Simmons James, Haines Philip
Department of Cardiology, University of Texas Medical Branch, Galveston, TX 77555, USA.
Department of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA.
J Cardiovasc Dev Dis. 2024 Oct 24;11(11):339. doi: 10.3390/jcdd11110339.
Left ventricular (LV) dysfunction is associated with poor clinical outcomes in acute respiratory failure (ARF). This study evaluates the efficacy of LV strain in detecting LV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to conventionally measured left ventricular ejection fraction (LVEF). ARF patients requiring IMV who had echocardiography performed during MICU admission were included. LV global longitudinal strain (LVGLS) and LVEF were measured retrospectively using speckle tracking (STE) and traditional transthoracic echocardiography (TTE), respectively, by investigators blinded to the status of IMV and clinical data. The cohort was divided into three groups: TTE during IMV (TTE-IMV), before IMV (TTE-bIMV), and after IMV (TTE-aIMV). Multivariable regression models, adjusted for illness severity score, chronic cardiac disease, acute respiratory failure etiology, body mass index, chronic obstructive pulmonary disease, and obstructive sleep apnea, evaluated associations between LV function parameters and the presence of IMV. Among 376 patients, TTE-IMV, TTE-bIMV, and TTE-aIMV groups constituted 223, 68, and 85 patients, respectively. The median age was 65 years (IQR: 56-74), with 53.2% male participants. Adjusted models showed significantly higher LVGLS in groups not on IMV at the time of TTE (TTE-bIMV: β = 4.19, 95% CI 2.31 to 6.08, < 0.001; TTE-aIMV: β = 3.79, 95% CI 2.03 to 5.55, < 0.001), while no significant differences in LVEF were observed across groups. In a subgroup analysis of patients with LVEF ≥55%, the significant difference in LVGLS among the groups remained (TTE-bIMV: β = 4.18, 95% CI 2.22 to 6.15, < 0.001; TTE-aIMV: β = 3.45, 95% CI 1.50 to 5.40, < 0.001), but was no longer present in those with LVEF < 55%. This suggests an association between IMV and lower LVGLS in ARF patients requiring IMV, indicating that LVGLS may be a more sensitive marker for detecting subclinical LV dysfunction compared to LVEF in this population. Future studies should track and assess serial echocardiography data in the same cohort of patients pre-, during, and post-IMV in order to validate these findings and prognosticate STE-detected LV dysfunction in ARF patients requiring IMV.
左心室（LV）功能障碍与急性呼吸衰竭（ARF）的不良临床结局相关。本研究评估了与传统测量的左心室射血分数（LVEF）相比，左心室应变在检测需要有创机械通气（IMV）的ARF患者左心室功能障碍方面的疗效。纳入了在入住重症监护病房（MICU）期间接受超声心动图检查的需要IMV的ARF患者。由对IMV状态和临床数据不知情的研究人员分别使用斑点追踪（STE）和传统经胸超声心动图（TTE）回顾性测量左心室整体纵向应变（LVGLS）和LVEF。该队列分为三组：IMV期间的TTE（TTE-IMV）、IMV前的TTE（TTE-bIMV）和IMV后的TTE（TTE-aIMV）。多变量回归模型在调整了疾病严重程度评分、慢性心脏病、急性呼吸衰竭病因、体重指数、慢性阻塞性肺疾病和阻塞性睡眠呼吸暂停后，评估了左心室功能参数与IMV存在之间的关联。在376例患者中，TTE-IMV、TTE-bIMV和TTE-aIMV组分别有223例、68例和85例患者。中位年龄为65岁（四分位间距：56 - 74岁），男性参与者占53.2%。调整后的模型显示，在TTE时未接受IMV的组中LVGLS显著更高（TTE-bIMV：β = 4.19，95%置信区间2.31至6.08，P < 0.001；TTE-aIMV：β = 3.79，95%置信区间2.03至5.55，P < 0.001），而各组间LVEF未观察到显著差异。在LVEF≥55%的患者亚组分析中，各组间LVGLS的显著差异仍然存在（TTE-bIMV：β = 4.18，95%置信区间2.22至6.15，P < 0.001；TTE-aIMV：β = 3.45，95%置信区间1.50至5.40，P < 0.001），但在LVEF < 55%的患者中不再存在。这表明在需要IMV的ARF患者中，IMV与较低的LVGLS相关，表明在该人群中与LVEF相比，LVGLS可能是检测亚临床左心室功能障碍更敏感的标志物。未来的研究应在同一组患者IMV前、期间和之后追踪和评估系列超声心动图数据，以验证这些发现并对需要IMV的ARF患者中STE检测到的左心室功能障碍进行预后评估。
