Pécora Matías, Pastorini Piero, Farolini Roberto, Burghi Gastón, Hurtado F Javier
Unidad Académica de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Laboratorio de Exploración Funcional Respiratoria, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Intensive Care Med Exp. 2025 Jun 17;13(1):62. doi: 10.1186/s40635-025-00770-8.
In the intensive care unit (ICU), left ventricular systolic function is traditionally assessed by measuring the left ventricular ejection fraction (LVEF). Recently, left ventricular global systolic longitudinal strain (SL-S) has emerged as a more sensitive marker of myocardial function in this setting. However, obtaining high-quality echocardiographic images remains a significant challenge, particularly in patients undergoing invasive mechanical ventilation (IMV), and data on the feasibility and reproducibility of these measurements in critically ill patients are limited.
To assess the feasibility and reproducibility (both global and per chamber) of SL-S and LVEF (both manual and automatic) in ICU patients under IMV.
Thirty ICU patients receiving IMV were randomly selected. The feasibility and reproducibility of SL-S (global and per chamber) and LVEF were assessed using both manual and automatic methods. The analysis was performed using the intraclass correlation coefficient (ICC) with its 95% confidence interval (CI), and Bland-Altman analysis (BA), which reported the mean difference and limits of agreement (lower-upper limits of agreement).
SL-S was feasible in 70% of patients and demonstrated excellent intra- and interobserver reproducibility for both manual and automatic methods. Intraobserver reproducibility for automatic SL-S: ICC 0.97 (CI: 0.94-0.99), BA 0.26 (-1.89 to 2.40) and interobserver reproducibility: ICC 0.96 (CI: 0.92-0.98), and BA 0.53 (-2.41 to 3.47). The reproducibility of manual SL-S was comparable to automatic measurements. Additionally, the reproducibility per chamber was excellent. LVEF was feasible in 80% of patients. Manual LVEF (Simpson's biplane) reproducibility demonstrated good reproducibility: intraobserver ICC: 0.82 (CI: 0.48-0.93), BA -5.00 (-19.70 to 9.70); interobserver ICC 0.78 (CI: 0.55-0.91), BA 7.50 (-5.40 to 20.40). Automatic LVEF (auto-LVEF) demonstrated excellent reproducibility: intraobserver ICC: 0.94 (CI: 0.86-0.98), BA -0.95 (-10.02 to 8.13); and interobserver ICC: 0.94 (CI: 0.87-0.97), BA 1.75 (-6.38 to 10.33).
SL-S (global and per chamber) and auto-LVEF were feasible and showed excellent reproducibility. LVEF demonstrated the highest feasibility, while SL-S exhibited the greatest reproducibility. These parameters may represent a useful tool in the evaluation of LV function in ICU patients under IMV.
在重症监护病房（ICU）中，传统上通过测量左心室射血分数（LVEF）来评估左心室收缩功能。最近，左心室整体收缩纵向应变（SL-S）已成为该环境下心肌功能更敏感的标志物。然而，获取高质量的超声心动图图像仍然是一项重大挑战，尤其是在接受有创机械通气（IMV）的患者中，并且关于这些测量在危重症患者中的可行性和可重复性的数据有限。
评估IMV下ICU患者中SL-S和LVEF（手动和自动）的可行性和可重复性（整体和每个腔室）。
随机选择30例接受IMV的ICU患者。使用手动和自动方法评估SL-S（整体和每个腔室）和LVEF的可行性和可重复性。使用组内相关系数（ICC）及其95%置信区间（CI）以及Bland-Altman分析（BA）进行分析，BA报告平均差异和一致性界限（一致性下限-上限）。
70%的患者SL-S可行，并且手动和自动方法在观察者内和观察者间均显示出极好的可重复性。自动SL-S的观察者内可重复性：ICC 0.97（CI：0.94 - 0.99），BA 0.26（-1.89至2.40）；观察者间可重复性：ICC 0.96（CI：0.92 - 0.98），BA 0.53（-2.41至3.47）。手动SL-S的可重复性与自动测量相当。此外，每个腔室的可重复性极好。80%的患者LVEF可行。手动LVEF（双平面辛普森法）的可重复性显示出良好的可重复性：观察者内ICC：0.82（CI：0.48 - 0.93），BA -5.00（-19.70至9.70）；观察者间ICC 0.78（CI：0.55 - 0.91），BA 7.50（-5.40至20.40）。自动LVEF（自动LVEF）显示出极好的可重复性：观察者内ICC：0.94（CI：0.86 - 0.98），BA -0.95（-10.02至8.13）；观察者间ICC：0.94（CI：0.87 - 0.97），BA 1.75（-6.38至10.33）。
SL-S（整体和每个腔室）和自动LVEF可行且显示出极好的可重复性。LVEF显示出最高的可行性，而SL-S表现出最大的可重复性。这些参数可能是评估IMV下ICU患者左心室功能的有用工具。
