Acute respiratory distress syndrome (ARDS)-associated acute cor pulmonale and patent foramen ovale: a multicenter noninvasive hemodynamic study.

Annick Legras,Laurent Martin-Lefèvre,Emmanuelle Begot,Thierry Lherm,Anne Courte,On Behalf Of The Arco And Crics Network ,Agnès Caille,Gwenaëlle Lhéritier,Philippe Vignon,Jean-Pierre Frat,Armelle Mathonnet,Jean-Paul Gouëllo,Emmanuelle Mercier

doi:10.1186/s13054-015-0898-5

Abstract

IntroductionAcute cor pulmonale (ACP) and patent foramen ovale (PFO) remain common in patients under protective ventilation for acute respiratory distress syndrome (ARDS). We sought to describe the hemodynamic profile associated with either ACP or PFO, or both, during the early course of moderate-to-severe ARDS using echocardiography.MethodsIn this 32-month prospective multicenter study, 195 patients with moderate-to-severe ARDS were assessed using echocardiography during the first 48 h of admission (age: 56 (SD: 15) years; Simplified Acute Physiology Score: 46 (17); PaO2/FiO2: 115 (39); VT: 6.5 (1.7) mL/kg; PEEP: 11 (3) cmH2O; driving pressure: 15 (5) cmH2O). ACP was defined by the association of right ventricular (RV) dilatation and systolic paradoxical ventricular septal motion. PFO was detected during a contrast study using agitated saline in the transesophageal bicaval view.ResultsACP was present in 36 patients, PFO in 21 patients, both PFO and ACP in 8 patients and the 130 remaining patients had neither PFO nor ACP. Patients with ACP exhibited a restricted left ventricle (LV) secondary to RV dilatation and had concomitant RV dysfunction, irrespective of associated PFO, but preserved LV systolic function. Despite elevated systolic pulmonary artery pressure (sPAP), patients with isolated PFO had a normal RV systolic function. sPAP and PaCO2 levels were significantly correlated.ConclusionsIn patients under protective mechanical ventilation with moderate-to-severe ARDS, ACP was associated with LV restriction and RV failure, whether PFO was present or not. Despite elevated sPAP, PFO shunting was associated with preserved RV systolic function.

Highlights

Acute cor pulmonale (ACP) and patent foramen ovale (PFO) remain common in patients under protective ventilation for acute respiratory distress syndrome (ARDS)
right ventricular (RV) systolic function was reduced in ACP patients, irrespective of associated PFO, as reflected by significantly lower median values of RV fractional area change (RVFAC) and tricuspid annular plane systolic elevation (TAPSE)
In patients under protective mechanical ventilation with moderate-to-severe ARDS, ACP was associated with left ventricular (LV) restriction and RV failure, whether PFO was concomitantly present or not, while LV systolic function was preserved. systolic pulmonary artery pressure (sPAP) was significantly correlated with partial pressure of arterial carbon dioxide (PaCO2) level

Summary

Introduction

Acute cor pulmonale (ACP) and patent foramen ovale (PFO) remain common in patients under protective ventilation for acute respiratory distress syndrome (ARDS). We sought to describe the hemodynamic profile associated with either ACP or PFO, or both, during the early course of moderate-to-severe ARDS using echocardiography. In patients with the acute respiratory distress syndrome (ARDS), acute right ventricular (RV) afterloading secondary to increased pulmonary vascular resistance may result in acute cor pulmonale (ACP) or patent foramen ovale (PFO). We sought to describe the hemodynamic profile in patients who develop ACP and shunting through a PFO in a large, multicenter, previously described population of mechanically ventilated patients during the early course of moderate-to-severe ARDS [3]

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