Abstract
IntroductionAssessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).MethodsFifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI).ResultsEBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively).ConclusionsEBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.
Highlights
Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient
The systolic pulsed tissue Doppler velocity of the LV septal wall (TDIs) is another new index of the longitudinal LV systolic function [25,26]. Both these parameters have been validated against LV ejection fraction (LVEF) measured by different methods in patients with cardiac disease [27,28]
Patients admitted to the mixed-bed intensive care unit (ICU) of Malmö University Hospital, Sweden, were screened for eligibility, and we included 55 consecutive patients with shock, defined as failure to maintain mean arterial pressure ≥70 mm Hg despite adequate fluid resuscitation according to the surviving sepsis campaign algorithm [30]
Summary
Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. Calculation of stroke volume (SV) in the LV outflow tract (LVOT) requires measurements of the velocity time integral (VTI) in LVOT and LVOT cross-sectional area The latter can be difficult to obtain and is a known source of error in cardiac output (CO) measurement [18,19]. LVOT VTI, called stroke distance, is feasible and reproducible in patients with cardiac disease [20] and is an accepted measure of LV function under changing hemodynamic conditions in experimental settings [21,22]. The systolic pulsed tissue Doppler velocity of the LV septal wall (TDIs) is another new index of the longitudinal LV systolic function [25,26] Both these parameters have been validated against LVEF measured by different methods in patients with cardiac disease [27,28]. The aim of this study was to describe the feasibility, association between, and repeatability of, the different methods of evaluating LV systolic function in mechanically ventilated patients with shock, by using TTE
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