Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study

Jérémie Lemarié,Charles-Henri Maigrat,Sébastien Gibot,Olivier Huttin,Antoine Kimmoun,Nathalie Dumont,Christine Selton-Suty,Pierre-Edouard Bollaert

doi:10.1186/s13613-020-0636-2

Abstract

BackgroundRight ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate–severe ARDS patients.ResultsForty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S′, RV FAC). A RV global LSS value > − 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters.ConclusionsGlobal STE assessment of the RV was highly achievable and reproducible in moderate–severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness.Trial registration NCT02638844: NCT

Highlights

Right ventricular (RV) function evaluation by echocardiography is key in the management of intensive care units (ICU) patients with acute respiratory distress syndrome (ARDS), it remains challenging
Exclusion criteria were (i) vulnerable patients under curatorship or guardianship; (ii) a history of chronic respiratory failure or (iii) chronic right ventricular failure or (iv) chronic heart failure with LVEF < 35% or (v) severe valvular heart disease and (vi) extracorporeal membrane oxygenation started before echocardiography assessment
The main findings of the present study are that 2D speckle tracking imaging of the right ventricle is feasible in ARDS patients under invasive mechanical ventilation (MV), is reproducible and is able to discriminate patients with RV dysfunction when compared to conventional parameters

Summary

Introduction

Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), it remains challenging. Quantification of RV defor‐ mation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. Right ventricular (RV) dysfunction in acute respiratory distress syndrome (ARDS) is common and several mechanisms, including elevated pulmonary vascular. Assessment of RV function is part of ARDS patient care [2]. There is currently significant interest for echocardiographic strain measurement derived from 2D speckle tracking imaging (STE), as it provides an objective quantification of myocardial mechanical function with unrivalled sensitivity. Data are scarce regarding its usefulness in mechanically ventilated patients in general and in ARDS patients in particular

Objectives

Methods

Results

Conclusion