Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

Bergenzaun, Lill; Gudmundsson, Petri; Öhlin, Hans; Düring, Joachim; Ersson, Anders; Ihrman, Lilian; Willenheimer, Ronnie; Chew, Michelle

doi:10.1186/cc10368

Cited by 95 publications

(67 citation statements)

References 55 publications

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“…4,5 Our intra-observer variability for CO TTE measurement was low (much lower than the changes in CO we observed during PLR and after fluid loading) and similar to previous reports. 20 Moreover, we required high-quality TTE criteria, which explains the high rate of exclusion and strengthens the internal validity of our results. It is noteworthy that TTE offered a continuous beatto-beat and noninvasive CO measurement while esCCO averaged 64 consecutive heart beats.…”

Section: Discussionsupporting

confidence: 62%

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Estimated continuous cardiac output (esCCO) is a new and noninvasive cardiac output (CO) monitoring device using pulse wave transit time. The aim of this study was to assess rapid changes in CO using esCCO (DCO esCCO ) without invasive calibration and to compare the results with those using transthoracic Doppler echocardiography (DCO TTE ). Methods Fifty-four consecutive patients were enrolled in this study following elective cardiac surgery. The CO esCCO and CO TTE were collected during four consecutive steps: 1) at baseline, 2) during passive leg raising (PLR), 3) at return to baseline, and 4) after a fluid challenge. The relationship between DCO esCCO and DCO TTE induced by PLR and a fluid challenge was assessed and a polar plot analysis was performed. Relationship, Bland-Altman analysis, and percentage error for absolute values of CO esCCO and CO TTE were also performed. Results Twenty-four patients were excluded from the analysis. No correlation was found between DCO esCCO and DCO TTE during PLR (r = 0.07; P = 0.732; n = 30) and after a fluid challenge (r = 0.24; P = 0.394; n = 14). The polar plot analysis showed that 21 data points (87%) of significant changes in CO were above the 30°radial sector lines and confirmed that esCCO was unable to track changes in CO. A weak positive relationship was found between absolute values of CO esCCO and CO TTE (r = 0.28; P = 0.004). Bias, precision, and limits of agreement were 0.25 LÁmin -1 , 2.4 LÁmin -1 , and -4.4 to 4.9 LÁmin -1 , respectively. The percentage error was 80%. Conclusions Estimated continuous cardiac output without external calibration seems unable to assess rapid changes in CO following cardiac surgery and was not interchangeable with transthoracic Doppler echocardiography.

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Section: Discussionsupporting

confidence: 62%

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

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“…Echocardiographic studies have reported similar results with a reduced global systolic function in 30 to 60% of septic shock patients (23,35) and reversibility in survivors (26,28,102). The definition of systolic dysfunction has varied (LVEF 45 to 55%) and comparison between studies is therefore complicated.…”

Section: Echocardiographysupporting

confidence: 57%

“…Varying use of vasopressor and inotropic drugs, rapid fluid shifts and positive pressure ventilation are just some of the challenges during image acquisition and interpretation. However, the addition of observer dependency to the interpretation of the echocardiographic findings has been remarkably less studied in intensive care than in cardiology (35). Thus, the extent to which the differing results in the incidence and spectrum of cardiac dysfunction in sepsis is related to the reading of the echocardiograms is unclear.…”

Section: Variability Of Measurementsmentioning

confidence: 99%

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Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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“…In a cohort of 50 patients undergoing mechanical ventilation with shock, LVEF evaluation with the Simpson technique displayed the worst intra and inter-observer variability [30]. STE is an operator-independent technique with low inter-observer variability (from 2 [31] to 13% [32]) regarding strain data but higher variability regarding strain rate [28]. In patients with mechanical ventilation, we found an inter-observer variability of 8% [25] while others [20,24] have also found a good inter-observer agreement with a Bland-Altman analysis.…”

Section: What Could Ste Add In the Icu Field?mentioning

confidence: 99%

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

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Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient's outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

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Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

Cited by 95 publications

References 55 publications

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

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