Early detection of right ventricular dysfunction using transthoracic echocardiography in <scp>ARDS</scp>: a more objective approach

Wadia, Subeer; Shah, Trushil; Hedstrom, Grady; Kovach, Julie A.; Tandon, Rajive

doi:10.1111/echo.13350

Cited by 26 publications

(23 citation statements)

References 27 publications

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“…The reported incidence of RVD in ARDS varies across studies (22% to 50% (Table 1). [15][16][17][18][19][20][21][22][23][24] ) Although there is no robust evidence to support a definitive causal relationship between RVD and mortality in ARDS, it has been shown that RVD has a negative impact on the ARDS course and that severe RVD is associated with increased mortality even during lung protective mechanical ventilation.…”

Section: Epidemiology and Prognosismentioning

confidence: 99%

“…In a prospective observational study 20 which enrolled 226 patients with moderate to severe ARDS (Berlin definition) 25 (Table 1). 15,16 There is a need for a consensual definition that reflects the pathophysiology of RVD in the context of ARDS and positive pressure ventilation. This will enable intensive care specialists to identify patients at risk of RVF and implement strategies that may protect the RV.…”

Section: A N U S C R I P Tmentioning

confidence: 99%

“…Quantitative assessment of RV function can be performed by several methods. TAPSE can be obtained routinely and correlates well with RV function 12,15,16,58 Interpretation of the TAPSE has two potential pitfalls however, it assumes the single segment represents the function of the entire RV, and its measurement is angle dependent. 63 The…”

Section: Echocardiographymentioning

confidence: 99%

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The Right Ventricle in ARDS

Zochios

Parhar

Tunnicliffe

et al. 2017

Chest

183

154

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ARDS is associated with poor clinical outcomes, with a pooled mortality rate of approximately 40% despite best standards of care. Current therapeutic strategies are based on improving oxygenation and pulmonary compliance while minimizing ventilator-induced lung injury. It has been demonstrated that relative hypoxemia can be well tolerated, and improvements in oxygenation do not necessarily translate into survival benefit. Cardiac failure, in particular right ventricular dysfunction (RVD), is commonly encountered in moderate to severe ARDS and is reported to be one of the major determinants of mortality. The prevalence rate of echocardiographically evident RVD in ARDS varies across studies, ranging from 22% to 50%. Although there is no definitive causal relationship between RVD and mortality, severe RVD is associated with increased mortality. Factors that can adversely affect RV function include hypoxic pulmonary vasoconstriction, hypercapnia, and invasive ventilation with high driving pressure. It might be expected that early diagnosis of RVD would be of benefit; however, echocardiographic markers (qualitative and quantitative) used to prospectively evaluate the right ventricle in ARDS have not been tested in adequately powered studies. In this review, we examine the prognostic implications and pathophysiology of RVD in ARDS and discuss available diagnostic modalities and treatment options. We aim to identify gaps in knowledge and directions for future research that could potentially improve clinical outcomes in this patient population.

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Section: Epidemiology and Prognosismentioning

confidence: 99%

Section: A N U S C R I P Tmentioning

confidence: 99%

Section: Echocardiographymentioning

confidence: 99%

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The Right Ventricle in ARDS

Zochios

Parhar

Tunnicliffe

et al. 2017

Chest

183

154

View full text Add to dashboard Cite

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“…It’s reported that NT-proBNP is an important biomarker of heart failure [ 20 ]. Previous studies suggested that patients with diagnosis of ARDS often had right ventricular dysfunction [ 21 , 22 ], which would damage cardiopulmonary function. This study showed that, the levels of NT-proBNP on day 1 were increased in both groups, while the levels in control group were statistically significantly higher than those in the ARDS group ( p = 0.046).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome

Huang

Xiao

et al. 2018

BMC Pulm Med

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BackgroundLung ultrasound and echocardiography are mainly applied in critical care and emergency medicine. However, the diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome (ARDS) is still unclear.MethodsConsecutive patients admitted to ICU with the diagnosis of suspected ARDS based on clinical grounds were enrolled. Cardiopulmonary ultrasound was performed as part of monitoring on day 1, day 2 and day 3. On each day a bedside ultrasound was performed to examine the lungs and calculate the Left Ventricular Ejection Fraction (LVEF). On day 3, a thoracic CT was performed on each patient as gold standard for ARDS imaging diagnosis. According to the results from CT scan, patients were grouped into ARDS group or Non-ARDS group. The relation between the cardiopulmonary ultrasound results on each day and the results of CT scan was analyzed.ResultsFifty one consecutive patients aged from 73 to 97 years old were enrolled. Based on CT criteria, 33 patients were classified into the ARDS group, while 18 patients were included in non-ARDS group. There was no significant difference between the two groups in baseline characteristics, including gender, age, underlying disease, comorbidities, APACHE II score, SOFA score, and PaO2/FiO2 ratio (P > 0.05). Lung ultrasound (LUS) examination results were consistent with the CT scan results in diagnosis of pulmonary lesions. The Kappa values were 0.55, 0.74 and 0.82 on day 1, day 2 and day 3, respectively. The ROC analysis showed that the sensitivity, specificity and area under curve of ROC (AUROC) for lung ultrasound in diagnose ARDS were 0.788,0.778,0.783;0.909,0.833,0.871;0.970,0.833,0.902 on day 1, day 2 and day 3, respectively. However, cardiopulmonary ultrasound performed better in diagnosing ARDS in elderly patients. The sensitivity, specificity and AUROC were 0.879,0.889,0.924;0.939,0.889,0.961;and 0.970,0.833,0.956 on day 1, day 2 and day 3, respectively. The combined performances of cardiopulmonary ultrasound, N-terminal pro-brain natriuretic peptide (NT-proBNP), and PaO2/FiO2 ratio improved the specificity of the diagnosis of ARDS in elderly patients.ConclusionsLUS examination results were consistent with the CT scan results in diagnosis of pulmonary lesions. Cardiopulmonary ultrasound has a greater diagnostic accuracy in elderly patients with ARDS, compared with LUS alone. The combined performances of cardiopulmonary ultrasound, NT-proBNP, and PaO2/FiO2 increased the specificity of the diagnosis of ARDS in elderly patients.

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“…At present, echocardiography is still the prefered choice for evaluating RV function of patients with ARDS, with the advantages of bedside, non-invasive and convenient. Tricuspid annular plane systolic excursion (TAPSE) is widely used as a quantitative index to evaluate RV function, which is highly correlated with the mortality of ARDS patients, thus providing a good parameter for us to interpret RV function in COVID-19 patients [9].…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic Evaluation of Right Ventricular Function in ARDS Patients caused by COVID-19 pneumonia

Li¹,

Zheng²,

Yu³

et al. 2020

Preprint

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Backgound: To investigate the right heart function in COVID-19 (coronavirus disease 2019) patients with acute respiratory distress syndrome (ARDS). Methods: A retrospective analysis of 49 COVID-19 patients with ARDS was performed. Patients were divided into severe and critically severe group according to severity of illness. Age-matched healthy volunteers were recruited serving as a control group. The cardiac cavity diameters, tricuspid annular plane systolic excursion (TAPSE), tricuspid valve regurgitation pressure gradient biggest (TRPG), pulmonary arterial systolic pressure (PASP), maximum inferior vena cava diameter (IVCmax) and minimum diameter (IVCmin), and inferior vena cava collapse index (ICV-CI) were measured using echocardiography. Results: We found the TAPSE was significantly decreased in pneumonia patients compared to healthy subjects (P<0.0001), which was significantly lower in critically severe patients (P=0.0068). TAPSE was less than 17mm in 3 (8.6%) severe and 5 (35.7%) critically severe patients. There were no significant differences in PASP and TRPG between severe and critically severe patients. The IVCmax and IVCmin were significantly increased in critically severe patients compared to healthy subjects and severe patients (P < 0.01), whereas ICV-CI was significantly decreased (P < 0.05). COVID-19 patients had significantly larger right atrium and ventricle than healthy controls (P < 0.01). The left ventricular ejection fraction (LVEF) in critically severe patients was significantly lower than that in severe patients and healthy controls (P < 0.05). Conclusion: Right ventricular function is impaired in critically severe COVID-19 patients. The assessment and protection of the right heart function in COVID-19 patients should be strengthened.

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Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS: a more objective approach

Abstract: Mild RV dysfunction is common after ARDS onset. RV morphologic changes coupled with dysfunction can be detected noninvasively through TTE changes with TAPSE, MPI, and FAC. Mild RV dysfunction by TAPSE is associated with ARDS severity and mortality.

Cited by 26 publications

References 27 publications

The Right Ventricle in ARDS

The Right Ventricle in ARDS

Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome

Echocardiographic Evaluation of Right Ventricular Function in ARDS Patients caused by COVID-19 pneumonia

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