Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study

Abstract

Background Non-invasive evaluation of left ventricular filling pressure has been scarcely studied in critically ill patients. Accordingly, we prospectively assessed the ability of transoesophageal echocardiography (TEE) Doppler to predict an invasive pulmonary artery occlusion pressure (PAOP) ≤ 18 mmHg in ventilated patients.

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

“…There has been increased interest in using bedside transthoracic echocardiography to identify subclinical heart failure during weaning trials. [49][50][51][52] Studies have shown that assessment of early diastolic mitral inflow (E), late diastolic mitral inflow (A), and early diastolic mitral annular velocity (EЈ) using tissue Doppler imaging and the resulting E/A and E/EЈ ratios correlate with the left ventricular filling pressure. [50][51][52] In a group of subjects who had previously failed SBTs, a combination of E/A Ͼ 0.95 and E/EЈ Ͼ 8.5 at the end of an SBT trial predicted weaninginduced elevation in pulmonary artery occlusion pressure (Ն 18 mm Hg) with 82% sensitivity and 91% specificity.…”

“…[49][50][51][52] Studies have shown that assessment of early diastolic mitral inflow (E), late diastolic mitral inflow (A), and early diastolic mitral annular velocity (EЈ) using tissue Doppler imaging and the resulting E/A and E/EЈ ratios correlate with the left ventricular filling pressure. [50][51][52] In a group of subjects who had previously failed SBTs, a combination of E/A Ͼ 0.95 and E/EЈ Ͼ 8.5 at the end of an SBT trial predicted weaninginduced elevation in pulmonary artery occlusion pressure (Ն 18 mm Hg) with 82% sensitivity and 91% specificity. 50 In a small study of mechanically ventilated subjects, an E/EЈ cutoff value of 14.5 during an SBT trial had a sensitivity of 75% and specificity of 95.8% in predicting failure of extubation (4/20 subjects) or failure of SBT (16/20 subjects).…”

The use of Tricuspid Annular Plane Systolic Excursion and Tissue Doppler Imaging Velocities for the Estimation of Pulmonary Hypertension and Right Ventricular Function in Mechanically Ventilated Patients

“…Moreover, tissue Doppler imaging (TDI) techniques that measure velocities of cardiac tissue have been studied for the assessment of left ventricular diastolic function in the ICU (Combes et al, 2004;Vignon et al, 2008), whereas only a limited number of researchers have investigated their diagnostic accuracy on right ventricular (RV) dysfunction, in different clinical settings (Meluzin et al, 2001;Sundereswaran et al, 1998;Moustapha et al, 2001). …”

The use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association

“…The use of additional Doppler parameters is recommended in patients with E/A ratios ≥1 to <2 to distinguish those with increased LV filling pressures, 53 and in ventilated patients a combination of Doppler parameters (mitral inflow, Doppler myocardial imaging, pulmonary vein Doppler and colour Doppler M-mode flow propagation velocity) is recommended. 54 The diagnosis of HF with normal ejection fraction (HFnEF), largely corresponding to diastolic HF, is more challenging. HFnEF accounts for more than 50% of all HF patients.…”