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

Abstract

Background: Right 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.Results: Forty-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. Conclusions:Global 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

Left and right ventricular longitudinal strains are associated with poor outcome in COVID-19: a systematic review and meta-analysis

“…The right ventricular strain has previously been shown to be useful for prognostication of patients with ARDS [5,38]. Inflammation is thought to cause RV overload and damage that resulted in RV failure, which can be assessed by RV-LS [17].…”

“…Global longitudinal strain (GLS) measurement provides direct measurement of myocardial deformation; thus, it is less affected by different loading conditions compared to ejection fraction [4]. Ventricular strain has been shown to be a useful tool for prognostication in patients with acute respiratory distress syndrome (ARDS) [5]. Studies indicate the potential use of ventricular strain assessment for prognostication in patients with COVID-19 [6][7][8].…”

Usefulness of Right Ventricular Longitudinal Shortening Fraction to Detect Right Ventricular Dysfunction in Acute Cor Pulmonale Related to COVID-19

“…One of the major limitation of TAPSE is its large overlap between patients with and without RV dysfunction [31]. Focusing on patients with ARDS, Lemarié et al used the widely accepted cut-off value of TAPSE (TAPSE<17mm) and found no difference in survival [32]. Moreover, TAPSE evaluates only the motion of the tricuspid annulus without taking into account the complete longitudinal contraction (from base to apex) as RV-LSF does.…”

“…ml.m -2 vs 33[27][28][29][30][31][32][33][34][35] ml.m -2 , p=0.94), RA volume index(19 [16-29] ml.m -2 vs 19[15][16][17][18][19][20][21][22] ml.m -2 ,p=0.85) and AT RVOT (95 [82-145] ms vs 90 [80-120] ms,p=0.72) between the ACP group and the non ACP group. Pulmonary arterial systolic pressure could not be evaluated because more than 70% of the patients had poor quality of the tricuspid regurgitation doppler flow.…”

Echocardiographic assessment of the right ventricle in COVID -related acute respiratory syndrome

“…Speckle tracking echocardiography is not discussed in the present paper, since it has been recently and extensively described [8]. Moreover, since this technique is time-consuming, it may not be feasible in COVID-19 patients in everyday clinical practice.…”