TY - JOUR
T1 - Right ventricular strain measurements in critically ill patients
T2 - an observational SICS sub-study
AU - SICS Study Group
AU - Vos, Madelon E.
AU - Cox, Eline G.M.
AU - Schagen, Maaike R.
AU - Hiemstra, Bart
AU - Wong, Adrian
AU - Koeze, Jacqueline
AU - van der Horst, Iwan C.C.
AU - Wiersema, Renske
N1 - Funding Information:
We would like to thank all medical students and coordinators from the SICS Study Group for their devoted involvement with patient inclusions. SICS Study Group information: The SICS Study Group members include the following: project leaders: Iwan CC van der Horst, MD-PhD; Frederik Keus, MD-PhD; Jacqueline Koeze, MD-PhD; Geert Koster, MD-PhD. Research coordinator: Willem Dieperink, PhD. Researchers who conducted patient inclusions: Yasmin Farah Cawale, Roos Blijendaal, Anja Haker, Kim Boerma, Pieter Simons, Jose Castela Forte, Eline Rijnhart, Lotte Braam, Britt Keuning, Jan-Paul de Bruin, Kim Selles, Koen Geertzen, Paul van Stee, Lothar Mastenbroek, Carine Schilte, Tamar van der Aart, Bart Hiemstra, Thomas Kaufmann, Ruben Eck, Jelle Wolters, Elsa Doornbos, Nymke Trouwborst, Jeroen Boekema, Koen Geertzen, Chantal Dankfort, Hidde Pelsma, Xantia Heeres, Nynke van der Veen, Alexander Irk, Arlinde Roelofs and Leonie Tijsma.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Right ventricular (RV) dysfunction is common in critically ill patients and is associated with poor outcomes. RV function is usually evaluated by Tricuspid Annular Plane Systolic Excursion (TAPSE) which can be obtained using critical care echocardiography (CCE). Myocardial deformation imaging, measuring strain, is suitable for advanced RV function assessment and has widely been studied in cardiology. However, it is relatively new for the Intensive Care Unit (ICU) and little is known about RV strain in critically ill patients. Therefore, the objectives of this study were to evaluate the feasibility of RV strain in critically ill patients using tissue-Doppler imaging (TDI) and explore the association between RV strain and conventional CCE measurements representing RV function.Methods: This is a single-center sub-study of two prospective observational cohorts (Simple Intensive Care Studies (SICS)-I and SICS-II). All acutely admitted adults with an expected ICU stay over 24 h were included. CCE was performed within 24 h of ICU admission. In patients in which CCE was performed, TAPSE, peak systolic velocity at the tricuspid annulus (RV s’) and TDI images were obtained. RV free wall longitudinal strain (RVFWSL) and RV global four-chamber longitudinal strain (RV4CSL) were measured during offline analysis.Results: A total of 171 patients were included. Feasibility of RVFWSL and RV4CSL was, respectively, 62% and 56% in our population; however, when measurements were performed, intra- and inter-rater reliability based on the intraclass correlation coefficient were good to excellent. RV dysfunction based on TAPSE or RV s’ was found in 56 patients (33%) and 24 patients (14%) had RV dysfunction based on RVFWSL or RV4CSL. In 14 patients (8%), RVFWSL, RV4CSL, or both were reduced, despite conventional RV function measurements being preserved. These patients had significantly higher severity of illness scores. Sensitivity analysis with fractional area change showed similar results.Conclusions: TDI RV strain imaging in critically ill patients is challenging; however, good-to-excellent reproducibility was shown when measurements were adequately obtained. Future studies are needed to elucidate the diagnostic and prognostic value of RV strain in critically ill patients, especially to outweigh the difficulty and effort of imaging against the clinical value.
AB - Background: Right ventricular (RV) dysfunction is common in critically ill patients and is associated with poor outcomes. RV function is usually evaluated by Tricuspid Annular Plane Systolic Excursion (TAPSE) which can be obtained using critical care echocardiography (CCE). Myocardial deformation imaging, measuring strain, is suitable for advanced RV function assessment and has widely been studied in cardiology. However, it is relatively new for the Intensive Care Unit (ICU) and little is known about RV strain in critically ill patients. Therefore, the objectives of this study were to evaluate the feasibility of RV strain in critically ill patients using tissue-Doppler imaging (TDI) and explore the association between RV strain and conventional CCE measurements representing RV function.Methods: This is a single-center sub-study of two prospective observational cohorts (Simple Intensive Care Studies (SICS)-I and SICS-II). All acutely admitted adults with an expected ICU stay over 24 h were included. CCE was performed within 24 h of ICU admission. In patients in which CCE was performed, TAPSE, peak systolic velocity at the tricuspid annulus (RV s’) and TDI images were obtained. RV free wall longitudinal strain (RVFWSL) and RV global four-chamber longitudinal strain (RV4CSL) were measured during offline analysis.Results: A total of 171 patients were included. Feasibility of RVFWSL and RV4CSL was, respectively, 62% and 56% in our population; however, when measurements were performed, intra- and inter-rater reliability based on the intraclass correlation coefficient were good to excellent. RV dysfunction based on TAPSE or RV s’ was found in 56 patients (33%) and 24 patients (14%) had RV dysfunction based on RVFWSL or RV4CSL. In 14 patients (8%), RVFWSL, RV4CSL, or both were reduced, despite conventional RV function measurements being preserved. These patients had significantly higher severity of illness scores. Sensitivity analysis with fractional area change showed similar results.Conclusions: TDI RV strain imaging in critically ill patients is challenging; however, good-to-excellent reproducibility was shown when measurements were adequately obtained. Future studies are needed to elucidate the diagnostic and prognostic value of RV strain in critically ill patients, especially to outweigh the difficulty and effort of imaging against the clinical value.
KW - Critical care
KW - Echocardiography
KW - Prospective study
KW - Right ventricular function
KW - Strain imaging
U2 - 10.1186/s13613-022-01064-y
DO - 10.1186/s13613-022-01064-y
M3 - Article
AN - SCOPUS:85139446593
SN - 2110-5820
VL - 12
JO - Annals of Intensive Care
JF - Annals of Intensive Care
M1 - 92
ER -