Right ventricular strain measurements in critically ill patients: an observational SICS sub-study
Abstract 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 deform...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2022-10-01
|
| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-022-01064-y |
| _version_ | 1828161318391119872 |
|---|---|
| author | Madelon E. Vos Eline G. M. Cox Maaike R. Schagen Bart Hiemstra Adrian Wong Jacqueline Koeze Iwan C. C. van der Horst Renske Wiersema SICS Study Group |
| author_facet | Madelon E. Vos Eline G. M. Cox Maaike R. Schagen Bart Hiemstra Adrian Wong Jacqueline Koeze Iwan C. C. van der Horst Renske Wiersema SICS Study Group |
| author_sort | Madelon E. Vos |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-12T00:36:45Z |
| format | Article |
| id | doaj.art-c029f43af2d14dd1a258a0f18c6cb34c |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-12T00:36:45Z |
| publishDate | 2022-10-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-c029f43af2d14dd1a258a0f18c6cb34c2022-12-22T03:55:08ZengSpringerOpenAnnals of Intensive Care2110-58202022-10-011211810.1186/s13613-022-01064-yRight ventricular strain measurements in critically ill patients: an observational SICS sub-studyMadelon E. Vos0Eline G. M. Cox1Maaike R. Schagen2Bart Hiemstra3Adrian Wong4Jacqueline Koeze5Iwan C. C. van der Horst6Renske Wiersema7SICS Study GroupUniversity Medical Center Groningen, Department of Anaesthesiology, University of GroningenUniversity Medical Center Groningen, Department of Critical Care, University of GroningenErasmus Medical Center, Department of Internal Medicine, Erasmus University RotterdamDepartment of Anaesthesiology, Location VU Medical Center, Amsterdam University Medical CenterDepartment of Critical Care, King’s College HospitalUniversity Medical Center Groningen, Department of Critical Care, University of GroningenDepartment of Intensive Care Medicine, University of Maastricht, University Medical Center MaastrichtUniversity Medical Center Groningen, Department of Critical Care, University of GroningenAbstract 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.https://doi.org/10.1186/s13613-022-01064-yProspective studyRight ventricular functionStrain imagingEchocardiographyCritical care |
| spellingShingle | Madelon E. Vos Eline G. M. Cox Maaike R. Schagen Bart Hiemstra Adrian Wong Jacqueline Koeze Iwan C. C. van der Horst Renske Wiersema SICS Study Group Right ventricular strain measurements in critically ill patients: an observational SICS sub-study Annals of Intensive Care Prospective study Right ventricular function Strain imaging Echocardiography Critical care |
| title | Right ventricular strain measurements in critically ill patients: an observational SICS sub-study |
| title_full | Right ventricular strain measurements in critically ill patients: an observational SICS sub-study |
| title_fullStr | Right ventricular strain measurements in critically ill patients: an observational SICS sub-study |
| title_full_unstemmed | Right ventricular strain measurements in critically ill patients: an observational SICS sub-study |
| title_short | Right ventricular strain measurements in critically ill patients: an observational SICS sub-study |
| title_sort | right ventricular strain measurements in critically ill patients an observational sics sub study |
| topic | Prospective study Right ventricular function Strain imaging Echocardiography Critical care |
| url | https://doi.org/10.1186/s13613-022-01064-y |
| work_keys_str_mv | AT madelonevos rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT elinegmcox rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT maaikerschagen rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT barthiemstra rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT adrianwong rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT jacquelinekoeze rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT iwanccvanderhorst rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT renskewiersema rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy AT sicsstudygroup rightventricularstrainmeasurementsincriticallyillpatientsanobservationalsicssubstudy |