Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography

Romel Garcia-Montilla, Faryal Imam, Mi Miao, Kathryn Stinson, Akram Khan, Stephen Heitner

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Right ventricular (RV) systolic dysfunction is common in acute respiratory distress syndrome (ARDS). While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP). We analyzed the utility of RV free wall longitudinal strain (RVFWS) in the estimation of optimal RV filling pressure in ARDS. Methods: A retrospective cross-sectional analysis of clinical data and echocardiograms of patients with ARDS was performed. Tricuspid annular plane systolic excursion (TAPSE), tricuspid peak systolic velocity (Sʹ), RV fractional area change (RVFAC), RVFWS, CVP, systolic pulmonary artery pressure (SPAP), and left ventricular ejection fraction (LVEF) were measured. Results: Fifty-one patients with moderate-severe ARDS were included. There were inverse correlations between CVP and TAPSE, Sʹ, RVFAC, RVFWS, and LVEF. The most significant was with RVFWS (r:.74, R2:.55, P:.00001). Direct correlations with creatinine and lactate were noted. Receiver operating characteristic analysis showed that RVFWS −21% (normal reference value) was associated with CVP: 13 mm Hg (AUC: 0.92, 95% CI: 0.83–1.00). Regression model analysis of CVP, and RVFWS interactions established an RVFWS range from −18% to −24%. RVFWS −24% corresponded to CVP: 11 mm Hg and RVFWS −18% to CVP: 15 mm Hg. Beyond a CVP of 15 mm Hg, biventricular systolic dysfunction rapidly ensues. Conclusions: Our data are the first to show that an RV filling pressure of 13±2 mm Hg—as by CVP—correlates with optimal RV mechanics as evaluated by strain echocardiography in patients with moderate-severe ARDS.

Original languageEnglish (US)
Pages (from-to)851-861
Number of pages11
JournalEchocardiography
Volume34
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Central Venous Pressure
Adult Respiratory Distress Syndrome
Echocardiography
Pressure
Severe Acute Respiratory Syndrome
Ventricular Pressure
Stroke Volume
Reference Values
Right Ventricular Dysfunction
Hydrodynamics
Mechanics
ROC Curve
Pulmonary Artery
Area Under Curve
Lactic Acid
Creatinine
Cross-Sectional Studies
Regression Analysis

Keywords

  • acute respiratory distress syndrome
  • filling pressure
  • right ventricle
  • strain echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography. / Garcia-Montilla, Romel; Imam, Faryal; Miao, Mi; Stinson, Kathryn; Khan, Akram; Heitner, Stephen.

In: Echocardiography, Vol. 34, No. 6, 01.06.2017, p. 851-861.

Research output: Contribution to journalArticle

Garcia-Montilla, Romel ; Imam, Faryal ; Miao, Mi ; Stinson, Kathryn ; Khan, Akram ; Heitner, Stephen. / Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography. In: Echocardiography. 2017 ; Vol. 34, No. 6. pp. 851-861.
@article{95842c41c0f24c43bfcb8de5ff1391dc,
title = "Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography",
abstract = "Introduction: Right ventricular (RV) systolic dysfunction is common in acute respiratory distress syndrome (ARDS). While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP). We analyzed the utility of RV free wall longitudinal strain (RVFWS) in the estimation of optimal RV filling pressure in ARDS. Methods: A retrospective cross-sectional analysis of clinical data and echocardiograms of patients with ARDS was performed. Tricuspid annular plane systolic excursion (TAPSE), tricuspid peak systolic velocity (Sʹ), RV fractional area change (RVFAC), RVFWS, CVP, systolic pulmonary artery pressure (SPAP), and left ventricular ejection fraction (LVEF) were measured. Results: Fifty-one patients with moderate-severe ARDS were included. There were inverse correlations between CVP and TAPSE, Sʹ, RVFAC, RVFWS, and LVEF. The most significant was with RVFWS (r:.74, R2:.55, P:.00001). Direct correlations with creatinine and lactate were noted. Receiver operating characteristic analysis showed that RVFWS −21{\%} (normal reference value) was associated with CVP: 13 mm Hg (AUC: 0.92, 95{\%} CI: 0.83–1.00). Regression model analysis of CVP, and RVFWS interactions established an RVFWS range from −18{\%} to −24{\%}. RVFWS −24{\%} corresponded to CVP: 11 mm Hg and RVFWS −18{\%} to CVP: 15 mm Hg. Beyond a CVP of 15 mm Hg, biventricular systolic dysfunction rapidly ensues. Conclusions: Our data are the first to show that an RV filling pressure of 13±2 mm Hg—as by CVP—correlates with optimal RV mechanics as evaluated by strain echocardiography in patients with moderate-severe ARDS.",
keywords = "acute respiratory distress syndrome, filling pressure, right ventricle, strain echocardiography",
author = "Romel Garcia-Montilla and Faryal Imam and Mi Miao and Kathryn Stinson and Akram Khan and Stephen Heitner",
year = "2017",
month = "6",
day = "1",
doi = "10.1111/echo.13546",
language = "English (US)",
volume = "34",
pages = "851--861",
journal = "Echocardiography",
issn = "0742-2822",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography

AU - Garcia-Montilla, Romel

AU - Imam, Faryal

AU - Miao, Mi

AU - Stinson, Kathryn

AU - Khan, Akram

AU - Heitner, Stephen

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Introduction: Right ventricular (RV) systolic dysfunction is common in acute respiratory distress syndrome (ARDS). While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP). We analyzed the utility of RV free wall longitudinal strain (RVFWS) in the estimation of optimal RV filling pressure in ARDS. Methods: A retrospective cross-sectional analysis of clinical data and echocardiograms of patients with ARDS was performed. Tricuspid annular plane systolic excursion (TAPSE), tricuspid peak systolic velocity (Sʹ), RV fractional area change (RVFAC), RVFWS, CVP, systolic pulmonary artery pressure (SPAP), and left ventricular ejection fraction (LVEF) were measured. Results: Fifty-one patients with moderate-severe ARDS were included. There were inverse correlations between CVP and TAPSE, Sʹ, RVFAC, RVFWS, and LVEF. The most significant was with RVFWS (r:.74, R2:.55, P:.00001). Direct correlations with creatinine and lactate were noted. Receiver operating characteristic analysis showed that RVFWS −21% (normal reference value) was associated with CVP: 13 mm Hg (AUC: 0.92, 95% CI: 0.83–1.00). Regression model analysis of CVP, and RVFWS interactions established an RVFWS range from −18% to −24%. RVFWS −24% corresponded to CVP: 11 mm Hg and RVFWS −18% to CVP: 15 mm Hg. Beyond a CVP of 15 mm Hg, biventricular systolic dysfunction rapidly ensues. Conclusions: Our data are the first to show that an RV filling pressure of 13±2 mm Hg—as by CVP—correlates with optimal RV mechanics as evaluated by strain echocardiography in patients with moderate-severe ARDS.

AB - Introduction: Right ventricular (RV) systolic dysfunction is common in acute respiratory distress syndrome (ARDS). While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP). We analyzed the utility of RV free wall longitudinal strain (RVFWS) in the estimation of optimal RV filling pressure in ARDS. Methods: A retrospective cross-sectional analysis of clinical data and echocardiograms of patients with ARDS was performed. Tricuspid annular plane systolic excursion (TAPSE), tricuspid peak systolic velocity (Sʹ), RV fractional area change (RVFAC), RVFWS, CVP, systolic pulmonary artery pressure (SPAP), and left ventricular ejection fraction (LVEF) were measured. Results: Fifty-one patients with moderate-severe ARDS were included. There were inverse correlations between CVP and TAPSE, Sʹ, RVFAC, RVFWS, and LVEF. The most significant was with RVFWS (r:.74, R2:.55, P:.00001). Direct correlations with creatinine and lactate were noted. Receiver operating characteristic analysis showed that RVFWS −21% (normal reference value) was associated with CVP: 13 mm Hg (AUC: 0.92, 95% CI: 0.83–1.00). Regression model analysis of CVP, and RVFWS interactions established an RVFWS range from −18% to −24%. RVFWS −24% corresponded to CVP: 11 mm Hg and RVFWS −18% to CVP: 15 mm Hg. Beyond a CVP of 15 mm Hg, biventricular systolic dysfunction rapidly ensues. Conclusions: Our data are the first to show that an RV filling pressure of 13±2 mm Hg—as by CVP—correlates with optimal RV mechanics as evaluated by strain echocardiography in patients with moderate-severe ARDS.

KW - acute respiratory distress syndrome

KW - filling pressure

KW - right ventricle

KW - strain echocardiography

UR - http://www.scopus.com/inward/record.url?scp=85020848712&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020848712&partnerID=8YFLogxK

U2 - 10.1111/echo.13546

DO - 10.1111/echo.13546

M3 - Article

C2 - 28631361

AN - SCOPUS:85020848712

VL - 34

SP - 851

EP - 861

JO - Echocardiography

JF - Echocardiography

SN - 0742-2822

IS - 6

ER -