The online version of this article (doi:10.1186/cc10368) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
LB made substantial contributions to the conception and design of the study, participated in interpretation of data, made substantial contributions in acquisition and analysis of data, and helped to draft the manuscript. RW and AE made substantial contributions to conception and design of the study. MC made substantial contributions to conception and design of the study, participated in interpretation of data, and helped to draft the manuscript. PG made substantial contributions to conception and design of the study and made substantial contributions to acquisition and analysis of data. JD made substantial contributions to conception and design of the study and made contributions to the acquisition of data. HO participated in interpretation of data and helped to draft the manuscript. LI made contributions to the acquisition of data. All authors have made substantial intellectual contributions to the manuscript and have given final approval of the version to be published.
Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).
Fifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI).
EBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively).
EBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.
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- Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care
Michelle S Chew
- BioMed Central
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