Introduction
Materials and methods
Transthoracic echocardiography
Statistical analysis
Results
Characteristic | Values |
---|---|
Number of patients | 50 |
Gender (M/F) | 36/14 |
Age (years) | 65 (54:74) |
SOFA day 1 | 12 (9:14) |
APACHE II | 24 (19:29) |
ICU LOS | 8 (4:13) |
Days on mechanical ventilation | 6.5 (3:13) |
Vasopressor μg/kg/min | 0.09 (0.05: 0.14) |
Cardiac disease (%) | 24 |
Preexisting therapy (%) | 48 |
ICU mortality (%) | 24 |
Assessment of feasibility
Day 1 n= 47 | Day 2 n= 44 | Day 3 n= 34 | Day 4 n= 31 | Day 5 n= 28 | Day 6 n= 26 | Day 7 n= 21 | p value (over time) | |
---|---|---|---|---|---|---|---|---|
Simpson (%) | 50 (41:58) | 53 (45:62) | 53 (45:58) | 56 (48:64) | 59 (50:63) | 62 (57:71)a | 62 (54:65) | < 0.05 |
EBEF (%) | 49 (40:55) | 50 (40:65) | 50 (40:59) | 52 (45:63) | 58 (45:61)a | 65 (55:70)a | 65 (50:70)a | < 0.05 |
AVPDm (mm) | 10.5 (8.0:12.6) | 11 (9.1:12.6) | 11 (9.0:13.0) | 12 (9.1:14.0) | 11 (9.9:14.0) | 12 (10.0:14.8)a | 12.5 (11.0:14.0)a | < 0.05 |
TDIs (cm/sec) | 8.9 (7.1:10.0) | 9.1 (7.6:10.4) | 8.3 (7.1:10.0) | 9 (7.4:10.0) | 9.3 (8.5:11.0) | 10 (8.9:12.3)a | 11 (9.0:13.5) | < 0.05 |
LVOT VTI (cm) | 18 (15:23) | 20 (17:26)a | 21(18:24)a | 21(18:24)a | 22 (18:24)a | 22 (20:24)a | 23 (20:24) | < 0.05 |
SOFA | 12 (9:14) | 10 (8:13)a | 8 (6:12)a | 8 (6:11)a | 7 (5:10)a | 8 (5:9)a | 7 (5:9)a | < 0.05 |
Day 1 n= 47 | Day 2 n= 44 | Day 3 n= 34 | Day 4 n= 31 | Day 5 n= 28 | Day 6 n= 26 | Day 7 n= 21 | All measurements n= 253 | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
r
|
P
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r
|
P
|
r
|
P
|
r
|
P
|
r
|
P
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r
|
P
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r
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r
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P
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Simpson vs. EBEF | 0.896 |
a
| 0.949 |
a
| 0.910 |
a
| 0.859 |
a
| 0.855 |
a
| 0.794 |
a
| 0.942 |
a
| 0.905 |
a
|
Simpson vs. AVPDm | 0.495 |
a
| 0.346 |
b
| 0.281 | 0.392 |
b
| 0.322 | 0.101 | 0.577 |
a
| 0.404 |
a
| |||
Simpson vs. TDIs | 0.609 |
a
| 0.559 |
a
| 0.530 |
a
| 0.413 |
b
| 0.152 | 0.123 | 0.310 | 0.473 |
a
| |||
Simpson vs. LVOT VTI | 0.616 |
a
| 0.408 |
a
| 0.288 | 0.499 |
b
| 0.570 |
a
| 0.450 |
b
| 0.742 |
a
| 0.513 |
a
| |
AVPD vs. TDIs | 0.427 |
a
| 0.264 | 0.456 |
a
| 0.356 | 0.535 |
a
| 0.635 |
a
| 0.630 |
a
| 0.439 |
a
| ||
a
| Corr sign at the 0.01 level. | |||||||||||||||
b
| Corr sign at the 0.05 level. |
Repeatability of measurements
EBEF | Simpson | TDIs | AVPDm | LVOT VTI | |
---|---|---|---|---|---|
Intraobserver | 6.8 | 10.6 | 8.2 | 4.4 | 3.1 |
Interobserver | 9.9 | 8.2 | 7.2 | 5.3 | 4.8 |
Discussion
Feasibility
Systolic function over time
Correlations between the Simpson method and other methods
Repeatability
Limitations
Conclusions
Key messages
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Assessment of left ventricular (LV) systolic function by transthoracic echocardiography (TTE) using five different echocardiographic parameters over a 7-day period in ventilated patients with shock.
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All parameters were easy obtainable (93% to 100%) and had acceptable repeatability (coefficient of variation, 3.1% to 10.6%); their correlation to one another showed substantial variation (r = 0.101 to 0.949) over time.
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Eyeball ejection fraction (EBEF) can be used instead of single-plane Simpson when assessing LV ejection fraction, but markers of the LV longitudinal function, such as tissue Doppler and atrioventricular plane displacement, are not interchangeable with LV ejection fraction.