Introduction
Material and methods
Patients
Echocardiography
Statistical analysis
Results
Parameters
|
PFO and ACP
|
PFO only
|
ACP only
|
No PFO and no ACP
|
P
value
|
---|---|---|---|---|---|
(n = 8)
|
(n = 21)
|
(n = 36)
|
(n = 130)
| ||
VT/predicted body weight (mL/kg) | 6.5 [5; 7] | 6 [5; 7] | 6.5 [6; 8] | 6 [5; 7] | 0.64 |
PEEP (cmH2O) | 10 [6; 13] | 10 [8; 12] | 10 [8; 14] | 11 [8; 12] | 0.36 |
Driving pressure (cmH2O)b
| 15 [13; 16] | 16 [13; 17] | 15 [12; 20] | 14 [11; 17] | 0.22 |
PaO2/FiO2
| 95 [75; 115] | 107 [71; 153] | 114 [72; 145] | 112 [91; 154] | 0.33 |
PaCO2 (mmHg) | 47 [40; 62] | 48 [41; 52] | 50 [44; 58] | 45 [39; 53] | 0.28 |
Heart rate (bpm) | 106 [91; 116] | 105 [97; 128] | 97 [85; 113] | 100 [85; 116] | 0.29 |
mBP (mmHg) | 79 [70; 85] | 79 [70; 89] | 80 [74; 88] | 81 [73; 90] | 0.80 |
CVP (mmHg) | 11 [10; 13] | 11 [10; 12] | 11 [10; 14] | 10 [9; 12] | 0.96 |
Lactates (mmol/L) | 1.3 [1.2; 1.9] | 1.3 [1; 2] | 1.3 [1; 2.1] | 1.4 [1.1; 2] | 0.93 |
Prone positioning (n) | 2 (25%) | 3 (14%) | 18 (50%) | 44 (34%) | 0.04 |
Nitric oxide (n) | 3 (38%) | 2 (10%) | 6 (17%) | 14 (11%) | 0.15 |
Vasopressor support (n) | 6 (75%) | 10 (48%) | 18 (50%) | 62 (48%) | 0.55 |
28-day mortality (n) | 1 (13%) | 6 (29%) | 9 (25%) | 29 (22%) | 0.82 |
Parameters
|
PFO and ACP
|
PFO only
|
ACP only
|
No PFO and no ACP
|
P
value
|
---|---|---|---|---|---|
(n = 8)
|
(n = 21)
|
(n = 36)
|
(n = 130)
| ||
RVEDA/LVEDA (cm2) | 0.88 [0.69; 1.34] | 0.71 [0.57; 0.77] | 0.75 [0.64; 0.92] | 0.62 [0.52; 0.72] | 0.0002 |
LV eccentricity index at end-systole | 1.32 [1.3; 1.44] | 1.07 [1.02; 1.09] | 1.33 [1.27; 1.51] | 1.06 [1; 1.11] | <0.0001 |
LV eccentricity index at end-diastole | 1.13 [1.07; 1.2] | 1.08 [1.01; 1.14] | 1.09 [1.04; 1.18] | 1.07 [1.01; 1.13] | 0.21 |
Cardiac index (L/min/m2) | 3.58 [2.78; 3.71] | 3.28 [2.84; 4.18] | 2.93 [2.62; 3.37] | 3.16 [2.6; 3.98] | 0.27 |
LV stroke volume (mL) | 59 [46; 68] | 61 [48; 76] | 58 [49; 61] | 63 [52; 73] | 0.09 |
LVEDV (mL) | 67 [51; 85] | 85 [54; 100] | 79 [66; 93] | 87 [68; 106] | 0.04 |
LVEF (%) | 65 [55; 74] | 62 [46; 70] | 58 [48; 66] | 56 [44; 68] | 0.60 |
RVFAC (%) | 18 [15; 25] | 32 [24; 40] | 26 [17; 34] | 34 [26; 42] | 0.0007 |
TAPSE (mm) | 15 [14; 20] | 20 [17; 23] | 18 [16; 20] | 20 [16; 23] | 0.02 |
Doppler-derived sPAP (mmHg) | 46 [41; 60] | 50 [39; 67] | 45 [37; 55] | 42 [35; 49] | 0.17 |
Discussion
Conclusions
Key messages
-
In patients under protective mechanical ventilation for moderate-to-severe acute respiratory distress syndrome, acute cor pulmonale was associated with a restricted left ventricle and impaired right ventricular systolic function, irrespective of associated patent foramen ovale
-
In these patients, left ventricular stroke volume tended to be lower while left ventricular systolic function was preserved
-
Despite elevated systolic pulmonary artery pressure, patients with isolated patent foramen ovale shunting had normal right ventricular systolic function.