Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care.

Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE

Publication: London, UK : BioMed Central Ltd
Original Publication: London : Current Science Ltd, c1997-

Echocardiography* ; Shock, Septic*; Blood Pressure/*physiology ; Ventricular Dysfunction, Left/*diagnosis ; Ventricular Dysfunction, Left/*diagnostic imaging; Adult ; Diagnostic Tests, Routine/methods ; Feasibility Studies ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Reproducibility of Results ; Respiration, Artificial ; Young Adult

Introduction: 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).
Methods: 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).
Results: 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).
Conclusions: 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.

Intensive Care Med. 1997 May;23(5):553-60. (PMID: 9201528)
Crit Care. 2007;11(5):R97. (PMID: 17803827)
Crit Care Med. 1990 Oct;18(10):1055-60. (PMID: 2209030)
Clin Physiol. 2000 Jan;20(1):38-43. (PMID: 10651790)
Shock. 2010 Feb;33(2):141-8. (PMID: 19487972)
Clin Cardiol. 1991 Nov;14(11):898-902. (PMID: 1764826)
Clin Physiol. 2001 Sep;21(5):621-8. (PMID: 11576164)
Eur J Echocardiogr. 2008 Nov;9(6):748-53. (PMID: 18490302)
Intensive Care Med. 2003 Nov;29(11):1889-94. (PMID: 12955181)
Crit Care Med. 2008 Mar;36(3):766-74. (PMID: 18431265)
Clin Sci (Lond). 2004 Jan;106(1):53-60. (PMID: 12924982)
Eur J Anaesthesiol. 2007 Jul;24(7):589-95. (PMID: 17462116)
Crit Care. 2010;14(2):R44. (PMID: 20331902)
Acta Med Scand. 1988;224(6):557-62. (PMID: 3207068)
J Am Soc Echocardiogr. 2000 Oct;13(10):896-901. (PMID: 11029713)
Clin Cardiol. 1991 Jul;14(7):588-94. (PMID: 1747969)
Intensive Care Med. 2007 Dec;33(12):2143-9. (PMID: 17928992)
Heart. 1997 Sep;78(3):230-6. (PMID: 9391283)
Am J Cardiol. 1998 Mar 1;81(5):538-44. (PMID: 9514446)
Heart. 2010 Sep;96(18):1463-8. (PMID: 20813727)
Echocardiography. 1990 Jan;7(1):21-25. (PMID: 10149188)
Int J Cardiol. 2004 Nov;97(2):289-95. (PMID: 15458697)
Eur J Heart Fail. 2009 Aug;11(8):779-88. (PMID: 19549647)
Chest. 1999 Nov;116(5):1354-9. (PMID: 10559099)
Cardiology. 2004;101(4):170-84. (PMID: 14967960)
Eur J Echocardiogr. 2001 Mar;2(1):52-61. (PMID: 11882426)
Intensive Care Med. 2006 Jan;32(1):9-10. (PMID: 16292627)
Heart. 2002 Feb;87(2):121-5. (PMID: 11796546)
Am J Cardiol. 2002 Nov 15;90(10):1174-7. (PMID: 12423730)
Eur J Anaesthesiol. 2004 Sep;21(9):700-7. (PMID: 15595582)
Echocardiography. 2002 Apr;19(3):207-13. (PMID: 12022928)
Am J Cardiol. 1991 May 1;67(11):1013-21. (PMID: 2018004)
J Am Soc Echocardiogr. 2003 Sep;16(9):906-21. (PMID: 12931102)
J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63. (PMID: 16376782)
Ann Surg. 1985 Dec;202(6):685-93. (PMID: 4073980)
Chest. 1994 Dec;106(6):1829-34. (PMID: 7988209)
Circulation. 1986 Jul;74(1):181-6. (PMID: 3085976)
Am J Cardiol. 2002 Nov 18;90(10A):28J-34J. (PMID: 12450588)
Crit Care Med. 1998 Nov;26(11):1793-800. (PMID: 9824069)
J Am Soc Echocardiogr. 2006 Sep;19(9):1085-91. (PMID: 16950462)
Heart. 1999 Aug;82(2):192-8. (PMID: 10409535)
Int J Cardiol. 2005 May 25;101(2):209-12. (PMID: 15882665)
Crit Care Med. 2008 Jun;36(6):1701-6. (PMID: 18496368)
Crit Care Med. 2004 Mar;32(3):858-73. (PMID: 15090974)
J Am Soc Echocardiogr. 1999 Aug;12(8):618-28. (PMID: 10441217)
Heart. 1999 Mar;81(3):229-31. (PMID: 10026340)
Crit Care Med. 2007 Apr;35(4):1019-26. (PMID: 17334249)
Clin Physiol. 1992 Jul;12(4):443-52. (PMID: 1505166)
Am J Cardiol. 2001 Jul 1;88(1):53-8. (PMID: 11423058)
Echocardiography. 2008 Sep;25(8):856-63. (PMID: 18986413)
Ann Intern Med. 1984 Apr;100(4):483-90. (PMID: 6703540)
Eur Heart J. 1998 May;19(5):808-16. (PMID: 9717017)
Am J Cardiol. 1991 Jan 15;67(2):222-4. (PMID: 1987731)

Date Created: 20110818 Date Completed: 20120821 Latest Revision: 20211020

20240628

PMC3387642

10.1186/cc10368

21846331