Invasive Mechanical Ventilation Is Associated with Worse Right Ventricular Strain in Acute Respiratory Failure Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Clinical Variables
2.2. Traditional 2-D and STE Measurements
2.3. Reliability Analysis for RV Function Parameters
2.4. Statistical Analysis
3. Results
3.1. Invasive Mechanical Ventilation as a Predictor of RV Function
3.2. Reliability Analysis
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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N = 376 | Total Cohort (N = 376) | TTE-IMV (N = 223) | TTE-bIMV (N = 68) | TTE-aIMV (N = 85) |
---|---|---|---|---|
Age | (n = 375) | (n = 223) | (n = 67) | (n = 85) |
Median (Q1–Q3) | 65 (56–74) | 65 (55–74) | 71 (57–76) | 63 (57–74) |
Sex | ||||
Male | 200 (53.2) | 121 (54.3) | 39 (57.4) | 40 (47.1) |
Documented smoking history | (n = 354) | (n = 201) | (n = 68) | (n = 85) |
Yes | 230 (64.9) | 126 (62.7) | 51 (75.0) | 53 (62.4) |
BMI (kg/m2) | ||||
Median (Q1–Q3) | 28.9 (24.3–35.6) | 29.7 (25.2–37.1) | 27.8 (22.9–35.3) | 28.2 (22.8–33.1) |
Chronic lung disease * | ||||
Chronic obstructive lung disease | 138 (36.7) | 71 (31.8) | 26 (38.2) | 41 (48.2) |
Asthma | 28 (7.5) | 13 (5.8) | 6 (8.8) | 9 (10.6) |
Interstitial lung disease | 10 (2.7) | 5 (2.2) | 1 (1.5) | 4 (4.7) |
Cystic fibrosis | 1 (0.27) | 1 (0.45) | 0 (--) | 0 (--) |
Pulmonary hypertension | 18 (4.8) | 12 (5.4) | 2 (2.9) | 4 (4.7) |
Obstructive sleep apnea | 51 (13.6) | 22 (9.9) | 12 (17.7) | 17 (20.0) |
History of primary lung cancer | (n = 375) | (n = 222) | (n = 68) | (n = 85) |
Yes | 19 (5.1) | 9 (4.1) | 4 (5.9) | 6 (7.1) |
Chronic cardiac disease *^ | 280 (74.5) | 159 (71.3) | 58 (85.3) | 63 (74.1) |
Chronic renal disease *# | 47 (12.5) | 32 (14.4) | 7 (10.3) | 8 (9.4) |
Shock requiring pressor support | 249 (66.2) | 162 (72.7) | 44 (64.7) | 43 (50.6) |
Number of pressors used | (n = 249) | (n = 162) | (n = 44) | (n = 43) |
1 | 125 (50.2) | 73 (45.1) | 21 (47.7) | 31 (72.1) |
2 | 84 (33.7) | 58 (35.8) | 16 (36.4) | 10 (23.3) |
3 | 40 (16.1) | 31 (19.1) | 7 (15.9) | 2 (4.7) |
Inotropes | (n = 375) | (n = 223) | (n = 68) | (n = 84) |
Yes | 18 (4.8) | 11 (4.9) | 5 (7.4) | 2 (2.4) |
Total APACHE II score | (n = 364) | (n = 223) | (n = 64) | (n = 77) |
Median (Q1–Q3) | 18 (12–24) | 22 (17–27) | 13.5 (10–19) | 11 (6–15) |
Etiology of acute respiratory failure | (n = 375) | (n = 222) | (n = 68) | (n = 85) |
Pneumonia | 120 (32.0) | 82 (36.9) | 19 (27.9) | 19 (22.4) |
Pulmonary edema | 64 (17.1) | 34 (15.3) | 17 (25.0) | 13 (15.3) |
Cardiac arrest | 60 (16.0) | 46 (20.7) | 2 (2.9) | 12 (14.1) |
Aspiration | 54 (14.4) | 29 (13.1) | 15 (22.1) | 10 (11.8) |
Acute exacerbation COPD | 24 (6.4) | 6 (2.7) | 3 (4.4) | 15 (17.7) |
Encephalopathy | 15 (4.0) | 5 (2.3) | 4 (5.9) | 6 (7.1) |
Other | 38 (10.1) | 20 (9.0) | 8 (11.8) | 10 (11.8) |
ARDS diagnosed | (n = 369) | (n = 223) | (n = 62) | (n = 84) |
Yes | 37 (10.0) | 21 (9.4) | 10 (16.1) | 6 (7.1) |
N = 376 | Total Cohort (N = 376) | TTE-IMV (N = 223) | TTE-bIMV (N = 68) | TTE-aIMV (N = 85) | p-Value 1 |
---|---|---|---|---|---|
RV GLS | |||||
Median (Q1–Q3) | 19.0 (13.5–24.7) | 15.9 (10.6–20.8) | 22.3 (19.3–22.3) | 23.8 (19.8–27.0) | <0.001 |
TAPSE (mm) | (n = 295) | (n = 163) | (n = 57) | (n = 75) | |
Median (Q1–Q3) | 20 (16.1–23.7) | 18.1 (15.4–21.6) | 21.6 (17.3–24.1) | 22.9 (19.4–25.2) | <0.001 |
RV FWLS | |||||
Median (Q1–Q3) | 23.2 (16.6–28.7) | 19.7 (14.0–25.8) | 25.5 (21.4–32.0) | 27.7 (22.9–31.8) | <0.001 |
RV FAC | (n = 313) | (n = 160) | (n = 68) | (n = 85) | |
Median (Q1–Q3) | 46.7 (37.9–55.1) | 51.3 (42.0–59.9) | 40.8 (34.9–49.6) | 44.1 (36.4–51.9) | <0.001 |
TTE Parameters | Unadjusted β (95% CI) | p-Value | Adjusted β * (95% CI) | p-Value |
---|---|---|---|---|
RV GLS | ||||
TTE-IMV | Reference | Reference | Reference | Reference |
TTE-bIMV | 7.05 (5.14, 8.96) | <0.001 | 7.28 (5.07, 9.48) | <0.001 |
TTE-aIMV | 8.04 (6.41, 9.67) | <0.001 | 9.39 (6.10, 10.69) | <0.001 |
TAPSE | ||||
TTE-IMV | Reference | Reference | Reference | Reference |
TTE-bIMV | 2.12 (0.49, 3.75) | 0.01 | 0.58 (−1.25, 2.41) | 0.53 |
TTE-aIMV | 3.68 (2.10, 5.18) | <0.001 | 1.38 (−0.76, 3.53) | 0.21 |
RV FWLS | ||||
TTE-IMV | Reference | Reference | Reference | Reference |
TTE-bIMV | 5.88 (3.69, 8.08) | <0.001 | 5.83 (3.36, 8.31) | <0.001 |
TTE-aIMV | 7.82 (5.82, 9.81) | <0.001 | 7.54 (4.83, 10.24) | <0.001 |
RV FAC | ||||
TTE-IMV | Reference | Reference | Reference | Reference |
TTE-bIMV | −9.76 (−13.23, −6.28) | <0.001 | −11.32 (−15.29, −7.35) | <0.001 |
TTE-aIMV | −6.91 (−9.99, −3.82) | <0.001 | −9.14 (−13.48, −4.81) | <0.001 |
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Wang, S.; Bashir, Z.; Chen, E.W.; Kadiyala, V.; Sherrod, C.F.; Has, P.; Song, C.; Ventetuolo, C.E.; Simmons, J.; Haines, P. Invasive Mechanical Ventilation Is Associated with Worse Right Ventricular Strain in Acute Respiratory Failure Patients. J. Cardiovasc. Dev. Dis. 2024, 11, 246. https://doi.org/10.3390/jcdd11080246
Wang S, Bashir Z, Chen EW, Kadiyala V, Sherrod CF, Has P, Song C, Ventetuolo CE, Simmons J, Haines P. Invasive Mechanical Ventilation Is Associated with Worse Right Ventricular Strain in Acute Respiratory Failure Patients. Journal of Cardiovascular Development and Disease. 2024; 11(8):246. https://doi.org/10.3390/jcdd11080246
Chicago/Turabian StyleWang, Shuyuan, Zubair Bashir, Edward W. Chen, Vishnu Kadiyala, Charles F. Sherrod, Phinnara Has, Christopher Song, Corey E. Ventetuolo, James Simmons, and Philip Haines. 2024. "Invasive Mechanical Ventilation Is Associated with Worse Right Ventricular Strain in Acute Respiratory Failure Patients" Journal of Cardiovascular Development and Disease 11, no. 8: 246. https://doi.org/10.3390/jcdd11080246