Respiratory failure & ventilation
Diagnostic, prognostic and clinical value of left ventricular radial strain to identify paradoxical septal motion in ventilated patients with the acute respiratory distress syndrome: an observational prospective multicenter study
Authors' conclusion
In objectively depicting PSM and quantitatively assessing its severity, TEE LV radial strain appears as a valuable adjunct to conventional two-dimensional imaging.
Study context
- Population
- Patients under protective ventilation for acute respiratory distress syndrome (ARDS) related to COVID-19 assessed with transesophageal echocardiography (TEE)
- Participants
- 182 participants · 310 TEE examinations
- Exposure
- Two-dimensional imaging alone vs LV radial strain
- Outcome
- Inter-rater reliability of PSM grading
Methodological detailsbicentric
- Bicentric
Main finding
As reported in the abstract
2D imaging alone
0.49
kappa · 95% CI 0.40–0.58
2D + LV radial strain
0.84
kappa · 95% CI 0.79–0.90
- Grade 1 paradoxical septal motion (PSM) on two-dimensional assessment (examinations)
- 100 (32%)
- Grade 2 PSM on two-dimensional assessment (examinations)
- 48 (15%)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| ICU mortality | 6.27 (2.28–17.2) | |
| 0.050.21520Hazard ratio (log scale) |
- ICU mortality: requalification in an upper PSM grade using LV radial strain; vs. 2.80 [95% CI 1.11-7.09]
- ICU mortality: multivariate Cox model, new-onset PSM as time-dependent variable; subset with serial TEE examinations
Time-to-peak and area under the strain curve by PSM grade
- Time-to-peak of mid-septal and mid-lateral segments occurred significantly later in systole and increased with PSM grade
- Area under the strain curve of these segments increased significantly with PSM grade, compared with mid-anterior or mid-inferior segments
ICU mortality
- Severe acute cor pulmonale (ACP) with grade 2 PSM significantly associated with mortality
Original publication
Diagnostic, prognostic and clinical value of left ventricular radial strain to identify paradoxical septal motion in ventilated patients with the acute respiratory distress syndrome: an observational prospective multicenter study. Crit Care. Published 2 November 2023. doi:10.
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