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[Predictive value of left ventricular diastolic dysfunction on mechanical ventilation weaning].

Hui Wang1, Ming Ma, Desheng Chen

  • 1Department of Surgery Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China (Wang H, Chen DS, Li Gang, Wang SP, Duan J); Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China (Xia JG); Department of Plastic and Cosmetology, Beijing Haidian Hospital, Beijing 100080, China (Ma M). Corresponding author: Duan Jun,

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
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Summary

Left ventricular diastolic dysfunction predicts mechanical ventilation weaning failure in patients with preserved ejection fraction. Echocardiographic parameters like E/A ratio and E/Em ratio can identify high-risk patients.

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Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Echocardiography

Background:

  • Mechanical ventilation is a life support measure for critically ill patients.
  • Weaning from mechanical ventilation can be challenging, especially in patients with cardiac dysfunction.
  • Left ventricular ejection fraction (LVEF) > 0.50 indicates preserved systolic function, but diastolic function may be impaired.

Purpose of the Study:

  • To evaluate the predictive value of left ventricular diastolic function for successful mechanical ventilation weaning.
  • To assess echocardiographic parameters of diastolic function in predicting weaning outcomes in patients with LVEF > 0.50.

Main Methods:

  • Retrospective case-control study of 65 patients with LVEF > 0.50 on mechanical ventilation > 48 hours.
  • Echocardiographic parameters of left ventricular diastolic function were assessed before spontaneous breathing trial (SBT).
  • Patients were categorized by diastolic dysfunction severity and compared for weaning success rates.
  • Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of diastolic parameters.

Main Results:

  • Weaning failure occurred in 43.1% of patients.
  • Increased severity of left ventricular diastolic dysfunction correlated with higher weaning failure rates (16.1% to 76.0%).
  • Patients failing weaning showed impaired diastolic function, evidenced by altered mitral valve flow filling parameters (e.g., decreased E/A, increased E/Em).
  • ROC analysis indicated that E/A ratio > 1.2 and lateral E/Em ratio > 7.9 predicted weaning failure with high sensitivity and specificity (AUC 0.81-0.85).

Conclusions:

  • Left ventricular diastolic dysfunction is a significant predictor of weaning failure in critically ill patients with preserved LVEF.
  • Echocardiographic assessment of diastolic function, particularly the E/A and E/Em ratios, can identify patients at high risk for weaning failure.
  • Combined use of E/A > 1.2 and lateral E/Em > 7.9 demonstrated strong predictive performance for weaning failure.