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Critical Care Echocardiography as a Routine Procedure for the Detection and Early Treatment of Cardiac Pathologies
Stefan Schmidt1, Jana-Katharina Dieks2, Michael Quintel1
1Department of Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
Insights
Routine transthoracic echocardiography in the ICU detects significant cardiac pathologies in most patients. Early detection of these conditions, which impact survival, can inform timely interventions.
Area of Science:
- Critical Care Medicine
- Cardiology
- Diagnostic Imaging
Background:
- Transthoracic echocardiography (TTE) and transesophageal echocardiography are vital for diagnosing cardiac issues and assessing hemodynamics in intensive care units (ICUs).
- Current critical care echocardiography (CCE) recommendations lack a robust evidence base.
- The feasibility and clinical utility of routine TTE in ICUs remain unclear.
Purpose of the Study:
- To investigate the feasibility and clinical usefulness of routinely performing TTE in non-cardiac surgical ICU patients.
- To determine the prevalence and types of cardiac pathologies detectable by routine TTE in critically ill patients.
- To assess the impact of echocardiographic findings on patient survival in the ICU.
Main Methods:
- A single-center, prospective observational study involving 111 consecutive non-cardiac, non-cardiothoracic surgical ICU patients.
- Routine transthoracic echocardiography was performed on all eligible patients.
- Cardiac pathologies and hemodynamic status were assessed, with a focus on critical findings.
Main Results:
- Significant cardiac pathologies were identified in 76.6% of patients, with critical pathologies in 30.8%.
- Common critical findings included elevated pulmonary artery systolic pressure (sPAP > 50 mmHg), reduced tricuspid annular plane systolic excursion (≤ 13 mm), grade III diastolic dysfunction, severe tricuspid valve insufficiency, and low left ventricular ejection fraction (LV-EF < 30%).
- Patients with echocardiographic abnormalities faced a significant survival disadvantage in the ICU.
Conclusions:
- Routine transthoracic CCE in ICU patients is feasible and reveals a high prevalence of cardiac pathologies.
- Early detection of cardiac conditions through routine TTE can guide early interventions, potentially improving outcomes.
- Findings suggest that cardiac pathologies significantly impact ICU survival and warrant greater emphasis in CCE training and recommendations.
Abstract:
Transthoracic and transesophageal echocardiography are important investigations in the intensive care unit (ICU) to diagnose acute cardiac pathologies and assess the haemodynamic status. Recommendations for critical care echocardiography (CCE) have been published recently, but these still lack an evidence-based foundation. It is not known if performing transthoracic echocardiography (TTE) on a routine basis instead of only when required in acute cases is feasible or clinically useful. In this single-centre prospective observational study, we routinely performed TTE on 111 consecutive non-cardiological, non-cardiothoracic surgical ICU patients in two surgical ICUs in a tertiary care facility. Significant cardiac pathologies were detected in 82 (76.6%) and critical cardiac pathologies in 33 (30.8%) of the 107 patients. The most common critical cardiac pathologies were sPAP > 50 mmHg (19.63%), tricuspid annular plane systolic excursion ≤ 13 mm (9.4%), grade III diastolic dysfunction (8.4%), severe tricuspid valve insufficiency (5.6%) and left ventricular ejection fraction (LV-EF) ˂ 30% (4.7%). Some of the most commonly found cardiac pathologies are not well emphasised in current recommendations and training programs. We observed a progression of the cardiac pathologies previously described in 41 of the patients (91.1%). Patients with echocardiographic abnormalities had a significant survival disadvantage in the ICU. By performing CCE routinely, we observed the range and prevalence of cardiac pathologies that can be detected by echocardiography in critically ill patients. We recommend routine transthoracic CCE in ICU patients for early detection of cardiac pathologies and to help inform early intervention regimens, since cardiac conditions carry a significant survival disadvantage for the ICU patient.
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