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Right ventricular echocardiographic parameters and prediction of stroke volume in ischemic cardiogenic shock: A
Hazem Lashin1, Olusegun Olusanya2, Andrew Smith1
1Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK; William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK.
Insights
In patients with cardiogenic shock, the right ventricular outflow tract velocity time integral (RVOT VTI) best correlates with stroke volume (SV) compared to other echocardiographic parameters. RVOT VTI shows potential as a therapeutic target for optimizing SV in these critical patients.
Area of Science:
- Cardiology
- Echocardiography
- Critical Care Medicine
Background:
- Ischemic cardiogenic shock (CS) is a severe condition characterized by impaired cardiac output.
- Accurate assessment of right ventricular (RV) function and stroke volume (SV) is crucial for managing CS.
- Echocardiography is a primary tool for evaluating RV function, but the best parameter for correlating with SV in CS is debated.
Purpose of the Study:
- To determine which commonly used right ventricular (RV) echocardiographic parameter best correlates with stroke volume (SV) in patients with ischemic cardiogenic shock (CS).
- To identify a reliable echocardiographic marker for guiding therapeutic interventions aimed at optimizing SV in CS.
Main Methods:
- Retrospective review of 100 patients with CS admitted to the ICU.
- Correlation analysis between SV (estimated by Doppler echocardiography) and four RV echocardiographic parameters: Tricuspid annular plane systolic excursion (TAPSE), Tricuspid annulus systolic velocity (RV S'), Tricuspid regurgitation maximum velocity (TR Vmax), and RV outflow tract velocity time integral (RVOT VTI).
Main Results:
- RVOT VTI demonstrated the strongest correlation with SV (r=0.39, p=0.01) compared to TAPSE (r=0.26, p=0.01), RV S' (r=0.15, p=0.21), and TR Vmax (r=0.03, p=0.78).
- RVOT VTI independently predicted SV and had the best area under the curve (0.70, p=0.03) in univariate analysis.
- While the correlation was weak, RVOT VTI showed superior performance in predicting SV among the evaluated parameters.
Conclusions:
- RVOT VTI is a better echocardiographic correlate and predictor of SV than TAPSE, RV S', and TR Vmax in patients with CS.
- RVOT VTI holds potential as a valuable therapeutic target for optimizing stroke volume management in cardiogenic shock.
Purpose:
This study investigated which commonly used right ventricular (RV) echocardiographic parameter correlates best with stroke volume (SV) estimated by Doppler echocardiography in ischemic cardiogenic shock (CS).
Materials And Methods:
We retrospectively reviewed the records of 100 patients admitted to the ICU over 34 months with CS. Tricuspid annular plane systolic excursion (TAPSE), Tricuspid annulus systolic velocity (RV S'), Tricuspid regurgitation maximum velocity (TR Vmax), and RV outflow tract velocity time integral (RVOT VTI) were correlated to SV.
Results:
Mean age was 62.6 ± 12.7 years and 78% were male. The mean SV, TAPSE, RV S', TR Vmax, and RVOT VTI were 47 ± 16 ml, 16 ± 5 mm, 11 ± 4 mm/s, 1.97 ± 0.73 m/s, and 12.7 ± 5 cm, respectively. RVOT VTI correlated best to SV (r = 0.39 p = 0.01) compared to TAPSE, RV S', and TR Vmax (r = 0.26 p = 0.01, r = 0.15 p = 0.21, r = 0.03 p = 0.78). RVOT VTI independently predicted SV. Univariate analysis demonstrated that only RVOT VTI predicted SV (OD = 1.18 p = 0.04) and had the best area under the curve (0.70, p = 0.03).
Conclusion:
RVOT VTI correlated better (albeit weakly) to and best predicted SV compared to TAPSE, RV S', and TR Vmax in patients admitted to intensive care with CS. This study suggests that RVOT VTI has the potential as a therapeutic target to optimize SV in CS.
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