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The heart in the critically ill patient- an echocardiographic study

Bergenzaun, Lill LU (2014) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2014: 25.
Abstract
The thesis describes aspects of left ventricular systolic and diastolic function examined with echocardiography in

patients with systemic inflammation and shock.

Background: Myocardial depression is a well-known complication in critically ill patients with shock.

Echocardiography is increasingly used for assessing left ventricular (LV) function in these patients.

Aims: 1) To describe the feasibility and reliability of LV systolic function parameters, and the association between

different types of measurements 2) To investigate the time course of LV systolic and diastolic function parameters 3)

To examine the relation of LV longitudinal function to other LV function parameters and... (More)
The thesis describes aspects of left ventricular systolic and diastolic function examined with echocardiography in

patients with systemic inflammation and shock.

Background: Myocardial depression is a well-known complication in critically ill patients with shock.

Echocardiography is increasingly used for assessing left ventricular (LV) function in these patients.

Aims: 1) To describe the feasibility and reliability of LV systolic function parameters, and the association between

different types of measurements 2) To investigate the time course of LV systolic and diastolic function parameters 3)

To examine the relation of LV longitudinal function to other LV function parameters and biomarkers 4) To determine

whether LV function parameters and cardiac biomarkers are associated with mortality.

Methods: Transthoracic echocardiographic, hemodynamic parameters as well as laboratory measurements were

assessed daily for a total of 7 days. Measurements from day 1 were assessed for their relation to short (28-day) and

long term (1-year) mortality.

Results: LV systolic function parameters were easily obtainable (93% to 100%) and had acceptable repeatability

(coefficient of variation 3.1% to 10.6%). Eyeball ejection fraction and atrioventricular plane displacement¹ provided

the most reliable results. The different parameters variably correlated to each other, and showed substantial variation

over time (r= 0.101 to 0.949). LV systolic function parameters improved over time whereas most LV diastolic

function parameters did not. The LV longitudinal parameter mitral annular plane excursion (MAPSE)¹ correlated

significantly with markers of both LV systolic and diastolic function and with the cardiac biomarker high-sensitive

troponin T. MAPSE was significantly associated with 28-day mortality but not long term mortality. High-sensitive

TNT was an independent marker of 1-year mortality and was a univariate predictor of 28-day mortality. Some

echocardiographic measurements of LV filling pressure were significantly associated with 1-year mortality.

Conclusion: Transthoracic echocardiography is variably feasible in hemodynamically unstable, ventilated patients

with different methods of measuring LV systolic function. Eyeball EF is reliable and can be used instead of more

formal methods of EF quantification. The addition of parameters assessing LV longitudinal function, for example,

MAPSE, is an advantage. MAPSE seemed even to reflect LV diastolic function and myocardial injury. Serial

evaluations over the seven-day observation period revealed that most markers of LV diastolic function remained

unchanged despite improvement of LV systolic function, markers of critical illness and systemic hemodynamic

parameters. Echocardiographic measurements of LV filling pressure should be assessed as they may be related to long

term mortality. The association of the cardiac biomarker high-sensitive Troponin with long term mortality was strong.

¹The terms atrioventricualar plane displacement (AVPD) and mitral annular plane systolic excursion (MAPSE) are

used interchangeably. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Cholley, Bernard, Service d’Anesthésie-Réanimation Hôpital Européen Georges Pompidou Paris
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Echocardiography, shock, left ventricular function, biomarkers, and outcome
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2014: 25
pages
58 pages
publisher
Anaesthesiology and Intensive Care
defense location
Lilla Aulan, Medicinskt Forskningscentrum, ingång 59, Jan Waldenströmsgata 5, Skånes Universitetssjukhus Malmö
defense date
2014-02-27 09:15
ISSN
1652-8220
ISBN
978-91-87651-49-6
language
English
LU publication?
yes
id
2b8db656-75fd-427c-9f91-91656d5ba4e7 (old id 4275926)
date added to LUP
2014-02-11 09:39:51
date last changed
2016-09-19 08:44:50
@phdthesis{2b8db656-75fd-427c-9f91-91656d5ba4e7,
  abstract     = {The thesis describes aspects of left ventricular systolic and diastolic function examined with echocardiography in<br/><br>
patients with systemic inflammation and shock.<br/><br>
Background: Myocardial depression is a well-known complication in critically ill patients with shock.<br/><br>
Echocardiography is increasingly used for assessing left ventricular (LV) function in these patients.<br/><br>
Aims: 1) To describe the feasibility and reliability of LV systolic function parameters, and the association between<br/><br>
different types of measurements 2) To investigate the time course of LV systolic and diastolic function parameters 3)<br/><br>
To examine the relation of LV longitudinal function to other LV function parameters and biomarkers 4) To determine<br/><br>
whether LV function parameters and cardiac biomarkers are associated with mortality.<br/><br>
Methods: Transthoracic echocardiographic, hemodynamic parameters as well as laboratory measurements were<br/><br>
assessed daily for a total of 7 days. Measurements from day 1 were assessed for their relation to short (28-day) and<br/><br>
long term (1-year) mortality.<br/><br>
Results: LV systolic function parameters were easily obtainable (93% to 100%) and had acceptable repeatability<br/><br>
(coefficient of variation 3.1% to 10.6%). Eyeball ejection fraction and atrioventricular plane displacement¹ provided<br/><br>
the most reliable results. The different parameters variably correlated to each other, and showed substantial variation<br/><br>
over time (r= 0.101 to 0.949). LV systolic function parameters improved over time whereas most LV diastolic<br/><br>
function parameters did not. The LV longitudinal parameter mitral annular plane excursion (MAPSE)¹ correlated<br/><br>
significantly with markers of both LV systolic and diastolic function and with the cardiac biomarker high-sensitive<br/><br>
troponin T. MAPSE was significantly associated with 28-day mortality but not long term mortality. High-sensitive<br/><br>
TNT was an independent marker of 1-year mortality and was a univariate predictor of 28-day mortality. Some<br/><br>
echocardiographic measurements of LV filling pressure were significantly associated with 1-year mortality.<br/><br>
Conclusion: Transthoracic echocardiography is variably feasible in hemodynamically unstable, ventilated patients<br/><br>
with different methods of measuring LV systolic function. Eyeball EF is reliable and can be used instead of more<br/><br>
formal methods of EF quantification. The addition of parameters assessing LV longitudinal function, for example,<br/><br>
MAPSE, is an advantage. MAPSE seemed even to reflect LV diastolic function and myocardial injury. Serial<br/><br>
evaluations over the seven-day observation period revealed that most markers of LV diastolic function remained<br/><br>
unchanged despite improvement of LV systolic function, markers of critical illness and systemic hemodynamic<br/><br>
parameters. Echocardiographic measurements of LV filling pressure should be assessed as they may be related to long<br/><br>
term mortality. The association of the cardiac biomarker high-sensitive Troponin with long term mortality was strong.<br/><br>
¹The terms atrioventricualar plane displacement (AVPD) and mitral annular plane systolic excursion (MAPSE) are<br/><br>
used interchangeably.},
  author       = {Bergenzaun, Lill},
  isbn         = {978-91-87651-49-6},
  issn         = {1652-8220},
  keyword      = {Echocardiography,shock,left ventricular function,biomarkers,and outcome},
  language     = {eng},
  pages        = {58},
  publisher    = {Anaesthesiology and Intensive Care},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {The heart in the critically ill patient- an echocardiographic study},
  volume       = {2014: 25},
  year         = {2014},
}