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Ladha P, Truong EI, Kanuika P, Allan A, Kishawi S, Ho VP, Claridge JA, Brown LR. Diagnostic Adjunct Techniques in the Assessment of Hypovolemia: A Prospective Pilot Project. J Surg Res 2024; 293:1-7. [PMID: 37690381 PMCID: PMC11334708 DOI: 10.1016/j.jss.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Measuring the hypovolemic resuscitation end point remains a critical care challenge. Our project compared clinical hypovolemia (CH) with three diagnostic adjuncts: 1) noninvasive cardiac output monitoring (NICOM), 2) ultrasound (US) static IVC collapsibility (US-IVC), and 3) US dynamic carotid upstroke velocity (US-C). We hypothesized US measures would correlate more closely to CH than NICOM. METHODS Adult trauma/surgical intensive care unit patients were prospectively screened for suspected hypovolemia after acute resuscitation, excluding patients with burns, known heart failure, or severe liver/kidney disease. Adjunct measurements were assessed up to twice a day until clinical improvement. Hypovolemia was defined as: 1) NICOM: ≥10% stroke volume variation with passive leg raise, 2) US-IVC: <2.1 cm and >50% collapsibility (nonventilated) or >18% collapsibility (ventilated), 3) US-C: peak systolic velocity increase 15 cm/s with passive leg raise. Previously unknown cardiac dysfunction seen on US was noted. Observation-level data were analyzed with a Cohen's kappa (κ). RESULTS 44 patients (62% male, median age 60) yielded 65 measures. Positive agreement with CH was 47% for NICOM, 37% for US-IVC and 10% for US-C. None of the three adjuncts correlated with CH (κ -0.045 to 0.029). After adjusting for previously unknown cardiac dysfunction present in 10 patients, no adjuncts correlated with CH (κ -0.036 to 0.031). No technique correlated with any other (κ -0.118 to 0.083). CONCLUSIONS None of the adjunct measurements correlated with CH or each other, highlighting that fluid status assessment remains challenging in critical care. US should assess for right ventricular dysfunction prior to resuscitation.
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Affiliation(s)
- Prerna Ladha
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Evelyn I Truong
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter Kanuika
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Annie Allan
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Sami Kishawi
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vanessa P Ho
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio; Department of Population Health and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | | | - Laura R Brown
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio.
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Brault C, Zerbib Y, Mercado P, Diouf M, Michaud A, Tribouilloy C, Maizel J, Slama M. Mitral annular plane systolic excursion for assessing left ventricular systolic dysfunction in patients with septic shock. BJA OPEN 2023; 7:100220. [PMID: 37638090 PMCID: PMC10457489 DOI: 10.1016/j.bjao.2023.100220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/19/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023]
Abstract
Background Using easy-to-determine bedside measurements, we developed an echocardiographic algorithm for predicting left ventricular ejection fraction (LVEF) and longitudinal strain (LVLS) in patients with septic shock. Methods We measured septal and lateral mitral annular plane systolic excursion (MAPSE), septal and lateral mitral S-wave velocity, and the left ventricular longitudinal wall fractional shortening in patients with septic shock. We used a conditional inference tree method to build a stratification algorithm. The left ventricular systolic dysfunction was defined as an LVEF <50%, an LVLS greater than -17%, or both. Results We included 71 patients (males: 61%; mean [standard deviation] age: 61 [15] yr). Septal MAPSE (cut-off: 1.2 cm) was the best predictor of left ventricular systolic dysfunction. The level of agreement between the septal MAPSE and the left ventricular systolic dysfunction was 0.525 [0.299-0.751]. A septal MAPSE ≥1.2 cm predicted normal LVEF in 17/18 patients, or 94%. In contrast, a septal MAPSE <1.2 cm predicted left ventricular systolic dysfunction with impaired LVLS in 46/53 patients (87%), although 32/53 (60%) patients had a preserved LVEF. Conclusions Septal MAPSE is easily measured at the bedside and might help clinicians to detect left ventricular systolic dysfunction early-especially when myocardial strain measurements are not feasible.
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Affiliation(s)
- Clément Brault
- Intensive Care Department, Amiens-Picardie University Hospital, Amiens, France
| | - Yoann Zerbib
- Intensive Care Department, Amiens-Picardie University Hospital, Amiens, France
| | - Pablo Mercado
- Intensive Care Department, Amiens-Picardie University Hospital, Amiens, France
- Universidad del Desarrollo, Departamento de Paciente Crítico, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Momar Diouf
- Clinical Research Department Amiens-Picardie University Hospital, Amiens, France
| | - Audrey Michaud
- Clinical Research Department Amiens-Picardie University Hospital, Amiens, France
| | | | - Julien Maizel
- Intensive Care Department, Amiens-Picardie University Hospital, Amiens, France
| | - Michel Slama
- Intensive Care Department, Amiens-Picardie University Hospital, Amiens, France
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Berg EAR, Taskén AA, Nordal T, Grenne B, Espeland T, Kirkeby-Garstad I, Dalen H, Holte E, Stølen S, Aakhus S, Kiss G. Fully automatic estimation of global left ventricular systolic function using deep learning in transoesophageal echocardiography. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad007. [PMID: 39044786 PMCID: PMC11195714 DOI: 10.1093/ehjimp/qyad007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2024]
Abstract
Aims To improve monitoring of cardiac function during major surgery and intensive care, we have developed a method for fully automatic estimation of mitral annular plane systolic excursion (auto-MAPSE) using deep learning in transoesophageal echocardiography (TOE). The aim of this study was a clinical validation of auto-MAPSE in patients with heart disease. Methods and results TOE recordings were collected from 185 consecutive patients without selection on image quality. Deep-learning-based auto-MAPSE was trained and optimized from 105 patient recordings. We assessed auto-MAPSE feasibility, and agreement and inter-rater reliability with manual reference in 80 patients with and without electrocardiogram (ECG) tracings. Mean processing time for auto-MAPSE was 0.3 s per cardiac cycle/view. Overall feasibility was >90% for manual MAPSE and ECG-enabled auto-MAPSE and 82% for ECG-disabled auto-MAPSE. Feasibility in at least two walls was ≥95% for all methods. Compared with manual reference, bias [95% limits of agreement (LoA)] was -0.5 [-4.0, 3.1] mm for ECG-enabled auto-MAPSE and -0.2 [-4.2, 3.6] mm for ECG-disabled auto-MAPSE. Intra-class correlation coefficient (ICC) for consistency was 0.90 and 0.88, respectively. Manual inter-observer bias [95% LoA] was -0.9 [-4.7, 3.0] mm, and ICC was 0.86. Conclusion Auto-MAPSE was fast and highly feasible. Inter-rater reliability between auto-MAPSE and manual reference was good. Agreement between auto-MAPSE and manual reference did not differ from manual inter-observer agreement. As the principal advantages of deep-learning-based assessment are speed and reproducibility, auto-MAPSE has the potential to improve real-time monitoring of left ventricular function. This should be investigated in relevant clinical settings.
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Affiliation(s)
- Erik Andreas Rye Berg
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Anders Austlid Taskén
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim 7034, Norway
| | - Trym Nordal
- Department of Engineering Cybernetics, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim 7034, Norway
| | - Bjørnar Grenne
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Torvald Espeland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Idar Kirkeby-Garstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim 7030, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Espen Holte
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Stian Stølen
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Svend Aakhus
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
- Clinic of Cardiology, St Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, Trondheim 7030, Norway
| | - Gabriel Kiss
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Trondheim 7034, Norway
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Ma C, Sanderson JE, Chen Q, Liang Z, Zhan X, Wu C, Liu H, Xiao L, Fang F. Fast assessment of left ventricular systolic function in obstructive sleep apnea patients with automated function imaging: Comparison with mitral annular plane systolic excursion. Echocardiography 2022; 39:426-433. [PMID: 35128719 DOI: 10.1111/echo.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/17/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early detection of left ventricular (LV) subclinical dysfunction is clinically relevant before developing irreversible impairment in obstructive sleep apnea (OSA) patients. Mitral annulus plane systolic excursion (MAPSE) is a fast tool for OSA due to high prevalent obesity; another quick but more comprehensive tool is LV global longitudinal stain (GLS) based on automated function imaging (AFI). We therefore aimed to compare the feasibility and reproducibility of AFI to MAPSE in OSA patients, as a good model in whom obesity is common. METHODS A comprehensive echocardiographic examination was done in 186 consecutive patients having polysomnography for suspected OSA. MAPSE was measured by using M-mode to calculate excursion of mitral annulus. GLS was derived by offline analysis of three long-axis views that semi-automatically detects LV endocardial boundary, which is adjusted manually as necessary with AFI measurement. Variability of AFI and MAPSE were compared among the different subgroups. RESULTS Despite a relatively high obesity rate (42.9%), the feasibility of AFI was 94% (175/186) and that of 100% in MAPSE. AFI showed excellent correlation (r = .882) superior to MAPSE (r = .819) between the Expert and Beginner. Intra- and inter- observer variability of AFI and MAPSE in Bland-Altman analysis were 5.5% and 6.5%; 6.2% and 8.8%, respectively. In repeated measurements, AFI showed higher intra-class correlation (ICC = .95) than MAPSE (ICC = .87) (p < 0.05). Furthermore, analysis showed that AFI was feasible even in more obese patients (BMI≥28 kg/m2 ). CONCLUSIONS Even in obese patients with OSA, AFI-GLS is feasible and more reliable for less expert operators than MAPSE in detecting LV longitudinal dysfunction.
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Affiliation(s)
- ChenYao Ma
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.,Department of Ultrasound, Beijing DiTan Hospital, Capital Medical University, Beijing, China
| | - John E Sanderson
- Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Qi Chen
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhe Liang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - XiaoJun Zhan
- Sleep Medicine Center, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chan Wu
- Sleep Medicine Center, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hu Liu
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Lei Xiao
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Fang Fang
- Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Severity of acute respiratory distress syndrome and echocardiographic findings in clinical practice-an echocardiographic pilot study. Heart Lung 2020; 49:622-625. [PMID: 32220394 DOI: 10.1016/j.hrtlng.2020.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUNDS The still high poor outcome of ARDS may be more consequence of circulatory failure than hypoxemia per se. For patients with circulatory failure and ARDS, hemodynamic instability is directly related to ARDS following pulmonary circulation dysfunction and its consequence - right ventricular (RV) dysfunction. OBJECTIVES We hypothesize that in the era of protective ventilation, echocardiographic abnormalities did not parallel ARDS severity, defined by the degree of hypoxemia. METHODS We included 63 consecutively identified mechanically ventilated ARDS patients (1st January 2015 to 31th December 2016). All had echocardiography performed routinely within the first 12 h after ICU admission. RESULTS The analysis included 110 exams. Twenty-eight patients had severe ARDS (28/63, 44.4%), 27 had moderate ARDS (27/63, 42.1%) and 8 mild ARDS (8/63, 12.7%).There was no difference in echocardiographic findings between mild-moderate and severe ARDS. At Pearson's linear regression analysis, TAPSE was directly correlated with LVEF (r = 0.22, p = 0.021) and inversely with sPAP (r = -0.37, p < 0.001). Systolic pulmonary arterial pressure (sPAP) showed a direct correlation with pCO2 (r = 0.30, p = 0.002) and an inverse one with pH (r = -0.35, p < 0.001) and TAPSE (r =-0.35, p < 0.001). CONCLUSIONS Among patients with ARDS, the severity of disease (as indicated by pO2) does not translate into specific cardiac abnormalities, detected by echocardiography. However, RV function (as indicated by TAPSE) is inversely related to pCO2 and to sPAP (which therefore may be underestimated in presence ofRV dysfunction). Our data strongly suggest that in mechanically ventilated ARDS, the interpretation of echo findings should consider also pCO2 values.
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Tempe DK. A Quick and Simple Method to Assess Reliably the Left Ventricular Function With TEE: Is MAPSE the Answer? J Cardiothorac Vasc Anesth 2019; 33:1340-1342. [DOI: 10.1053/j.jvca.2018.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 11/11/2022]
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Shah A, Nanjayya V, Ihle J. Mitral Annular Plane Systolic Excursion as a predictor of Left Ventricular Ejection Fraction in mechanically ventilated patients. Australas J Ultrasound Med 2019; 22:138-142. [PMID: 34760550 DOI: 10.1002/ajum.12131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction The accurate measurement of Left Ventricular Ejection Fraction (LVEF) requires high-quality images and echocardiography expertise. Critically ill patients can present challenges in obtaining good acoustic windows for ultrasound, particularly for ICU trainees early in their ultrasound learning. Mitral Annular Plane Systolic Excursion (MAPSE), a simple measurement, may be useful in this context to estimate LV systolic function. Materials and Methods All adult patients admitted to the Alfred ICU between August 2012 and February 2013 who were on mechanical ventilation and needed an echocardiography examination were eligible to be included in the study. An ICU trainee in their first year of echocardiography training performed MAPSE measurements. An advanced echocardiographer classified LV systolic function into normal, mild, moderate or severe categories based on the visual estimation of LVEF. The relationship between the MAPSE measurements and the range of LV systolic function was assessed. Results Amongst 39 patients, the mean (SD) age was 55 (18.6) years, 20 (50%) were males, 36 (90%) were in sinus rhythm, 19 (48%) were on vasopressors, 12 (30%) were on inotropes and 23 (58%) were on mandatory mode mechanical ventilation. The mean (SD) MAPSE was 12.2 (5.28) mm. 28 (70%) of the patients had normal or mildly reduced LVEF. The ROC analysis showed that a MAPSE cut-off point of ≥12.5 mm diagnosed normal or mildly reduced LVEF with 82.14% sensitivity and 91.67% specificity. The area under ROC curve was 0.91 (95% CI 0.82-1.00). Conclusion MAPSE is useful as a surrogate for LVEF in mechanically ventilated patients. In early critical care echocardiography training, a novice learner can perform MAPSE easily, accurately, and find it helpful for assessment of LVEF.
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Affiliation(s)
- Asim Shah
- The Alfred ICU Melbourne Victoria 3004 Australia
| | | | - Josh Ihle
- The Alfred ICU Melbourne Victoria 3004 Australia
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Borde DP, Joshi S, Asegaonkar B, Apsingkar P, Pande S, More S, Takalkar U, Deodhar A. Mitral Annular Plane Systolic Excursion: A Simple, Reliable Echocardiographic Parameter to Detect Left Ventricular Systolic Dysfunction in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting with Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2018; 33:1334-1339. [PMID: 30477889 DOI: 10.1053/j.jvca.2018.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study's objective was to test the hypothesis that transesophageal echocardiography (TEE)-based mitral annular plane systolic excursion (MAPSE) measurement is useful in perioperative settings to detect left ventricular (LV) systolic dysfunction in patients undergoing off-pump coronary artery bypass grafting (OPCAB). DESIGN Retrospective observational study. SETTING Tertiary-care level hospitals. PARTICIPANTS The study comprised 116 patients undergoing OPCAB to obtain cutoffs of MAPSE to detect LV dysfunction. These cutoffs were validated in another 105 patients from 2 other institutions. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In 116 patients who had undergone OPCAB during the study period with TEE monitoring, MAPSE was measured post hoc at the lateral and septal mitral (and average) annulus using the software tool M.mode.ify (http://www.ultrasoundoftheweek.com/M.mode.ify). Receiver operating curves were constructed to obtain cutoff values of MAPSE at the lateral and septal (and average) annulus of the mitral valve to predict LV systolic dysfunction, which was defined by an ejection fraction <52% for men and <54% for women as measured using the biplane method of disks. These cutoff values then were validated in another 105 patients. LV systolic dysfunction was present in 43% patients. Youden's index values of 9mm for lateral MPASE (area under the receiver operating curve [AUC] 0.93 [confidence interval {CI} 0.87-0.97]; p < 0.0001); 7mm for septal MAPSE (AUC 0.87 [CI 0.79-0.92]; p < 0.0001); and 9mm for average MAPSE (AUC 0.92 [CI 0.86-0.96]; p < 0.0001) were obtained. These cutoffs were statistically significant in the validation cohort (p < 0.0001) with an AUC of 0.84 (CI 0.75-0.90), sensitivity of 86.2%, specificity of 80.8%, positive predictive value of 84.8%, and negative predictive value of 82.6%. CONCLUSIONS MAPSE is a simple, rapid, and reliable method to detect LV dysfunction using TEE in patients undergoing OPCAB. Its use as screening tool for LV dysfunction is recommended.
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Affiliation(s)
| | - Shreedhar Joshi
- Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | | | | | - Swati Pande
- Ozone Anesthesia Group, Aurangabad, MS, India
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Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Echocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2018; 33:1559-1583. [PMID: 30077562 DOI: 10.1053/j.jvca.2018.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 02/03/2023]
Abstract
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. Hence, M-mode can provide clinically relevant information in echocardiography and lung ultrasound-driven approaches for diagnosis, monitoring, and interventional procedures performed by anesthesiologists and intensivists. Although M-mode is feasible, this imaging modality progressively has been abandoned in echocardiography and is often underutilized in lung ultrasound. This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
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Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
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Hensel KO, Roskopf M, Wilke L, Heusch A. Intraobserver and interobserver reproducibility of M-mode and B-mode acquired mitral annular plane systolic excursion (MAPSE) and its dependency on echocardiographic image quality in children. PLoS One 2018; 13:e0196614. [PMID: 29746603 PMCID: PMC5944962 DOI: 10.1371/journal.pone.0196614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/15/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mitral annular plane systolic excursion (MAPSE) is an increasingly used echocardiography technique to assess left ventricular (LV) function. However, reproducibility and dependence on echocardiographic image quality for MAPSE in pediatric patients have not been studied to date. METHODS We analyzed 284 transthoracic echocardiograms performed on consecutive normotensive children without structural heart disease (mean age 12.6±3.1 years, 50.4% female). B-mode and M-mode derived MAPSE measurements were performed and analyzed regarding inter- and intraobserver reliability and the influence of echocardiographic image quality. RESULTS Overall, MAPSE measurements were highly reproducible with only minor bias. Both inter- and intraobserver reliability were significantly better for M-mode derived MAPSE (p<0.001). Echocardiographic image quality did not significantly influence M-mode MAPSE reproducibility (p>0.235). In contrast, B-mode lateral MAPSE was significantly better reproducible in optimal image quality (-0.07±1.04) when compared to suboptimal echocardiographic images (0.42±1.59, p<0.001). Moreover, poor quality images yielded significantly lower M-mode MAPSE values (14.3±2 mm) than near-optimal (15.2±1.9 mm, p<0.001) or optimal images (15.1±2.2 mm, p = 0.006). CONCLUSION Echocardiographic image quality essentially has a negligible effect on MAPSE reproducibility and measurements. Consequently, MAPSE is a robust echocardiographic parameter with convincing reproducibility for the assessment of LV function in children-even in patients with substandard imaging conditions.
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Affiliation(s)
- Kai O. Hensel
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
- University of Cambridge, Addenbrooke’s University Hospital, Department of Pediatrics, Cambridge, United Kingdom
- * E-mail:
| | - Markus Roskopf
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| | - Lucia Wilke
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| | - Andreas Heusch
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
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