Evaluation of the Right Ventricular Systolic Function Using Real-time Three-dimensional Echocardiography in Intensive Care Unit Patients

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participants needed

308
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University Hospital, Limoges

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Updated on 19 February 2024

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pulmonary disease

ejection fraction

respiratory distress

sepsis

tapse

3d echocardiography

infarction

tricuspid annular plane systolic excursion

lung disorder

Summary

Show definitions

Right ventricular failure (RVF) is an independent factor of mortality for many pulmonary diseases. Currently, RVF is defined as the incapacity of the RV to maintain the flow without dilating to use the Frank-Starling law (i.e., increase of the ejection volume associated to an increase of the preload). RVF is associated to RV systolic dysfunction which is conventionally defined as a decrease of the RV ejection fraction (RVEF) < 45%.

In the intensive care unit (ICU), acute RVF is mainly due to the acute respiratory distress syndrome (ARDS), sepsis or septic shock, and less often to severe pulmonary embolism or RV infarction.

The anatomical complexity of the RV precludes any geometrical assumption to estimate its volume, hence its ejection fraction (EF) using two-dimensional (2D) echocardiography. For this reason, the evaluation of RV systolic function is currently based on parameters used as surrogates of RVEF: fraction area change in 2D-mode, tricuspid annular plane systolic excursion (TAPSE) in M-mode, and maximal velocity of the systolic S' wave using tissue Doppler imaging.

Real-time three-dimensional (3D) echocardiography now enables accurate on-line measurement of RV volume and provides at the bedside the non-invasive assessment of RVEF. 3D transthoracic echocardiography (TTE) has been validated to measure RV volume and RVEF compared to MRI which is the gold standard. However, 3D transesophageal echocardiography (TEE) has not yet been validated in this specific clinical setting, while 2D TEE is frequently used in ICU in ventilated and sedated patients. Accordingly, the diagnostic ability of 3D echocardiography to quantify RV systolic function in ICU patients with RVF of any origin is currently unknown.

Details

Condition	intensive care unit, Pulmonary Disease, RIGHT VENTRICULAR DYSFUNCTION
Age	18years - 100years
Treatment	Real-time three-dimensional echocardiography
Clinical Study Identifier	NCT04222764
Sponsor	University Hospital, Limoges
Last Modified on	19 February 2024

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	Adult patients ( 18 years old) hospitalized in the ICU and requiring echocardiography for any reason
	With a disease at risk of being associated with RVF
	ARDS (Berlin definition)
	Sepsis or septic shock (Sepsis-3 definition)
	Pulmonary embolism
	RV infarction
	Affiliated to Social Security
	Consent of the patient and/or his authorized representative to participate in the study
Exclusion Criteria
	History of congenital cardiac disease
	Patient under legal protection
	Under any method of oxygen support or extracorporeal circulatory support (veno-venous extracorporeal membrane oxygenation, extracorporeal Life support...)
	Non sinusal rhythm
	Documented preexisting right cardiac disease
	Quality of echocardiographic images incompatible with 3D assessment

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Evaluation of the Right Ventricular Systolic Function Using Real-time Three-dimensional Echocardiography in Intensive Care Unit Patients