Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index

Muddassir Mehmood; Robert W. Biederman; Ronald J. Markert; Mary C. McCarthy; Kathryn M. Tchorz

doi:10.1016/j.hlc.2019.05.186

Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index

Muddassir Mehmood, Robert W. Biederman, Ronald J. Markert, Mary C. McCarthy, Kathryn M. Tchorz

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3> Background </h3> The gold standard for right heart function is the assessment of right ventricular-pulmonary arterial coupling defined as the ratio of arterial to end-systolic elastance (Ea/Emax). This study demonstrates the use of the volumetric pulmonary artery (PA) catheter for estimation of Ea/Emax and describes trends of Ea/Emax, right ventricular ejection fraction (RVEF), and pulmonary artery pulsatility index (PAPi) during initial 48&emsp14;hours of resuscitation in the trauma surgical intensive care unit (ICU). <h3> Methods </h3> Review of prospectively collected data for 32 mechanically ventilated adult trauma and emergency general surgery patients enrolled within 6&emsp14;hours of admission to the ICU. Haemodynamics, recorded every 12&emsp14;hours for 48&emsp14;hours, were compared among survivors and non-survivors to hospital discharge. <h3> Results </h3> Mean age was 49&emsp14;±&emsp14;20 years, 69% were male, and 84% were trauma patients. Estimated Ea/Emax was associated with pulmonary vascular resistance and inversely related to pulmonary arterial capacitance and PA catheter derived RVEF. Seven (7) trauma patients did not survive to hospital discharge. Non-survivors had higher estimated Ea/Emax, suggesting right ventricular-pulmonary arterial uncoupling, with a statistically significant difference at 48&emsp14;hours (2.3&emsp14;±&emsp14;1.7 vs 1.0&emsp14;±&emsp14;0.58, p&emsp14;=&emsp14;0.018). RVEF was significantly lower in non-survivors at study initiation and at 48&emsp14;hours. PAPi did not show a consistent trend. <h3> Conclusions </h3> Estimation of Ea/Emax using volumetric PA catheter is feasible. Serial assessment of RVEF and Ea/Emax may help in early identification of right heart dysfunction in critically ill mechanically ventilated patients at risk for acute right heart failure.</p>

Original language	American English
Journal	Heart, Lung and Circulation
DOIs	https://doi.org/10.1016/j.hlc.2019.05.186
State	Published - Jun 1 2019

Keywords

Right Heart Failure
Ventricular-Arterial Coupling
Critical Care
Pulmonary Artery Catheter

Disciplines

Medical Specialties
Medicine and Health Sciences
Surgery

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10.1016/j.hlc.2019.05.186License: CC BY

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Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index. / Mehmood, Muddassir; Biederman, Robert W.; Markert, Ronald J. et al.
In: Heart, Lung and Circulation, 01.06.2019.

Research output: Contribution to journal › Article › peer-review

@article{788ca0ed5f704deb9ce44c40581d45e6,

title = "Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index",

abstract = " Background The gold standard for right heart function is the assessment of right ventricular-pulmonary arterial coupling defined as the ratio of arterial to end-systolic elastance (Ea/Emax). This study demonstrates the use of the volumetric pulmonary artery (PA) catheter for estimation of Ea/Emax and describes trends of Ea/Emax, right ventricular ejection fraction (RVEF), and pulmonary artery pulsatility index (PAPi) during initial 48\&emsp14;hours of resuscitation in the trauma surgical intensive care unit (ICU). Methods Review of prospectively collected data for 32 mechanically ventilated adult trauma and emergency general surgery patients enrolled within 6\&emsp14;hours of admission to the ICU. Haemodynamics, recorded every 12\&emsp14;hours for 48\&emsp14;hours, were compared among survivors and non-survivors to hospital discharge. Results Mean age was 49\&emsp14;\±\&emsp14;20 years, 69\% were male, and 84\% were trauma patients. Estimated Ea/Emax was associated with pulmonary vascular resistance and inversely related to pulmonary arterial capacitance and PA catheter derived RVEF. Seven (7) trauma patients did not survive to hospital discharge. Non-survivors had higher estimated Ea/Emax, suggesting right ventricular-pulmonary arterial uncoupling, with a statistically significant difference at 48\&emsp14;hours (2.3\&emsp14;\±\&emsp14;1.7 vs 1.0\&emsp14;\±\&emsp14;0.58, p\&emsp14;=\&emsp14;0.018). RVEF was significantly lower in non-survivors at study initiation and at 48\&emsp14;hours. PAPi did not show a consistent trend. Conclusions Estimation of Ea/Emax using volumetric PA catheter is feasible. Serial assessment of RVEF and Ea/Emax may help in early identification of right heart dysfunction in critically ill mechanically ventilated patients at risk for acute right heart failure.",

keywords = "Right Heart Failure, Ventricular-Arterial Coupling, Critical Care, Pulmonary Artery Catheter",

author = "Muddassir Mehmood and Biederman, \{Robert W.\} and Markert, \{Ronald J.\} and McCarthy, \{Mary C.\} and Tchorz, \{Kathryn M.\}",

year = "2019",

month = jun,

day = "1",

doi = "10.1016/j.hlc.2019.05.186",

language = "American English",

journal = "Heart, Lung and Circulation",

}

TY - JOUR

T1 - Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index

AU - Mehmood, Muddassir

AU - Biederman, Robert W.

AU - Markert, Ronald J.

AU - McCarthy, Mary C.

AU - Tchorz, Kathryn M.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background The gold standard for right heart function is the assessment of right ventricular-pulmonary arterial coupling defined as the ratio of arterial to end-systolic elastance (Ea/Emax). This study demonstrates the use of the volumetric pulmonary artery (PA) catheter for estimation of Ea/Emax and describes trends of Ea/Emax, right ventricular ejection fraction (RVEF), and pulmonary artery pulsatility index (PAPi) during initial 48&emsp14;hours of resuscitation in the trauma surgical intensive care unit (ICU). Methods Review of prospectively collected data for 32 mechanically ventilated adult trauma and emergency general surgery patients enrolled within 6&emsp14;hours of admission to the ICU. Haemodynamics, recorded every 12&emsp14;hours for 48&emsp14;hours, were compared among survivors and non-survivors to hospital discharge. Results Mean age was 49&emsp14;±&emsp14;20 years, 69% were male, and 84% were trauma patients. Estimated Ea/Emax was associated with pulmonary vascular resistance and inversely related to pulmonary arterial capacitance and PA catheter derived RVEF. Seven (7) trauma patients did not survive to hospital discharge. Non-survivors had higher estimated Ea/Emax, suggesting right ventricular-pulmonary arterial uncoupling, with a statistically significant difference at 48&emsp14;hours (2.3&emsp14;±&emsp14;1.7 vs 1.0&emsp14;±&emsp14;0.58, p&emsp14;=&emsp14;0.018). RVEF was significantly lower in non-survivors at study initiation and at 48&emsp14;hours. PAPi did not show a consistent trend. Conclusions Estimation of Ea/Emax using volumetric PA catheter is feasible. Serial assessment of RVEF and Ea/Emax may help in early identification of right heart dysfunction in critically ill mechanically ventilated patients at risk for acute right heart failure.

AB - Background The gold standard for right heart function is the assessment of right ventricular-pulmonary arterial coupling defined as the ratio of arterial to end-systolic elastance (Ea/Emax). This study demonstrates the use of the volumetric pulmonary artery (PA) catheter for estimation of Ea/Emax and describes trends of Ea/Emax, right ventricular ejection fraction (RVEF), and pulmonary artery pulsatility index (PAPi) during initial 48&emsp14;hours of resuscitation in the trauma surgical intensive care unit (ICU). Methods Review of prospectively collected data for 32 mechanically ventilated adult trauma and emergency general surgery patients enrolled within 6&emsp14;hours of admission to the ICU. Haemodynamics, recorded every 12&emsp14;hours for 48&emsp14;hours, were compared among survivors and non-survivors to hospital discharge. Results Mean age was 49&emsp14;±&emsp14;20 years, 69% were male, and 84% were trauma patients. Estimated Ea/Emax was associated with pulmonary vascular resistance and inversely related to pulmonary arterial capacitance and PA catheter derived RVEF. Seven (7) trauma patients did not survive to hospital discharge. Non-survivors had higher estimated Ea/Emax, suggesting right ventricular-pulmonary arterial uncoupling, with a statistically significant difference at 48&emsp14;hours (2.3&emsp14;±&emsp14;1.7 vs 1.0&emsp14;±&emsp14;0.58, p&emsp14;=&emsp14;0.018). RVEF was significantly lower in non-survivors at study initiation and at 48&emsp14;hours. PAPi did not show a consistent trend. Conclusions Estimation of Ea/Emax using volumetric PA catheter is feasible. Serial assessment of RVEF and Ea/Emax may help in early identification of right heart dysfunction in critically ill mechanically ventilated patients at risk for acute right heart failure.

KW - Right Heart Failure

KW - Ventricular-Arterial Coupling

KW - Critical Care

KW - Pulmonary Artery Catheter

UR - https://corescholar.libraries.wright.edu/surg/780

U2 - 10.1016/j.hlc.2019.05.186

DO - 10.1016/j.hlc.2019.05.186

M3 - Article

C2 - 31257001

JO - Heart, Lung and Circulation

JF - Heart, Lung and Circulation

ER -

Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index

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