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Critical Care
Published in: Critical Care 3/2012

Open Access 01-06-2012 | Research

Transthoracic Echocardiography with Doppler Tissue Imaging predicts weaning failure from mechanical ventilation: evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome

Authors: Sébastien Moschietto, Denis Doyen, Ludovic Grech, Jean Dellamonica, Hervé Hyvernat, Gilles Bernardin

Published in: Critical Care | Issue 3/2012

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Abstract

Introduction

There is growing evidence to suggest that transthoracic echocardiography (TTE) should be used to identify the cardiac origin of respiratory weaning failure. The aims of our study were: first, to evaluate the ability of transthoracic echocardiography, with mitral Doppler inflow E velocity to annular tissue Doppler Ea wave velocity (E/Ea) ratio measurement, to predict weaning failure from mechanical ventilation in patients, including those with atrial fibrillation; and second, to determine whether the depressed left ejection fraction and/or diastolic dysfunction participate in weaning outcome.

Methods

The sample included patients on mechanical ventilation for over 48 hours. A complete echocardiography was performed just before the spontaneous breathing trial (SBT) and 10 minutes after starting the SBT. Systolic dysfunction was defined by a left ventricle ejection fraction under 50% and relaxation impairment by a protodiastolic annulus mitral velocity Ea under or equal to 8 cm/second.

Results

A total of 68 patients were included. Twenty failed the weaning process and the other 48 patients succeeded. Before the SBT, the E/Ea ratio was higher in the failed group than in the successful group. The E/Ea measured during the SBT was also higher in the failed group. The cut-off value, obtained from receiver operating characteristics (ROC) curve analysis, to predict weaning failure gave an E/Ea ratio during the SBT of 14.5 with a sensitivity of 75% and a specificity of 95.8%. The left ventricular ejection fraction did not differ between the two groups whereas Ea was lower in the failed group. Ea increased during SBT in the successful group while no change occurred in the failed group.

Conclusions

Measurement of the E/Ea ratio with TTE could predict weaning failure. Diastolic dysfunction with relaxation impairment is strongly associated with weaning failure. Moreover, the impossibility of enhancing the left ventricle relaxation rate during the SBT seems to be the key factor of weaning failure. In contrast, the systolic dysfunction was not associated with weaning outcome.
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Literature
1.
Richard C, Teboul JL, Archambaud F, Hebert JL, Michaut P, Auzepy P: Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensive Care Med 1994, 20: 181-186. 10.1007/BF01704697CrossRefPubMed
2.
Richard C, Teboul JL: Weaning failure from cardiovascular origin. Intensive Care Med 2005, 31: 1605-1607. 10.1007/s00134-005-2698-xCrossRefPubMed
3.
Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM: Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 1988, 69: 171-179. 10.1097/00000542-198808000-00004CrossRefPubMed
4.
Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C, Teboul JL: Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med 2009, 37: 1696-1701. 10.1097/CCM.0b013e31819f13d0CrossRefPubMed
5.
Shimizu Y, Uematsu M, Shimizu H, Nakamura K, Yamagishi M, Miyatake K: Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function: comparison with transmitral flow velocity indices. J Am Coll Cardiol 1998, 32: 1418-1425. 10.1016/S0735-1097(98)00394-5CrossRefPubMed
6.
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA: Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997, 30: 1527-1533. 10.1016/S0735-1097(97)00344-6CrossRefPubMed
7.
Oki T, Tabata T, Yamada H, Wakatsuki T, Shinohara H, Nishikado A, Iuchi A, Fukuda N, Ito S: Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol 1997, 79: 921-928. 10.1016/S0002-9149(97)00015-5CrossRefPubMed
8.
Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS: Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol 2001, 37: 278-285. 10.1016/S0735-1097(00)01056-1CrossRefPubMed
9.
Vignon P, AitHssain A, Francois B, Preux PM, Pichon N, Clavel M, Frat JP, Gastinne H: Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study. Crit Care 2008, 12: R18. 10.1186/cc6792PubMedCentralCrossRefPubMed
10.
Caille V, Amiel JB, Charron C, Belliard G, Vieillard-Baron A, Vignon P: Echocardiography: a help in the weaning process. Crit Care 2010, 14: R120. 10.1186/cc9076PubMedCentralCrossRefPubMed
11.
Arora S, Lang I, Nayyar V, Stachowski E, Ross DL: Atrial fibrillation in a tertiary care multidisciplinary intensive care unit--incidence and risk factors. Anaesth Intensive Care 2007, 35: 707-713.PubMed
12.
Nagueh SF, Kopelen HA, Quinones MA: Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation 1996, 94: 2138-2145.CrossRefPubMed
13.
Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T: Weaning from mechanical ventilation. Eur Respir J 2007, 29: 1033-1056. 10.1183/09031936.00010206CrossRefPubMed
14.
Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, Macias S, Allegue JM, Blanco J, Carriedo D, León M, de la Cal MA, Taboada F, Gonzalez de Velasco J, Palazón E, Carrizosa F, Tomás R, Suarez J, Goldwasser RS: Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997, 156: 459-465.CrossRefPubMed
15.
MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ: Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001, 120: 375S-395S. 10.1378/chest.120.6_suppl.375SCrossRefPubMed
16.
Yang KL, Tobin MJ: A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991, 324: 1445-1450. 10.1056/NEJM199105233242101CrossRefPubMed
17.
Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW: Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997, 30: 474-480. 10.1016/S0735-1097(97)88335-0CrossRefPubMed
18.
Jubran A, Mathru M, Dries D, Tobin MJ: Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 1998, 158: 1763-1769.CrossRefPubMed
19.
Appleton CP, Hatle LK, Popp RL: Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988, 12: 426-440. 10.1016/0735-1097(88)90416-0CrossRefPubMed
20.
Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ: Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 2000, 102: 1788-1794.CrossRefPubMed
21.
Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quinones MA, Zoghbi WA: Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation 1998, 98: 1644-1650.CrossRefPubMed
22.
Mekontso-Dessap A, de Prost N, Girou E, Braconnier F, Lemaire F, Brun-Buisson C, Brochard L: B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 2006, 32: 1529-1536. 10.1007/s00134-006-0339-7CrossRefPubMed
23.
Zapata L, Vera P, Roglan A, Gich I, Ordonez-Llanos J, Betbese AJ: B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med 2011, 37: 477-485. 10.1007/s00134-010-2101-4CrossRefPubMed
24.
Zile MR, Baicu CF, Gaasch WH: Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 2004, 350: 1953-1959. 10.1056/NEJMoa032566CrossRefPubMed
25.
Zile MR: Heart failure with preserved ejection fraction: is this diastolic heart failure? J Am Coll Cardiol 2003, 41: 1519-1522. 10.1016/S0735-1097(03)00186-4CrossRefPubMed
26.
Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D: Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 1999, 33: 1948-1955. 10.1016/S0735-1097(99)00118-7CrossRefPubMed
27.
Devereux RB, Roman MJ, Liu JE, Welty TK, Lee ET, Rodeheffer R, Fabsitz RR, Howard BV: Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong Heart Study. Am J Cardiol 2000, 86: 1090-1096. 10.1016/S0002-9149(00)01165-6CrossRefPubMed
28.
Vlahovic A, Popovic AD: [Evaluation of left ventricular diastolic function using Doppler echocardiography]. Med Pregl 1999, 52: 13-18.PubMed
29.
Bruch C, Marin D, Kuntz S, Schmermund A, Bartel T, Schaar J, Erbel R: [Analysis of mitral annulus excursion with tissue Doppler echocardiography (tissue Doppler echocardiography = TDE). Noninvasive assessment of left ventricular, diastolic dysfunction]. Z Kardiol 1999, 88: 353-362. 10.1007/s003920050297CrossRefPubMed
30.
Ait-Oufella H, Tharaux PL, Baudel JL, Vandermeersch S, Meyer P, Tonnellier M, Dussaule JC, Guidet B, Offenstadt G, Maury E: Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study. Intensive Care Med 2007, 33: 1183-1186. 10.1007/s00134-007-0627-xCrossRefPubMed
31.
Nonogi H, Hess OM, Ritter M, Krayenbuehl HP: Diastolic properties of the normal left ventricle during supine exercise. Br Heart J 1988, 60: 30-38. 10.1136/hrt.60.1.30PubMedCentralCrossRefPubMed
32.
Kitzman DW, Higginbotham MB, Cobb FR, Sheikh KH, Sullivan MJ: Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol 1991, 17: 1065-1072. 10.1016/0735-1097(91)90832-TCrossRefPubMed
33.
Ha JW, Oh JK, Pellikka PA, Ommen SR, Stussy VL, Bailey KR, Seward JB, Tajik AJ: Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr 2005, 18: 63-68. 10.1016/j.echo.2004.08.033CrossRefPubMed
34.
Pinsky MR: Breathing as exercise: the cardiovascular response to weaning from mechanical ventilation. Intensive Care Med 2000, 26: 1164-1166. 10.1007/s001340000619CrossRefPubMed
35.
Funk GC, Lang I, Schenk P, Valipour A, Hartl S, Burghuber OC: Left ventricular diastolic dysfunction in patients with COPD in the presence and absence of elevated pulmonary arterial pressure. Chest 2008, 133: 1354-1359.CrossRefPubMed
36.
Boyer JK, Thanigaraj S, Schechtman KB, Perez JE: Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004, 93: 870-875. 10.1016/j.amjcard.2003.12.026CrossRefPubMed
37.
Vasan RS, Benjamin EJ, Levy D: Congestive heart failure with normal left ventricular systolic function. Clinical approaches to the diagnosis and treatment of diastolic heart failure. Arch Intern Med 1996, 156: 146-157. 10.1001/archinte.1996.00440020046007CrossRefPubMed
Metadata
Title
Transthoracic Echocardiography with Doppler Tissue Imaging predicts weaning failure from mechanical ventilation: evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome
Authors
Sébastien Moschietto
Denis Doyen
Ludovic Grech
Jean Dellamonica
Hervé Hyvernat
Gilles Bernardin
Publication date
01-06-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11339

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