The Role of LVOT-VTI Measurement in the Evaluation of Systolic Heart Function in Pulmonary ICU Patients

Abstract

Introduction: The detection of cardiac systolic dysfunction is very important for well management of pulmonary critical care patients (PCCPs). However, there is a poor correlation between echocardiographic cardiac systolic function (CSF) parameters and it is not easy to obtain these parameters in PCCPs. Therefore, this cross-sectional observational study was planned for the detection of a more easily obtainable echocardiographic CSF parameter that is well correlated with other CSF parameters in PCCPs. Materials and Methods: Total 88 PCCPs were included. Demographic and clinical information and laboratory tests of all patients were recorded. The CSF parameters of the heart were obtained by transthoracic echocardiography with appropriate technique. LVOT-VTI (Left ventricular outflow tract velocity time integral), CO (cardiac output), EPSS (e point septal separation), Left ventricular EF (ejection fraction) and TAPSE (Tricuspid Annular Plane Systolic Excursion) as an indicator of CSF were tried to obtain from all patients. We also calculated sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 parameters to diagnose heart failure. Results: The mean age of the patients was 73±12, 40% were female, 38% were intubated and 52% had COPD. LVOT-VTI, EF, CO, EPSS parameters were obtained in 54(61%), 24(27%), 48(54%), 48(54%) patients, respectively. Decreased LVOT-VTI (<20 cm) was well correlated with decreased EF (<45%) (p=0.001, r=0.77), decreased CO (<5 L/dk) (p=0.03, r=0.64) and decreased TAPSE (<17 mm) (p=0.001, r=0.71). Also, there was good agreement between the EF and LVOTVTI measurements (Kappa:0.78, p:0.001). Sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 for heart failure were 58, 78, 84, 49, repectively. Conclusion: LVOT-VTI is a more easily obtainable and well correlated parameter, which can be used as an indicator of CSF in PCCPs. Clinical Significances: The authors believe that LVOT-VTI measurement has good correlation with other echocardiographic systolic function parameters, and its easy measurement in intensive care patients makes it a very useful test for cardiac systolic function evaluation.