P784Correlation of left atrial longitudinal strain imaging with semi-invasive measurement of fluid responsiveness in critically ill patients


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Abstract

Background: Preload dynamic indices (e.g., pulse pressure variation, PPV) have been shown useful predictors of fluid responsiveness in different clinical settings. They help clinicians in improving hemodynamic status while avoiding potential fluid overload. Echo indices, such as E/E' ratio and left atrial (LA) deformation analysis by speckle tracking echocardiography (STE), are widely used in order to estimate left ventricular (LV) filling pressures. This study aimed at exploring the relationship between PPV and echocardiographic indices of LV filling pressures in critically ill patients.Methods: 26 consecutive patients (mean age:50.9±21.6) admitted to intensive care unit, requiring mechanical ventilation and invasive arterial pressure monitoring, were studied. In all patients, two independent operators assessed simultaneously PPV, using MostCare (a pulse contour method), and mean E/E' ratio and mean peak atrial longitudinal strain (global PALS) by means of STE. The ROC analysis was applied.Results: A significant negative correlation was found between mean E/E' ratio and PPV (R2=-0.76; p<0.001). A positive correlation between global PALS and PPV was found (R2=0.80, p<0.001). Mean global PALS of 26.2% demonstrated good accuracy (AUC of 0.86, p<0.001), good sensitivity (92%) and specificity (86%) in predicting a PPV above 15%.Conclusions: In a group of mechanically ventilated patients, PPV derived from pulse contour analysis and echocardiographic preload parameters were well correlated. Global PALS by STE provided a better estimation of PPV than mean E/E' ratio. PALS seems a possible alternative to PPV in assessing fluid responsiveness either when an invasive arterial pressure monitoring is not essential for clinical management or in case of PPV is not reliable.

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