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Left ventricular volumes but not filling pressure are determinants of mortality in critically ill patients

Introduction

Transthoracic echocardiography (TTE) is gaining acceptance as a powerful diagnostic tool in critical illness. It can assess left ventricular (LV) volumes, as well as indices of ventricular filling pressure (including the ratio of mitral E velocity/mitral annular velocity [E/E']). TTE evidence of raised filling pressure is associated with mortality following myocardial infarction but its prognostic value in critical illness is undefined. The aim of this study was to evaluate the prognostic significance of echo-cardiographic LV volumes and filling pressure in the critically ill.

Methods

A consecutive group of 94 patients (66 males, mean ± SD age 61 ± 15 years) who had standard TTE supplemented by measurement of E/E' in a tertiary referral ICU were enrolled. TTE was performed 5 ± 6 days after ICU admission. Severity of critical illness was assessed using APACHE III. Cox proportional hazards regression analysis was based on 28-day mortality from the date of echo with survivors censored on hospital discharge.

Results

The mean APACHE III score was 72 ± 25. Hospital mortality was 33% (n = 31). Table 1 summarises correlates of 28-day mortality. The independent predictors of mortality were APACHE III risk of hospital death (HR 1.3 (1.1–1.5), P = 0.003), and increased LV end systolic volume (HR 2.1 (1.2–3.7), P = 0.007). Indices of ventricular filling pressure (E/E', left atrial area/volume) were not predictors of mortality.

Table 1 (abstract P278)

Conclusion

In this cohort of critically ill patients, increased echocardiographic LV end systolic volume, but not filling pressure, is a highly significant predictor of mortality that adds incremental value to APACHE III prediction.

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Sturgess, D., Marwick, T., Joyce, C. et al. Left ventricular volumes but not filling pressure are determinants of mortality in critically ill patients. Crit Care 11, P278 (2007). https://doi.org/10.1186/cc5438

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Keywords

  • Critical Illness
  • Filling Pressure
  • Ventricular Volume
  • Transthoracic Echocardiography
  • Left Ventricular Volume