Early signs of right ventricular systolic and diastolic dysfunction in acute severe respiratory failure: the importance of diastolic restrictive pattern

Abstract

Background: The incidence and pathophysiology of right ventricular failure in patients with severe respiratory insufficiency has been largely investigated. However, there is a lack of early signs suggesting right ventricular systolic and diastolic dysfunction prior to acute cor pulmonale development. Methods: We conducted a retrospective analytical cohort study of patients for acute respiratory distress syndrome undertaking an echocardiography during admission in the cardiothoracic intensive care unit. Patients were divided according to treatment: conventional protective ventilation (38 patients, 38%); interventional lung assist (23 patients, 23%); veno-venous extracorporeal membrane oxygenation (37 patients, 37%). Systolic and diastolic function was studied assessing, respectively: right ventricular systolic longitudinal function (tricuspid annular plane systolic excursion) and systolic contraction duration (tricuspid annular plane systolic excursion length); right ventricular diastolic filling time and right ventricular diastolic restrictive pattern (presence of pulmonary valve presystolic ejection wave). Correlation between the respiratory mechanics and systo-diastolic parameters were analysed. Results: In 98 patients studied, systolic dysfunction (tricuspid annular plane systolic excursion <16 mm) was present in 33.6% while diastolic restrictive pattern was present in 64%. A negative correlation was found between tricuspid annular plane systolic excursion and tricuspid annular plane systolic excursion length ( P<0.0001; r −0.42). Tricuspid annular plane systolic excursion and tricuspid annular plane systolic excursion length correlated with right ventricular diastolic filling time ( P<0.001; r −0.39). Pulmonary valve presystolic ejection wave was associated with tricuspid annular plane systolic excursion ( P<0.0001), tricuspid annular plane systolic excursion length ( P<0.0001), right ventricular diastolic filling time ( P<0.0001), positive end-expiratory pressure ( P<0.0001) and peak inspiratory pressure ( P<0.0001). Conclusion: Diastolic restrictive pattern is present in a remarkable percentage of patients with respiratory distress syndrome. Bedside echocardiography allows a mechanistic evaluation of systolic and diastolic interaction of the right ventricle.

Ventilator-Associated Lung Injury

“…4 ) ( Vieillard-Baron et al, 2013 ; Boissier et al, 2013 ; Chiumello and Pesenti, 2013 ). This coupling between the pulmonary vasculature and the right ventricle was particularly important in ARDS induced by more vascular inflammation as experienced globally during the coronavirus pandemic ( Patel et al, 2020 ; Ridge et al, 2020 ; Tavazzi et al, 2019 ; Bleakley et al, 2020 ).

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Protecting the Injured Right Ventricle in COVID-19 Acute Respiratory Distress Syndrome: Can Clinicians Personalize Interventions and Reduce Mortality?

“…6 Right ventricular diastolic dysfunction is common in patients with ARDS in the absence of RV dilatation; it is therefore important to consider that increases in pulmonary vascular resistance, will also adversely affect diastolic function and possibly earlier than that demonstrated on systolic assessment. 13 Assessment of RV diastolic function (morphological assessment of the inferior vena cava, doppler interrogation of tricuspid inflow, tissue doppler at the lateral tricuspid annulus, and pulsed wave doppler sampling of hepatic vein flow) should be considered and included in future clinical prediction models determining RV injury risk in ARDS. 14 A recent observational study exploring myocardial phenotypes and clinical associations of RV dysfunction in COVID-19 ARDS showed that severe COVID-19 ARDS is associated with a specific phenotype characterized by radial impairment with sparing of longitudinal function.…”

Influence of cigarette smoking on biventricular systolic function independent of respiratory function: a cross-sectional study

“…Although the effects of respiratory function against cardiac function have already been reported [27][28][29], there were few studies investigating the relationship between smoking exposure and cardiac function, after adjusting for respiratory function. In the present study, the higher the participants' smoking exposure, the larger the values of FVC and VC.…”