BACKGROUND Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients. RESULTS Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S', RV FAC). A RV global LSS value > - 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters. CONCLUSIONS Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT.

中文翻译：

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二维散斑跟踪超声心动图对ARDS患者右心室应变的可行性，可重复性和诊断价值：ARD应变研究。

背景技术通过超声心动图评估右心室（RV）功能是ICU急性呼吸窘迫综合征（ARDS）患者管理的关键，但是，它仍然具有挑战性。通过散斑跟踪超声心动图（STE）量化RV变形是一种最近可用且可重现的技术，可对RV进行综合分析。但是，有关在重症患者中使用它的数据很少。这项研究的目的是评估其在中重度ARDS患者中的可行性和临床实用性。结果有创机械通气（MV）的48例ARDS患者被连续纳入一项前瞻性观察研究。在开始MV后36小时内进行全胸腔超声心动图检查。记录了STE衍生参数和常规参数。RV外侧，下壁和隔壁的应变成像非常可行（47/48（98％）患者）。观察者间RV应变值的可重复性在ARDS患者中显示出良好的可靠性（所有STE衍生参数的类内相关系数（ICC）> 0.75）。ROC曲线分析显示，与几种常规指标（TAPSE，S'，RV FAC）相比，外侧，下部，整体（3个RV壁的平均值）纵向收缩期应变（LSS）和整体应变率显示出显着的诊断价值。RV全球LSS值>-13.7％区分TAPSE <vs> 12 mm的患者，敏感性为88％，特异性为83％。关于临床结果，STE来源参数正常与异常的患者在第28天的死亡率和MV断奶的累积发生率无差异。结论在中，重度ARDS患者中，在MV下，对RV的全球性STE评估是高度可实现的，并且可与RV功能的几个常规参数相关。在我们的队列中，从MV预测的生存或断奶角度来看，STE衍生的参数没有提供任何增量值。需要进一步的研究以评估其治疗上的用处。试用注册NCT02638844：NCT。