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Introduction <p>In the intensive care unit (ICU), left ventricular systolic function is traditionally assessed by measuring the left ventricular ejection fraction (LVEF). Recently, left ventricular global systolic longitudinal strain (SL-S) has emerged as a more sensitive marker of myocardial function in this setting. However, obtaining high-quality echocardiographic images remains a significant challenge, particularly in patients undergoing invasive mechanical ventilation (IMV), and data on the feasibility and reproducibility of these measurements in critically ill patients are limited.</p> Objective <p>To assess the feasibility and reproducibility (both global and per chamber) of SL-S and LVEF (both manual and automatic) in ICU patients under IMV.</p> Materials and methods <p>Thirty ICU patients receiving IMV were randomly selected. The feasibility and reproducibility of SL-S (global and per chamber) and LVEF were assessed using both manual and automatic methods. The analysis was performed using the intraclass correlation coefficient (ICC) with its 95% confidence interval (CI), and Bland–Altman analysis (BA), which reported the mean difference and limits of agreement (lower–upper limits of agreement).</p> Results <p>SL-S was feasible in 70% of patients and demonstrated excellent intra- and interobserver reproducibility for both manual and automatic methods. Intraobserver reproducibility for automatic SL-S: ICC 0.97 (CI: 0.94–0.99), BA 0.26 (−1.89 to 2.40) and interobserver reproducibility: ICC 0.96 (CI: 0.92–0.98), and BA 0.53 (−2.41 to 3.47). The reproducibility of manual SL-S was comparable to automatic measurements. Additionally, the reproducibility per chamber was excellent. LVEF was feasible in 80% of patients. Manual LVEF (Simpson’s biplane) reproducibility demonstrated good reproducibility: intraobserver ICC: 0.82 (CI: 0.48–0.93), BA −5.00 (−19.70 to 9.70); interobserver ICC 0.78 (CI: 0.55–0.91), BA 7.50 (−5.40 to 20.40). Automatic LVEF (auto-LVEF) demonstrated excellent reproducibility: intraobserver ICC: 0.94 (CI: 0.86–0.98), BA −0.95 (−10.02 to 8.13); and interobserver ICC: 0.94 (CI: 0.87–0.97), BA 1.75 (−6.38 to 10.33).</p> Conclusion <p>SL-S (global and per chamber) and auto-LVEF were feasible and showed excellent reproducibility. LVEF demonstrated the highest feasibility, while SL-S exhibited the greatest reproducibility. These parameters may represent a useful tool in the evaluation of LV function in ICU patients under IMV.</p>

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Left ventricular systolic longitudinal strain in mechanically ventilated patients in the intensive care unit: assessment of global and chamber reproducibility

  • 期刊论文

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  • 发表日期：

    2025年6月17日

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  • Matías Pécora,
  • Piero Pastorini,
  • Roberto Farolini,
  • Gastón Burghi,
  • F. Javier Hurtado

摘要

Introduction

In the intensive care unit (ICU), left ventricular systolic function is traditionally assessed by measuring the left ventricular ejection fraction (LVEF). Recently, left ventricular global systolic longitudinal strain (SL-S) has emerged as a more sensitive marker of myocardial function in this setting. However, obtaining high-quality echocardiographic images remains a significant challenge, particularly in patients undergoing invasive mechanical ventilation (IMV), and data on the feasibility and reproducibility of these measurements in critically ill patients are limited.

Objective

To assess the feasibility and reproducibility (both global and per chamber) of SL-S and LVEF (both manual and automatic) in ICU patients under IMV.

Materials and methods

Thirty ICU patients receiving IMV were randomly selected. The feasibility and reproducibility of SL-S (global and per chamber) and LVEF were assessed using both manual and automatic methods. The analysis was performed using the intraclass correlation coefficient (ICC) with its 95% confidence interval (CI), and Bland–Altman analysis (BA), which reported the mean difference and limits of agreement (lower–upper limits of agreement).

Results

SL-S was feasible in 70% of patients and demonstrated excellent intra- and interobserver reproducibility for both manual and automatic methods. Intraobserver reproducibility for automatic SL-S: ICC 0.97 (CI: 0.94–0.99), BA 0.26 (−1.89 to 2.40) and interobserver reproducibility: ICC 0.96 (CI: 0.92–0.98), and BA 0.53 (−2.41 to 3.47). The reproducibility of manual SL-S was comparable to automatic measurements. Additionally, the reproducibility per chamber was excellent. LVEF was feasible in 80% of patients. Manual LVEF (Simpson’s biplane) reproducibility demonstrated good reproducibility: intraobserver ICC: 0.82 (CI: 0.48–0.93), BA −5.00 (−19.70 to 9.70); interobserver ICC 0.78 (CI: 0.55–0.91), BA 7.50 (−5.40 to 20.40). Automatic LVEF (auto-LVEF) demonstrated excellent reproducibility: intraobserver ICC: 0.94 (CI: 0.86–0.98), BA −0.95 (−10.02 to 8.13); and interobserver ICC: 0.94 (CI: 0.87–0.97), BA 1.75 (−6.38 to 10.33).

Conclusion

SL-S (global and per chamber) and auto-LVEF were feasible and showed excellent reproducibility. LVEF demonstrated the highest feasibility, while SL-S exhibited the greatest reproducibility. These parameters may represent a useful tool in the evaluation of LV function in ICU patients under IMV.