Speckle tracking echocardiography and right ventricle dysfunction in acute respiratory distress syndrome: A pilot study

Purpose: Speckle tracking echocardiography is a novel echocardiographic technique to assess RV myocardial function but no data are so far available in patients with acute respiratory distress syndrome (ARDS), and we aimed at assessing the feasibility of 2 dimensional (2D) speckle tracking echocardiography and the prognostic role of RV free wall speckle tracking strain in 30 consecutive patients with moderate-severe ARDS Materials and Methods: In an observational prospective study, 30 consecutive patients with moderate-severe ARDS were enrolled. Echocardiography was performed within 12 hours from ICU admission. Results: Mortality rate was 33% (10/30). Non-survivors showed lower values of pH (7.32 +/- 0.09, P = 0.03) and higher troponin I levels (0.32 (0.08-0.46), P = 0.04), NT-pro BNP (3091 (2662-7128), P = 0.009), and SAPS II (60.3 +/- 9.6, P < 0.001). At echocardiographic examination, non-survivors showed lower values of TAPSE (18.3 +/- 3, P = 0.034) and higher systolic pulmonary arterial pressure (49.6 +/- 16, P = 0.05). Two patients (6.6%) did not show valid acoustic windows. Only three patients showed normal values of RV strain free wall (22%, 25%, and 28% absolute values, respectively), among whom one patient died. When compared to survivors, non-survivors showed significantly lower values of RV strain free wall (-10.4 +/- 0.10, P < 0.001). Conclusions: In mechanically ventilated moderate-severe ARDS, 2D speckle tracking is feasible even though difficult acoustic windows are common. Further studies are needed to confirm our findings in a larger cohort of patients.