Impact of heart rate on Doppler echocardiography predictors of rhythm control in patients with septic shock.

Figures

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  Fig. 1. (Left) A trans-mitral Doppler 1 h after cardioversion in a patient with left ventricular relaxation disorder, showing an E wave of 68 cm/s, a deceleration time (DTe) of 302 ms, and an A wave velocity of 92 cm/s. (Center) The velocity–time integral of the A wave (Avti) is 9 cm (average of 8.8 and 9.2 cm), with a heart rate (HR) of 72beats/min. (Right) Another patient with sinus tachycardia 113/min and partial fusion of the E and A waves, demonstrating an Avti of 10.3 cm obtained by the trapezoid method.

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  Fig. 2. The trapezoid method for velocity–time integral (VTI) determination. The grey area labelled “a” corresponds to the E wave (Evti), while the A wave (Avti) is calculated by adding the white area (“b”) and the dark grey area (“c”).

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  Fig. 3. Flow chart of the study.

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  Fig. 4. Relationship between heart rate (HR, in beats per minute [bpm]) and transmitral A wave parameters at 1 h and 4 h post-cardioversion in patients with septic shock. Each panel shows a linear mixed-effects regression line (blue) with a 95% confidence interval (gray shaded area), the regression equation, coefficient of determination (R2), and P-value. All y-axes use logarithmic scales. (A) Scatter plot of HR versus Avti (cm) – a statistically significant, albeit very weak, positive correlation was observed (R2 = 0.019, p = 0.016). (B) Scatter plot of HR versus Avti/LVOTvti – a statistically significant, very weak, positive correlation was observed (R2 = 0.025, p = 0.006). (C) Scatter plot of HR versus natural logarithm of Avti/SV – a statistically significant, very weak, positive correlation was observed (R2 = 0.026, p = 0.004).

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  Fig. 5. Relationship between heart rate (HR, in beats per minute [bpm]) and transmitral Doppler parameters at 1 h and 4 h post-cardioversion in patients with septic shock. Each panel shows a linear mixed-effects regression line (blue) with a 95% confidence interval (gray shaded area), the regression equation, coefficient of determination (R2), and P-value. All y-axes use logarithmic scales. (A) Scatter plot of HR versus E wave velocity (cm/s) – no significant correlation was observed (R2 = 0.001, p = 0.558). (B) Scatter plot of HR versus A wave velocity (cm/s) – a statistically significant, albeit weak, positive correlation was observed (R2 = 0.043, p < 0.001). (C) Scatter plot of HR versus E/A ratio – a statistically significant, albeit weak, inverse correlation was observed (R2 = 0.029, p = 0.002).

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  Fig. 6. Forest plot showing the impact of HR (regression coefficient) on log-transformed Doppler parameters in the univariate (HR only) and multivariate (adjusted for age, sex, LV_EF and noradrenaline nose) model. See also Table 3 ESM 1.