September 30, 2021PLoS ONEOpen Access

Left ventricular longitudinal strain variations assessed by speckle-tracking echocardiography after a passive leg raising maneuver in patients with acute circulatory failure to predict fluid responsiveness: A prospective, observational study

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Why the study?

LV-LS is associated with preload, but its ability to predict fluid responsiveness after a passive leg raising maneuver in ICU patients with acute circulatory failure was unknown.

Does left ventricular longitudinal strain variation after a passive leg raising maneuver predict fluid responsiveness in ICU patients with acute circulatory failure?

Structured PICO

Does left ventricular longitudinal strain variation after a passive leg raising maneuver predict fluid responsiveness in ICU patients with acute circulatory failure?

Population

60 intensive care unit (ICU) patients with acute circulatory failure (ACF)

Intervention

Passive leg raising (PLR) maneuver with left ventricular longitudinal strain (LV-LS) assessment via speckle-tracking echocardiography

Comparator

Preload-dependent (PLD+) vs Preload-independent (PLD-) groups (defined by velocity time integral variation >10% between baseline and PLR)

Outcome

Sensitivity and specificity of LV-LS variations after a passive leg raising (PLR) maneuver to predict fluid responsivenesssurrogate

Left ventricular longitudinal strain variations after a passive leg raising maneuver do not reliably predict fluid responsiveness in ICU patients with acute circulatory failure.

Implication

LV-LS changes after PLR lack predictive value for fluid responsiveness; leaves open strain imaging utility in ACF preload assessment.

Abstract

BACKGROUND: An association was reported between the left ventricular longitudinal strain (LV-LS) and preload. LV-LS reflects the left cardiac function curve as it is the ratio of shortening over diastolic dimension. The aim of this study was to determine the sensitivity and specificity of LV-LS variations after a passive leg raising (PLR) maneuver to predict fluid responsiveness in intensive care unit (ICU) patients with acute circulatory failure (ACF). METHODS: Patients with ACF were prospectively included. Preload-dependency was defined as a velocity time integral (VTI) variation greater than 10% between baseline (T0) and PLR (T1), distinguishing the preload-dependent (PLD+) group and the preload-independent (PLD-) group. A 7-cycles, 4-chamber echocardiography loop was registered at T0 and T1, and strain analysis was performed off-line by a blind clinician. A general linear model for repeated measures was used to compare the LV-LS variation (T0 to T1) between the two groups. RESULTS: From June 2018 to August 2019, 60 patients (PLD+ = 33, PLD- = 27) were consecutively enrolled. The VTI variations after PLR were +21% (±8) in the PLD+ group and -1% (±7) in the PLD- group (p<0.01). Mean baseline LV-LS was -11.3% (±4.2) in the PLD+ group and -13.0% (±4.2) in the PLD- group (p = 0.12). LV-LS increased in the whole population after PLR +16.0% (±4.0) (p = 0.04). The LV-LS variations after PLR were +19.0% (±31) (p = 0.05) in the PLD+ group and +11.0% (±38) (p = 0.25) in the PLD- group, with no significant difference between the two groups (p = 0.08). The area under the curve for the LV-LS variations between T0 and T1 was 0.63 [0.48-0.77]. CONCLUSION: Our study confirms that LV-LS is load-dependent; however, the variations in LV-LS after PLR is not a discriminating criterion to predict fluid responsiveness of ICU patients with ACF in this cohort.