Key result
Peak systolic velocity of the mitral plane (s') assessed on serial echocardiography was not associated with 180-day neurological outcome in comatose survivors of out-of-hospital cardiac arrest.
Why the study?
Transthoracic echocardiographic indices of myocardial function in out-of-hospital cardiac arrest survivors have yielded inconsistent associations with neurological outcome.
Do serial echocardiographic parameters during targeted temperature management predict 180-day neurological outcome in comatose out-of-hospital cardiac arrest survivors?
Observational (n=99)
Assessor-blinded
No
Do serial echocardiographic parameters during targeted temperature management predict 180-day neurological outcome in comatose out-of-hospital cardiac arrest survivors?
Serial echocardiographic parameters, including peak systolic mitral annular velocity, assessed during targeted temperature management do not aid in prognosticating 6-month neurological outcome in comatose OHCA survivors.
No association of serial TTE indices with neurological outcome after OHCA; challenges routine echocardiography for prognostication and leaves open its added value.
Background: Transthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We aimed to evaluate whether echocardiography indices of myocardial function predicts six-month neurological outcome in comatose OHCA survivors treated with targeted temperature management (TTM).Methods: We investigated the association between peak systolic velocity of the mitral plane (s’) and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33±1°C for 24 hours (h) (n=47) vs. 48h (n=52) following OHCA (TTH48-trial). TTE was conducted at 24h, 48h, and 72h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s’. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e’, E/e’ and tricuspid annular plane systolic excursion (TAPSE). Results: s’, LVEF, GLS, E/e’, and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e’ at 48h following TTM was 5.74 cm/s (95%CI: 5.27-6.22) in patients with good outcome (CPC180 1-2) vs. 4.95 cm/s (95%CI: 4.37-5.54) in patients with poor outcome (CPC180 3-5) (p=0.04). Conclusions: s’ assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA.Trial registration: NCT02066753. Registered 14 February 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02066753
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Jensen et al. (2020) conducted an observational in Out-of-hospital cardiac arrest (n=99). Peak systolic velocity of the mitral plane (s') was evaluated on 180-day neurological outcome (Cerebral Performance Category score) (OR 1.01, 95% CI 0.78-1.30, p=0.96). Peak systolic velocity of the mitral plane (s') assessed on serial echocardiography was not associated with 180-day neurological outcome in comatose survivors of out-of-hospital cardiac arrest.
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