Key result
The overall feasibility of right ventricular speckle tracking echocardiography in the intensive care unit was 83.3%, with retrospective design, COVID-19, and mechanical ventilation reducing feasibility.
Why the study?
The feasibility of right ventricular speckle tracking echocardiography in ICU populations has not been well described, and variables influencing it had not been investigated.
Meta-Analysis (n=11)
RV-STE is generally feasible in the ICU setting (83.3%), though feasibility is significantly reduced in retrospective studies, COVID-19 patients, and those receiving invasive mechanical ventilation.
RV speckle tracking echocardiography is feasible for most ICU patients; supports broader clinical integration while identifying barriers for targeted prospective research.
OBJECTIVES: To identify variables that affect the feasibility of 2-dimensional right ventricular speckle tracking echocardiography (RV-STE) in the intensive care unit. BACKGROUND: Trans-thoracic echocardiography (TTE) of the right ventricle is challenging. RV-STE is a novel echocardiography method thought to measure global RV function more fully than conventional TTE parameters. The feasibility of RV-STE in ICU populations has not been well described, and variables influencing RV-STE in ICU have not been investigated. This study aimed to address this. METHODS: A literature review using Ovid MEDLINE(R) was undertaken. We performed meta-analysis with subgroup analysis of; RV-STE type (RV free-wall [RVFWLS] versus RV global longitudinal strain [RVGLS]), study design (prospective versus retrospective), coronavirus disease-19 (COVID-19) study or not, and strain software used. This was followed by meta-regression of proportion of invasive mechanical ventilation (IMV), with and without COVID-19 studies as a co-variate. RESULTS: Eleven relevant studies from the literature search were identified, reporting an overall feasibility of RV-STE of 83.3% (95%CI 74.6-89.4%). Prospective study design was associated with higher feasibility compared with retrospective studies (p = 0.02). There were no statistical differences on univariate analysis between RVFWLS versus RVGLS, COVID-19 study or not, or strain software used. Meta-regression with COVID-19 study as a covariate demonstrated that higher proportions of IMV were significantly associated with worse feasibility (p = 0.04), as were COVID-19 studies (p < 0.01). CONCLUSIONS: We have identified three variables associated with poor feasibility; retrospective study design, COVID-19 studies, and proportion of IMV. A prospective study design should be viewed as gold standard to maximise RV-STE feasibility.
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McErlane et al. (2023) conducted a meta-analysis in Critically ill patients in the intensive care unit (n=11). 2-dimensional right ventricular speckle tracking echocardiography (RV-STE) was evaluated on Feasibility of RV-STE (percentage of studies with images of sufficient quality) (95% CI 74.6-89.4). The overall feasibility of right ventricular speckle tracking echocardiography in the intensive care unit was 83.3%, with retrospective design, COVID-19, and mechanical ventilation reducing feasibility.
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