Critical Illness, Echocardiography, Elevated Left Atrial Pressure, Left Ventricular Diastolic Dysfunction
Conditions
Keywords
critical care echocardiography, transthoracic echocardiography, left atrial pressure, diastolic dysfunction, critically ill, echocardiography, tissue doppler imaging, intensive care, TE-e'
Brief summary
This study evaluates a new single-beat echocardiographic technique (TE-e', the time difference between the onset of the mitral inflow E wave and the septal e' wave on tissue Doppler imaging) for estimating left atrial pressure (LAP) in critically ill patients, comparing it against the standard two-beat method. The goal is to determine whether the faster, single-beat method gives results as reliable as the conventional method, and whether it can help identify patients with elevated left atrial pressure without an invasive procedure.
Detailed description
Left atrial pressure (LAP) is an important measure in the care of critically ill patients but usually requires an invasive catheter to assess directly. Echocardiography offers a non-invasive alternative. One promising marker, TE-e' (the time difference between the onset of the mitral inflow E wave and the septal e' wave on tissue Doppler imaging), was recently incorporated into the 2025 American Society of Echocardiography (ASE) diastolic function guidelines. The conventional method for calculating TE-e' requires measurements from two separate heartbeats, introducing potential error from beat-to-beat heart rate variability - a common issue in the critically ill patients. This study assesses a novel single-beat method, in which both waveforms are captured on the same Doppler display within one cardiac cycle, eliminating that source of variability. Patients undergoing clinically indicated transthoracic echocardiography (TTE) in the Adult Intensive Care Unit of Queen Mary Hospital, Hong Kong will have TE-e' measured by both methods, along with other echocardiographic parameters associated with LAP, to evaluate correlation between the two methods and their relationship with clinically assessed LAP.
Interventions
DIAGNOSTIC_TESTEchocardiography
Full echocardiogram performed on recruited patients.
Sponsors
Queen Mary Hospital, Hong Kong
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients ≥18 years admitted to the QMH Adult Intensive Care Unit (AICU) * Requiring a transthoracic echocardiogram (TTE) as part of routine clinical care * TE-e' obtainable by both the conventional and the novel method
Exclusion criteria
* Patients \<18 years of age * Patients in atrial fibrillation * Patients with a poor TTE acoustic window * Patients in whom TE-e' is technically difficult to obtain or interpret by either method
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Correlation between novel (single-beat) and conventional (two-beat) TE-e' values | At the time of index TTE (single time point for each patient) during the course of ICU stay (from day 1 of ICU admission till ICU discharge, up to 1 month) |
Secondary
| Measure | Time frame |
|---|---|
| Correlation between novel and conventional methods in obtaining septal e' and s' velocities - At time of index TTE | At the time of index TTE (single time point for each patient) during the course of ICU stay (from day 1 of ICU admission till ICU discharge, up to 1 month) |
| Correlation between clinical evaluation of LAP and TE-e' value | At the time of index TTE (single time point for each patient) during the course of ICU stay (from day 1 of ICU admission till ICU discharge, up to 1 month) |
| Correlation between other echocardiographic parameters of LAP (E/A ratio, LAVi, TR Vmax, lung ultrasound 6-point protocol) and TE-e' value | At the time of index TTE (single time point for each patient) during the course of ICU stay (from day 1 of ICU admission till ICU discharge, up to 1 month) |
Countries
Hong Kong
Contacts
CONTACTWincy Ng, MBBS
Outcome results
None listed