Clinical paperChanges in left ventricular systolic and diastolic function on serial echocardiography after out-of-hospital cardiac arrest
Introduction
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and morbidity among adults, leading to over 300,000 deaths in the United States annually [1]. Individuals resuscitated from OHCA frequently develop a characteristic post-cardiac arrest syndrome, including cardiovascular failure with circulatory shock and myocardial dysfunction [[2], [3]]. Post-arrest myocardial dysfunction (PAMD) occurs in up to 70% of subjects resuscitated from OHCA [3]. PAMD after OHCA can be reversible, with decreases in cardiac output and LV systolic function early after OHCA that often improve spontaneously over time [[3], [4], [5], [6]].
Prior studies have found that subjects who do not survive hospitalization after OHCA have more severe LV systolic dysfunction without subsequent recovery [[4], [5]]. Despite this, the presence of LV systolic dysfunction itself has not been consistently associated with adverse outcomes [[7], [8]]. On the contrary, at least one study has suggested that LV diastolic dysfunction rather than LV systolic dysfunction is associated with increased mortality after OHCA [8]. No prior studies have systematically examined the relationship between temporal echocardiographic changes and outcomes after OHCA. The goal of the current investigation was to determine if changes in LV systolic and diastolic function on serial Doppler echocardiography are associated with long-term mortality in subjects with OHCA.
Section snippets
Methods
This study was reviewed and approved by the Institutional Review Board of the Mayo Clinic (Rochester, MN) under a waiver of informed consent as posing minimal risk to subjects.
Results
During the study period, 190 adult subjects were admitted for TTM after OHCA, and 173 (91%) underwent inpatient TTE. The 59 subjects who had more than one TTE during hospitalization comprised the final study population (31% of total OHCA subjects; Supplementary Fig. 1). Baseline characteristics of subjects that underwent one or >1 TTE during admission are shown in Table 1. Subjects undergoing multiple TTEs were similar to those with a single TTE, except that they were younger (age 59 vs. 63
Discussion
This is the first published study describing changes in Doppler TTE hemodynamic parameters in OHCA subjects. In this study of 59 subjects undergoing TTM after OHCA who had serial TTE during hospitalization, we were able to demonstrate changes in cardiac systolic and diastolic function using Doppler echocardiographic parameters not previously described in this critically-ill population. TTE markers of LV systolic function and cardiac performance all increased significantly between TTEs. Markers
Conclusions
Using serial Doppler TTE in a cohort of subjects undergoing TTM after resuscitation from OHCA, this study characterized the evolving hemodynamic abnormalities of PAMD. Initial systolic function and Doppler-derived hemodynamic parameters did not predict mortality. Survivors had greater recovery of LV systolic dysfunction on follow-up TTE, and the increases in CO and CI between TTE were strongly associated with long-term mortality. This study demonstrates the novel finding that the mitral E/e’
Conflicts of interest
The authors have no conflicts of interest to report related to this work.
Relationships with Industry and Other Entities
None.
Funding
None.
Acknowledgement
The authors would like to thank the dedicated nurses and physicians who care for our OHCA patients every day.
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A Spanish translated version of the abstract of this article appears as Appendixi n the final online version at http://dx.doi.10.1016/j.resuscitation.2018.01.050.