Abstract 1864: LV Volumes But Not Filling Pressure Are Determinants Of Survival In Critically Ill Patients
Background: Transthoracic echocardiography (TTE) is able to assess LV volumes as well as LV filling pressure (from the ratio of mitral E velocity/mitral annular tissue velocity [E/e’]). E/e’ predicts outcome after infarction but its prognostic value in critical illness is undefined. The aim of this study was to evaluate the prognostic significance of echocardiographic LV volumes and filling pressure in the critically ill.
Methods: A consecutive group of 94 patients (66M, 28F, 61±15 years) who had standard TTE supplemented by measurement of E/e’ in a combined medical and surgical tertiary referral ICU were enrolled. TTE was performed 5±6 days after ICU admission. Severity of critical illness was assessed using APACHE III. Survival analysis was based on 28-day survival from date of echo with patients discharged alive censored at the time of leaving hospital. Results are presented as mean±SD.
Results: Mean APACHE III score was 72±25, and length of stay in ICU was 11±11 days and in hospital 32±48 days. Hospital mortality was 33% (n=31); correlates of hospital mortality are summarized in Table 1⇓. Univariate analysis of survival obtained similar results. The independent predictors of survival were APACHE III risk of hospital death (HR 1.3 (95%CI 1.1–1.5), p=0.003), and increased LVESV (HR 2.1 (95%CI 1.2–3.7), p=0.007). Peak E velocity and E/e’ were not predictors of survival. Table 1⇓. Univariate analysis of hospital mortality
Conclusion: In this cohort of critically ill patients, LVESV but not E/e’ is a highly significant predictor of survival that adds incremental value to APACHE III derived prediction.