Echocardiographic assessment of elevated pulmonary vascular pressures after resolution of critical illness

BackgroundPulmonary vascular pressures are freq[ABS]suently elevated in critically ill patients and are associated with worse outcomes. However, whether elevated pressures persist and their impact on outcomes after critical illness is unknown. Research QuestionsWhat factors asre associated with persistently elevated pulmonary vascular pressures? What are the outcomes associated with persistently elevated pulmonary vascular pressures? Study Design and MethodsThis is a single center retrospective cohort study of critically ill patients during the year 2021. Adult patients with a measured tricuspid regurgitant velocity[&ge;]2.8 m/s during critical illness and had a repeat echocardiogram done after hospital discharge were included. Kaplan Meier and logistic regression were used for mortality and multivariate analysis. ResultsOf 540 patients, 257 (47.6%) had an elevated TRV. Of 51 patients with a repeat echocardiogram, 33 (64.7%) had an elevated repeat TRV. These patients had higher heart rates (91{+/-}23 vs 73{+/-}14 bpm, p<0.01), lower hemoglobin levels (8.42{+/-}1.76 vs 10.0{+/-}2.16, p=0.02), decreased TAPSE (1.90 {+/-} 0.52 mm vs 2.23 {+/-} 0.43, p = 0.03), increased RV middle diameter(3.27{+/-}0.85 vs 2.72{+/-}0.78, p=0.04) and decreased left ventricular stroke volume (61.76{+/-}15.10 vs 84.36{+/-}27.09, p=0.01) compared to those with a normal repeat TRV. Hemoglobin (p=0.03, 95% CI: 0.30-0.90) and SVI (p=0.03, 95% CI: 0.77-0.98) were associated with elevated repeat TRV levels. Elevated TRV on repeat echocardiogram was not associated with worse survival (log-rank test, p=0.33). InterpretationElevated pulmonary vascular pressures persisted after critical illness in a large number of patients, although the impact of persistently elevated pulmonary vascular pressures is uncertain.