Thread by @dritsyk

1/🧵Suppl. material for abstract @ESICM #LIVES2023
LV dysfunction in #ICU is bad, yet the LV is not monitored.

Can we use #TEE➕AI➕#MAPSE to monitor LV function in ICU? ✅Yes, #AutoMAPSE had excellent feasibility!

#FOAMcc #FOAMed #MedTwitter #CardioTwitter #EchoFirst #POCUS

2/  INTRODUCTION

As LV function is a crucial for effective hemodynamic management, one would expect it to be closely monitored in #ICU patients - but its not.

LV function is only assessed intermittently, and often assessed late and when LV dysfunction is severe and complicated.

3/
Therefore, we have developed a method for continuous monitoring of LV function in #ICU.

Our method combines #TEE and AI to automatically estimate #MAPSE. We call it #AutoMAPSE.

1st📜 on #AutoMAPSE:

#EHJIMP #EchoFirst #CardioTwitter doi.org/10.1093/ehjimp…

4/
#MAPSE is the motion of the red/blue dots in the Fig below and reflects global LV longitudinal function.

MAPSE was shown to be more prognostic than LVEF and GLS:
#AHAJournals

For details on #MAPSE physiology: by @strain_rate doi.org/10.1161/JAHA.1…
folk.ntnu.no/stoylen/strain…

5/
Compared to LVEF and GLS, #MAPSE is ⬇️dependent on image quality. Figure shows feasible #AutoMAPSE despite poor img. Thus:

#MAPSE➕#TEE➕AI 🟰 Hands-FREE #EchoFirst.

This could make continuous monitoring of LV function possible in #ICU #CriticalCare

6/
❓RESEARCH QUESTION❓
We asked if the combination of #MAPSE➕#TEE➕AI (i.e. #AutoMAPSE) could be used for continuous monitoring of LV function in #ICU
#CriticalCare

7/ METHODS AND RESULTS

We monitored 50 #ICU patients after cardiac surgery.

Every 5 mins, we recorded a set of hands-free 2C and 4C views that comprised 10 ❤️-beats (Figure below).

To ⬆️precision, we report 1 "measurement" as the avg MAPSE of 10 beats from 1 specific wall.

8/
We deemed #AutoMAPSE feasible if it estimated MAPSE from ≥1 out of 4 LV walls.

In fig, the blue dot shows feasible #AutoMAPSE

This was because experiments have shown that the #MAPSE of any wall reflect global LV function, not regional LV function:
doi.org/10.1152/japplp…

9/
For monitoring, the same wall must be reassessed over time.

Thus, we defined 'monitoring feasibility' as
🟢'Excellent' if the same wall could be monitored >90% of the time.
🟡'Good' if the same wall could be monitored 50-90% of the time.
🔴'Poor' if <50%.

10/
Of all 50 patients, we found the monitoring feasibility of #AutoMAPSE to be
🟢'Excellent' in 88%
🟡'Good' in 6%
🔴'Poor' in 6%

11/
To asses the precision🎯of #AutoMAPSE, we recorded a triplicate sets of image. We report precision as 'least significant change'.

To asses of bias and agreement, we also measured #MAPSE manually in these triplicate images.

Details on manual MAPSE: doi.org/10.1093/ehjimp…

12/
We found that #AutoMAPSE was more precise than manual measurements (least significant change 2.4 vs 2.7 mm).

Also, #AutoMAPSE can easily⬆️precision by instantaneously avg more measurements, something manual measurements cannot due to high workload.

13/
Compared with manual MAPSE, #AutoMAPSE had a no bias and good agreement (bias -0.2 mm, limits of agreement -3.4 to 2.9 mm)

This means that #AutoMAPSE and manual #MAPSE on avg measures the same values👍✅

14/ CONCLUSION
LV dysfunction in #CriticalCare is bad. We need continuous monitoring of LV function #ICU.

Continuous monitoring of LV function using #AutoMAPSE had🟢excellent feasibility. Compared with manual #MAPSE, #AutoMAPSE was more precise🎯 and had no bias.

End🧵

unroll @threadreaderapp