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<p>Background: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular outflow tract (VTI<sub>LVOT</sub>), is widely used for this purpose. We hypothesized that PLR-induced changes in the mitral valve velocity-time integral (VTI<sub>Mi</sub>) could serve as a reliable alternative. Methods: This prospective single-center study included septic ICU patients requiring fluid responsiveness assessment. VTI<sub>LVOT</sub> and VTI<sub>Mi</sub> were measured at baseline and after PLR. Fluid responsiveness was defined as a PLR-induced increase in VTI<sub>LVOT</sub> ≥10%. The ability of PLR-induced VTI<sub>Mi</sub> changes to predict fluid responsiveness was assessed via ROC curve and gray zone analyses. Results: Fifty consecutive patients were included (median age 65 years [IQR: 57–73], APACHE II score 22 [IQR: 18–27]). Septic shock was present in 27 (54%), 21 (42%) were mechanically ventilated, and 23 (46%) were classified as responders. PLR-induced changes in VTI<sub>Mi</sub> and VTI<sub>LVOT</sub> were significantly correlated (ρ = 0.656, <i>p</i> &lt; 0.001). The area under the ROC curve for VTI<sub>Mi</sub> was 0.927 (95% CI: 0.849–1, <i>p</i> &lt; 0.001). A 10% increase in VTI<sub>Mi</sub> predicted fluid responsiveness with a sensitivity of 83% (95% CI: 61–95) and specificity of 96% (95% CI: 83–99). The gray zone ranged between 5% and 8%, encompassing 16% of the cohort. Conclusion: PLR-induced changes in VTI<sub>Mi</sub> reliably predict fluid responsiveness in critically ill patients. VTI<sub>Mi</sub> represents a viable alternative to VTI<sub>LVOT</sub> for fluid responsiveness assessment, contributing to individualized hemodynamic management. Trial registration: NCT05538637.</p>

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Evaluation of the mitral velocity-time integral changes induced by a passive leg raising test as a marker of fluid responsiveness in critically ill patients

  • 期刊论文

  • 发表日期：

    2025年7月8日

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  • Younes Aissaoui,
  • Mathieu Jozwiak,
  • Ayoub Bouchama,
  • Hamza Bennjakhoukh,
  • Bassam Bencharfa,
  • Mehdi Didi,
  • Redouane Abouqal,
  • Ayoub Belhadj

摘要

Background: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular outflow tract (VTILVOT), is widely used for this purpose. We hypothesized that PLR-induced changes in the mitral valve velocity-time integral (VTIMi) could serve as a reliable alternative. Methods: This prospective single-center study included septic ICU patients requiring fluid responsiveness assessment. VTILVOT and VTIMi were measured at baseline and after PLR. Fluid responsiveness was defined as a PLR-induced increase in VTILVOT ≥10%. The ability of PLR-induced VTIMi changes to predict fluid responsiveness was assessed via ROC curve and gray zone analyses. Results: Fifty consecutive patients were included (median age 65 years [IQR: 57–73], APACHE II score 22 [IQR: 18–27]). Septic shock was present in 27 (54%), 21 (42%) were mechanically ventilated, and 23 (46%) were classified as responders. PLR-induced changes in VTIMi and VTILVOT were significantly correlated (ρ = 0.656, p < 0.001). The area under the ROC curve for VTIMi was 0.927 (95% CI: 0.849–1, p < 0.001). A 10% increase in VTIMi predicted fluid responsiveness with a sensitivity of 83% (95% CI: 61–95) and specificity of 96% (95% CI: 83–99). The gray zone ranged between 5% and 8%, encompassing 16% of the cohort. Conclusion: PLR-induced changes in VTIMi reliably predict fluid responsiveness in critically ill patients. VTIMi represents a viable alternative to VTILVOT for fluid responsiveness assessment, contributing to individualized hemodynamic management. Trial registration: NCT05538637.