Changes in left ventricular systolic and diastolic function on serial echocardiography after out-of-hospital cardiac arrest

• Published in: Resuscitation Vol. 126; pp. 1 - 6
• Main Authors: Jentzer, Jacob C., Anavekar, Nandan S., Mankad, Sunil V., White, Roger D., Kashani, Kianoush B., Barsness, Gregory W., Rabinstein, Alejandro A., Pislaru, Sorin V.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2018
• Subjects: Aged; Cardiac arrest; Echocardiography; Echocardiography - methods; Echocardiography - statistics & numerical data; Humans; Hypothermia, Induced - methods; Male; Middle Aged; Out-of-Hospital Cardiac Arrest - diagnostic imaging; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - physiopathology; Out-of-Hospital Cardiac Arrest - therapy; Post-arrest myocardial dysfunction; Proportional Hazards Models; Retrospective Studies; Shock; Systolic dysfunction; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy; Post-arrest myocardial dysfunction; Shock; Echocardiography; Cardiac arrest; Systolic dysfunction
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2018.01.050

Reversible myocardial dysfunction is common after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine if changes on serial transthoracic echocardiography (TTE) can predict long-term mortality in OHCA subjects. This is a single-center historical cohort study of OHCA subjects undergoing targeted temperature management who received >1 TTE during hospitalization. Two-dimensional and Doppler parameters of systolic and diastolic function were compared between paired TTE. Univariate analysis was used to determine associations between TTE parameters and all-cause mortality. Fifty-nine patients were included; mean age was 59.4 ± 11.2 years (75% male). Initial rhythm was shockable in 90%. Initial TTE was done a median of 10.4 h after admission and repeat TTE was done 5.7 ± 4.1 days later. Between TTE studies, there were significant increases in left ventricular ejection fraction (LVEF, from 32% to 43%), cardiac output, stroke volume, and other Doppler-derived hemodynamic parameters, while systemic vascular resistance decreased (all p < 0.001). Systolic function and hemodynamic parameters on initial TTE were not associated with follow-up mortality. Patients who died during follow-up (n = 16, 27%) had smaller increases in LVEF and cardiac output-derived hemodynamic parameters than long-term survivors (p < 0.05). Significant changes in systolic function and hemodynamic parameters occur on serial Doppler TTE after OHCA, consistent with reversible post-arrest myocardial dysfunction. The magnitude of those changes is greater in long-term survivors, emphasizing that the degree of recovery from post-arrest myocardial dysfunction may be more important than its initial severity.