Interpretation and reproducibility of echocardiography studies in critically ill patients

Filippo Sanfilippo 1, Stephen Huang 2, Antoine Vieillard-Baron 3
  1. Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy.
  2. Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia.
  3. Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
Key words: guidelines; recommendations; critical care echocardiography; left ventricle; right ventricle
Citation: Sanfilippo F, Huang S, Vieillard-Baron A. Interpretation and reproducibility of echocardiography studies in critically ill patients. Anaesth. pain intensive care 2021;25(3):410–411. DOI: 10.35975/apic.v25i3.1514

Dear Editor,

We read with interest the prospective study conducted by El-Oraby et al.1, addressing sepsis-induced cardiomyopathy (SICM) by means of an overall echocardiographic evaluation, which included the evaluation of left ventricular (LV) systolic and diastolic function, and the assessment of right ventricular function and of preload.
The authors confirmed that LV diastolic dysfunction is an independent predictor of mortality in septic patients, as already suggested by previous evidence.2,3 The authors also showed good prognosis for patients with SICM, which they defined as a reversible impairment in LV systolic function (ejection fraction < 50% and with a decrease ≥ 10% as compared to the baseline value, eventually recovering within 1–2 weeks). Although the diagnosis of SICM is certainly challenging4 and possibly more sophisticated evaluation may be required (i.e. strain echocardiography5), the results presented by El-Oraby et al. are interesting and deserve attention.
However, we must admit that it is challenging to interpret the study findings because several information of essential value are not clearly reported, though these are most likely available to the authors themselves. It is apparent that the whole critical care echocardiography (CCE) literature is burdened by reporting inconsistencies in both methodology and results of research studies, and this issue has been systematically addressed recently.6 Such lack of information causes a significant bias in the interpretation and reproducibility of the CCE studies.
With the aim to decrease such reporting bias, we recently published the PRICES (Preferred Reporting Items for Critical care Echocardiography research Studies) recommendations,7 providing authors with checklists on the items that need reporting. Notably, the PRICES recommendations are not only based on experts’ opinion (panel of 20 experts in CCE) but also on an extensive systematic literature appraisal.6
In light of these recommendations, we kindly ask El-Oraby et al.1 to provide a full checklist of the items, as per PRICES recommendations (see checklist in Figure 2)7 This would benefit for the interpretation of the study findings and for their reproducibility, whilst stepping up the quality of the manuscript itself.

REFERENCES
  1. El-Oraby MA, El-Said Shaban, A.; El-Dada, AA.; El-Aziz, A.; El-Badawy, H. Echocardiographic evaluation of sepsis induced myocardial dysfunction in patients with sepsis or septic shock: a prospective cohort study. Anaesth. pain intensive care. 2021;25(2):150-62. [Free full text] DOI: 35975/apic.v25i2.1463
  2. Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M, et al. Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth 2017;119(4):583-94. [PubMed] DOI: 1093/bja/aex254
  3. Sanfilippo F, Corredor C, Fletcher N, Landesberg G, Benedetto U, Foex P, Cecconi M. Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Intensive Care Med. 2015 Jun;41(6):1004-13. [PubMed] DOI: 1007/s00134-015-3748-7
  4. Sanfilippo F, Orde S, Oliveri F, Scolletta S, Astuto M. The Challenging Diagnosis of Septic Cardiomyopathy. Chest. 2019;156(3):635-6. [PubMed] DOI: 1016/j.chest.2019.04.136
  5. Sanfilippo F, Corredor C, Fletcher N, Tritapepe L, Lorini FL, Arcadipane A, et al. Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis. Crit care. 2018;22(1):183. [PubMed] DOI: 1186/s13054-018-2113-y
  6. Huang S, Sanfilippo F, Herpain A, Balik M, Chew M, Clau-Terré F, et al. Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel. Ann Intensive Care. 2020 Apr25;10(1):49.. [PubMed] DOI: 10.1186/s13613-020-00662-y
  1. Sanfilippo F, Huang S, Herpain A, Balik M, Chew MS, Clau-Terré F, et al. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies. Intensive care med. 2021;47(1):1-13. [PubMed] DOI: 1007/s00134-020-06262-5