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A Simple Echocardiographic Approach in Assessing the Prognosis of Comatose Patients with Acute Intracerebral Hemorrhage by Using Right Ventricle-Pulmonary Artery Coupling

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Abstract

Background

It remains a challenge to judge whether comatose patients with acute intracerebral hemorrhage (ICH) can wake up. Here, we aimed to investigate the changes in right ventricle-pulmonary artery (RV-PA) coupling over time in these patients and to evaluate its performance for discriminating between those who woke up within 60 days and those who did not.

Methods

Thirty-five comatose patients with acute spontaneous ICH underwent bedside echocardiography on days 1, 3, and 5 after onset with the measurement of tricuspid annular plane systolic excursion and mean pulmonary artery pressure. The RV-PA coupling (the ratio of tricuspid annular plane systolic excursion to mean pulmonary artery pressure) was calculated.

Results

Within 60 days of the onset of coma, 11 individuals awakened and survived, and 24 individuals died. In awakened patients, RV-PA couplings did not differ among days 1, 3, and 5 (1.62 ± 0.38 vs. 1.61 ± 0.32 vs. 1.64 ± 0.25 mm/mm Hg, P > 0.05), whereas in unawakened patients, they decreased drastically from day 1 to day 3 and then to day 5 (1.26 ± 0.32 vs. 0.63 ± 0.05 vs. 0.43 ± 0.06 mm/mm Hg, P < 0.05). The area under receiver operating characteristic curve of 0.992 for the ratio of RV-PA coupling on day 5 to day 1 of the coma was superior to that for the Glasgow Coma Scale (area under receiver operating characteristic curve of 0.606) in the discrimination of comatose patients with ICH who woke up within 60 days from those who did not. The optimal cutoff value was 0.536, with a sensitivity of 100.00%, a specificity of 96.24%, and an accuracy of 97.13%.

Conclusions

Right ventricle-pulmonary artery coupling demonstrated a high performance for discriminating comatose patients with ICH who woke up within 60 days from those who did not.

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Acknowledgments

The authors gratefully acknowledge the technical assistance of Yan Zhu, Ya-Peng Li, Hong-Ye Wang, Lei Zhang, and Dan Huang from the Department of Ultrasound, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, P.R. China.

Funding

This study was not supported by any financial and material support.

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Authors and Affiliations

  1. Department of Ultrasound, Xining First People’s Hospital, Chengzhong District, Xining, Qinghai Province, People’s Republic of China

    Shang-Hua Zong & Li-Na Sun

  2. Department of Ultrasound, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China

    Xiao-Zhi Zheng

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  1. Shang-Hua Zong
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Contributions

S-HZ: conceived the project and main conceptual ideas, data acquisition, analysis, and writing of the article. L-NS: data acquisition, analysis, critical review. X-ZZ: conceived the project and main conceptual ideas and planned the study, data acquisition, analysis, result interpretation, study supervision, and took the lead in writing the article. All authors have read and approved of the final manuscript.

Corresponding author

Correspondence to Xiao-Zhi Zheng.

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We have no conflict of interest to disclose.

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This study adherence to ethical guidelines and has been approved by the Ethics Committee of Yangpu Hospital, School of Medicine, Tongji University (ID: 20190001394).

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Zong, SH., Sun, LN. & Zheng, XZ. A Simple Echocardiographic Approach in Assessing the Prognosis of Comatose Patients with Acute Intracerebral Hemorrhage by Using Right Ventricle-Pulmonary Artery Coupling. Neurocrit Care 38, 633–639 (2023). https://doi.org/10.1007/s12028-022-01617-w

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