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BioMed Research International
Volume 2013, Article ID 918548, 8 pages
Clinical Study

Influence of Positive End-Expiratory Pressure on Myocardial Strain Assessed by Speckle Tracking Echocardiography in Mechanically Ventilated Patients

1Department of Medical Biotechnologies, Unit of Intensive Care Medicine, University of Siena, Viale Bracci 10, 53100 Siena, Italy
2Department of Medical Biotechnologies, Unit of Cardiology, University of Siena, Viale Bracci, 53100 Siena, Italy
3Department of Intensive Care, Erasme University Hospital, Route de Lennik, 800-1070 Brussels, Belgium

Received 30 April 2013; Revised 27 July 2013; Accepted 30 July 2013

Academic Editor: Michael Gotzmann

Copyright © 2013 Federico Franchi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. The effects of mechanical ventilation (MV) on speckle tracking echocardiography- (STE-)derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP) ventilation on 4-chamber longitudinal strain (LS) analysis by STE. Methods. We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1) PEEP = 5 cmH2O; (T2) PEEP = 10 cmH2O; and (T3) PEEP = 15 cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote). Results. Left peak atrial-longitudinal strain (LS) was significantly reduced from T1 to T2 and from T2 to T3 ( ). Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 ( ). Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers’ volumes showed a significant reduction at higher levels of PEEP ( ). Conclusions. We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10 cmH2O to avoid misinterpreting data and making erroneous decisions.