Tei Index versus Pro BNP as Predictors of Weaning Failure in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients

Hesham M. El-Ashmawy¹, Tamer A. Helmy², Samier M. El-Awady², Doaa Hashad³, Ahmed M. Nabil²

¹Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
²Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
³Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

DOI: 10.4236/ojrd.2015.53007                

Abstract

Objective: This prospective cohort study was designed to assess the rule of myocardial performance (Tei) index and NT-Pro BNP serum levels in prediction of weaning failure in mechanically ventilated COPD patients. Methods: Forty patients with respiratory failure due to acute exacerbation of COPD were enrolled to this study. All patients underwent a comprehensive echocardiographic examination including tissue doppler imaging within first 12 hours of admission. NT-pro BNP serum levels were measured on admission. Patients were followed up for outcome of weaning failure. Results: Right ventricular Tei index was higher in patients with failed weaning in comparison to successfully weaned patients (mean 0.66 versus 0.36, P < 0.001), also left ventricular Tei index was higher in patients who failed to be weaned (mean 0.45 versus 0.36, P = 0.007). There was no difference in serum NT-Pro BNP between successfully weaned patients and patients with weaning failure. Right ventricular Tei index showed higher accuracy in predicting weaning failure than the left ventricular Tei index (AUC 0.932 versus 0.754), while serum NT-Pro BNP showed no discrimination in predicting weaning failure (AUC 0.556). Conclusion: Tei index was superior to NT-ProBNP in prediction of weaning failure in COPD patients.

Keywords

Acute Exacerbation of COPD, Tei Index, Tissue Doppler Imaging, Pro BNP, Weaning, Mechanical Ventilation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Boles, J.M., Bion, J., Connors, A., Herridge, M., Marsh, B., Melot, C., et al. (2007) Weaning from Mechanical Ventilation. European Respiratory Journal, 29, 1033-1056. http://dx.doi.org/10.1183/09031936.00010206
[2]	Pinsky, M.R. (2000) Breathing as Exercise: The Cardiovascular Response to Weaning from Mechanical Ventilation. Intensive Care Medicine, 2, 1164-1166. http://dx.doi.org/10.1007/s001340000619
[3]	Tei, C., Ling, L.H., Hodge, D.O., Bailey, K.R., Oh, J.K., Rodeheffer, R.J., et al. (1995) New Index of Combined Systolic and Diastolic Myocardial Performance: A Simple and Reproducible Measure of Cardiac Function—A Study in Normals and Dilated Cardiomyopathy. Journal of Cardiology, 26, 357-366.
[4]	Tei, C., Dujardin, K.S., Hodge, D.O., Bailey, K.R., McGoon, M.D., Tajik, A.J., et al. (1996) Doppler Echocardiographic Index for Assessment of Global Right Ventricular Function. Journal of the American Society of Echocardiography, 9, 838-847. http://dx.doi.org/10.1016/S0894-7317(96)90476-9
[5]	Buchner, S., Riegger, G. and Luchner, A. (2004) Clinical Utility of the Cardiac Markers BNP and NT-proBNP. Acta Medica Austriaca, 31, 144-151.
[6]	Morrison, L.K., Harrison, A., Krishnaswamy, P., Kazanegra, R., Clopton, P. and Maisel, A. (2002) Utility of a Rapid B-Natriuretic Peptide Assay in Differentiating Congestive Heart Failure from Lung Disease in Patients Presenting with Dyspnea. Journal of the American College of Cardiology, 39, 202-209. http://dx.doi.org/10.1016/S0735-1097(01)01744-2
[7]	Pirracchio, R., Salem, R. and Mebazaa, A. (2009) Use of B-Type Natriuretic Peptide in Critically Ill Patients. Biomarkers in Medicine, 3, 541-547. http://dx.doi.org/10.2217/bmm.09.45
[8]	Principi, T., Falzetti, G., Elisei, D., Donati, A. and Pelaia, P. (2009) Behavior of B-Type Natriuretic Peptide during Mechanical Ventilation and Spontaneous Breathing after Extubation. Minerva Anestesiologica, 75, 179-183.
[9]	Abroug, F. and Ouanes-Besbes, L. (2008) Detection of Acute Heart Failure in Chronic Obstructive Pulmonary Disease Patients: Role of B-Type Natriuretic Peptide. Current Opinion in Critical Care, 14, 340-347. http://dx.doi.org/10.1097/MCC.0b013e3282faa304
[10]	Chien, J.Y., Lin, M.S., Huang, Y.C., Chien, Y.F., Yu, C.J. and Yang, P.C. (2008) Changes in B-Type Natriuretic Peptide Improve Weaning Outcome Predicted by Spontaneous Breathing Trial. Critical Care Medicine, 36, 1421-1426. http://dx.doi.org/10.1097/CCM.0b013e31816f49ac
[11]	Mekontso-Dessap, A., de Prost, N., Girou, E., Braconnier, F., Lemaire, F., Brun-Buisson, C., et al. (2006) B-Type Natriuretic Peptide and Weaning from Mechanical Ventilation. Intensive Care Medicine, 32, 1529-1536. http://dx.doi.org/10.1007/s00134-006-0339-7
[12]	Gerbaud, E., Erickson, M., Grenouillet-Delacre, M., Beauvieux, M.C., Coste, P., Durrieu-Jais, C., et al. (2012) Echocardiographic Evaluation and N-Terminal Pro-Brain Natriuretic Peptide Measurement of Patients Hospitalized for Heart Failure during Weaning from Mechanical Ventilation. Minerva Anestesiologica, 78, 415-425.
[13]	Mekontso-Dessap, A., Tual, L., Kirsch, M., D’Honneur, G., Loisance, D., Brochard, L., et al. (2006) B-Type Natriuretic Peptide to Assess Haemodynamic Status after Cardiac Surgery. British Journal of Anaesthesia, 97, 777-782. http://dx.doi.org/10.1093/bja/ael271
[14]	Grasso, S., Leone, A., De Michele, M., Anaclerio, R., Cafarelli, A., Ancona, G., et al. (2007) Use of N-Terminal Pro- Brain Natriuretic Peptide to Detect Acute Cardiac Dysfunction during Weaning Failure in Difficult-to-Wean Patients with Chronic Obstructive Pulmonary Disease. Critical Care Medicine, 35, 96-105. http://dx.doi.org/10.1097/01.CCM.0000250391.89780.64
[15]	Zapata, L., Vera, P., Roglan, A., Gich, I., Ordonez-Llanos, J. and Betbese, A.J. (2011) B-Type Natriuretic Peptides for Prediction and Diagnosis of Weaning Failure from Cardiac Origin. Intensive Care Medicine, 37, 477-485. http://dx.doi.org/10.1007/s00134-010-2101-4
[16]	Moschietto, S., Doyen, D., Grech, L., Dellamonica, J., Hyvernat, H. and Bernardin, G. (2012) Transthoracic Echocardiography with Doppler Tissue Imaging Predicts Weaning Failure from Mechanical Ventilation: Evolution of the Left Ventricle Relaxation Rate during a Spontaneous Breathing Trial Is the Key Factor in Weaning Outcome. Critical Care, 16, R81. http://dx.doi.org/10.1186/cc11339
[17]	Papanikolaou, J., Makris, D., Saranteas, T., Karakitsos, D., Zintzaras, E., Karabinis, A., et al. (2011) New Insights into Weaning from Mechanical Ventilation: Left Ventricular Diastolic Dysfunction Is a Key Player. Intensive Care Medicine, 37, 1976-1985. http://dx.doi.org/10.1007/s00134-011-2368-0
[18]	Schifelbain, L.M., Vieira, S.R., Brauner, J.S., Pacheco, D.M. and Naujorks, A.A. (2011) Echocardiographic Evaluation during Weaning from Mechanical Ventilation. Clinics (Sao Paulo), 66, 107-111. http://dx.doi.org/10.1590/S1807-59322011000100019
[19]	El-Damarawy, M., Zeidan, H. and Suwailem, S. (2008) Myocardial Performance Index in Patients with Chronic Obstructive Pulmonary Disease. Heart Mirror Journal, 2, 1687-1692.
[20]	Tanaka, Y., Hino, M., Mizuno, K. and Gemma, A. (2013) Evaluation of Right Ventricular Function in Patients with COPD. Respiratory Care, 58, 816-823.
[21]	Das, M., Tapadar, S.R., Mahapatra, A.B., Chowdhury, S.P. and Basu, S. (2014) Assessment of RV Function in Patients of (COPD). Journal of Clinical and Diagnostic Research, 8, 11-13. http://dx.doi.org/10.7860/jcdr/2014/6440.4090
[22]	Sabit, R., Bolton, C.E., Fraser, A.G., Edwards, J.M., Edwards, P.H., Ionescu, A.A., et al. (2010) Sub-Clinical Left and Right Ventricular Dysfunction in Patients with COPD. Respiratory Medicine, 104, 1171-1178. http://dx.doi.org/10.1016/j.rmed.2010.01.020
[23]	Sadic, B.O., Euryksel, E. and Tanrikulu, M.A. (2011) Right Ventricular Function in Patient with Acute Exacerbation of COPD. Respiratory Medicine, 109, 1123-1135.
[24]	Botelho, C.M.A., Pena, J.L.B., Colosimo, E.A. and Moreira, M.C.V. (2008) B-Type Natriuretic Peptide (BNP) Regulation and Doppler Echocardiographic Alterations in Patients with Chronic Obstructive Pulmonary Disease Acute Exacerbations. European Journal of Heart Failure Supplements, 7, 82. http://dx.doi.org/10.1016/S1567-4215(08)60225-8