title: Acute respiratory distress syndrome (ARDS)-associated acute cor pulmonale and patent foramen ovale: a multicenter noninvasive hemodynamic study.
abstract: BACKGROUND
  Acute cor pulmonale (ACP) and patent foramen ovale (PFO) remain common in patients under protective ventilation for acute respiratory distress syndrome (ARDS). We sought to describe the hemodynamic profile associated with either ACP or PFO, or both, during the early course of moderate-to-severe ARDS using echocardiography.
  
  
  METHODS
  In this 32-month prospective multicenter study, 195 patients with moderate-to-severe ARDS were assessed using echocardiography during the first 48 h of admission (age: 56 (SD: 15) years; Simplified Acute Physiology Score: 46 (17); PaO2/FiO2: 115 (39); VT: 6.5 (1.7) mL/kg; PEEP: 11 (3) cmH2O; driving pressure: 15 (5) cmH2O). ACP was defined by the association of right ventricular (RV) dilatation and systolic paradoxical ventricular septal motion. PFO was detected during a contrast study using agitated saline in the transesophageal bicaval view.
  
  
  RESULTS
  ACP was present in 36 patients, PFO in 21 patients, both PFO and ACP in 8 patients and the 130 remaining patients had neither PFO nor ACP. Patients with ACP exhibited a restricted left ventricle (LV) secondary to RV dilatation and had concomitant RV dysfunction, irrespective of associated PFO, but preserved LV systolic function. Despite elevated systolic pulmonary artery pressure (sPAP), patients with isolated PFO had a normal RV systolic function. sPAP and PaCO2 levels were significantly correlated.
  
  
  CONCLUSIONS
  In patients under protective mechanical ventilation with moderate-to-severe ARDS, ACP was associated with LV restriction and RV failure, whether PFO was present or not. Despite elevated sPAP, PFO shunting was associated with preserved RV systolic function.
authors.affiliation: Medical ICU, Teaching hospital of Tours, 2 Bd Tonnellé, 37044, Tours, cedex 9, France. a.legras@chu-tours.fr.
authors.forename: Annick
authors.initials: A
authors.lastname: Legras
authors.affiliation: Inserm, CIC 1415, CHRU de Tours, 2, boulevard Tonnellé, 37044, Tours, cedex 9, France. agnes.caille@univ-tours.fr.|Université François-Rabelais. PRES Centre-Val de Loire, 60 rue du Plat d'Etain, 37020, Tours, cedex 1, France. agnes.caille@univ-tours.fr.
authors.forename: Agnès
authors.initials: A
authors.lastname: Caille
authors.affiliation: Medical-Surgical ICU, Teaching hospital of Limoges, 2 Av Martin Luther King, 87042, Limoges cedex 1, France. emmanuelle.begot@chu-limoges.fr.|INSERM, CIC1435, 2 Av Martin Luther King, 87042, Limoges, cedex 1, France. emmanuelle.begot@chu-limoges.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Begot
authors.affiliation: Medical-Surgical ICU, Teaching hospital of Limoges, 2 Av Martin Luther King, 87042, Limoges cedex 1, France. gwenaelle.lheritier@orange.fr.|INSERM, CIC1435, 2 Av Martin Luther King, 87042, Limoges, cedex 1, France. gwenaelle.lheritier@orange.fr.
authors.forename: Gwenaëlle
authors.initials: G
authors.lastname: Lhéritier
authors.affiliation: Medical ICU, Hospital of Chartres, 4 rue Claude Bernard, 28630, Coudray, France. tlherm@ch-chartres.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lherm
authors.affiliation: Medical ICU, Hospital of Orléans, 14 Av de l'Hôpital, 45100, Orléans, France. armelle.mathonnet@chr-orleans.fr.
authors.forename: Armelle
authors.initials: A
authors.lastname: Mathonnet
authors.affiliation: Medical ICU, Teaching hospital of Poitiers, 2 route de la Milétrie CS 90577, 86021, Poitiers, cedex, France. j.p.frat@chu-poitiers.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Frat
authors.affiliation: Medical-surgical ICU, Hospital of Saint-Brieuc, 10 rue Marcel Proust, 22000, Saint-Brieuc, France. anne.courte@ch-stbrieuc.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Courte
authors.affiliation: Medical ICU, Hospital of La Roche-sur-Yon, Les Oudairies, 85925, La Roche-sur-Yon, cedex 9, France. laurent.martin-lefevre@chd-vendee.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Martin-Lefèvre
authors.affiliation: Medical-surgical ICU, Hospital of Saint-Malo, 1 rue Marne, 35400, Saint-Malo, France. jp.gouello@ch-stmalo.fr.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Gouëllo
authors.affiliation: Medical ICU, Teaching hospital of Tours, 2 Bd Tonnellé, 37044, Tours, cedex 9, France. emercier@univ-tours.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mercier
authors.affiliation: Medical-Surgical ICU, Teaching hospital of Limoges, 2 Av Martin Luther King, 87042, Limoges cedex 1, France. philippe.vignon@unilim.fr.|INSERM, CIC1435, 2 Av Martin Luther King, 87042, Limoges, cedex 1, France. philippe.vignon@unilim.fr.|University of Limoges, 39E Rue Camille Guérin, 87000, Limoges, France. philippe.vignon@unilim.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000175:diagnosis / Q000209:etiology*; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011660:Pulmonary Heart Disease / Q000175:diagnosis / Q000209:etiology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*