Characterizing Cardiovascular Function In The Inflammatory Subphenotypes of Acute Respiratory Distress Syndrome.

OBJECTIVES

To compare transthoracic echocardiography (TTE) and cardiovascular parameters in patients with hyper- and hypoinflammatory acute respiratory distress syndrome (ARDS), derived using a validated, artificial intelligence clinical classifier. To compare overlap between latent class analysis-derived cardiovascular subphenotypes and clinical classifier-derived inflammatory subphenotypes of ARDS.

DESIGN

Retrospective single-center cohort study.

SETTING

University Hospital ICU, Birmingham, United Kingdom.

PATIENTS: Intubated patients who received a transthoracic echocardiogram within 7 days of ARDS onset between April 2016 and December 2021.

MEASUREMENTS AND MAIN

RESULTS

A total of 691 patients were included, age 61 years (interquartile range, 50-72 yr), 65% male, 41% 90-day mortality rate. A total of 30% (n = 207) were classified as hyperinflammatory and had higher mortality (64% vs. 31%; p < 0.0001) compared with the hypoinflammatory subgroup. Right ventricular (RV) size and function did not differ between hyper- and hypoinflammatory subphenotypes. Instead, the hyperinflammatory subgroup exhibited a hyperdynamic cardiovascular profile with higher left ventricular ejection fraction and cardiac output. Latent class analysis identified four cardiovascular subphenotypes; RV-related profiles were predominantly hypoinflammatory, whereas the hyperdynamic cardiovascular subtype was enriched in hyperinflammatory patients.

CONCLUSIONS

Inflammatory and cardiovascular subphenotypes represent complementary but distinct axes of ARDS pathobiology. The hyperinflammatory subphenotype aligns with a hyperdynamic circulation, whereas RV dysfunction may be mechanistically independent.