• Minesh Chotalia, Muzzammil Ali, Joseph E Alderman, Sukh Bansal, Jaimin M Patel, Mansoor N Bangash, and Dhruv Parekh.
• Birmingham Acute Care Research Group, University of Birmingham, Birmingham, United Kingdom.
• Crit. Care Med. 2023 Apr 1; 51 (4): 460470460-470.

ObjectivesTo use clustering methods on transthoracic echocardiography (TTE) findings and hemodynamic parameters to characterize circulatory failure subphenotypes and potentially elucidate underlying mechanisms in patients with acute respiratory distress syndrome (ARDS) and to describe their association with mortality compared with current definitions of right ventricular dysfunction (RVD).DesignRetrospective, single-center cohort study.SettingUniversity Hospital ICU, Birmingham, United Kingdom.PatientsICU patients that received TTE within 7 days of ARDS onset between April 2016 and December 2021.InterventionsNone.Measurements And Main ResultsLatent class analysis (LCA) of TTE/hemodynamic parameters was performed in 801 patients, 62 years old (interquartile range, 50-72 yr old), 63% male, and 40% 90-day mortality rate. Four cardiovascular subphenotypes were identified: class 1 (43%; mostly normal left and right ventricular [LV/RV] function), class 2 (24%; mostly dilated RV with preserved systolic function), class 3 (13%, mostly dilated RV with impaired systolic function), and class 4 (21%; mostly high cardiac output, with hyperdynamic LV function). The four subphenotypes differed in their characteristics and outcomes, with 90-day mortality rates of 19%, 40%, 78%, and 59% in classes 1-4, respectively ( p < 0.0001). Following multivariable logistic regression analysis, class 3 had the highest odds ratio (OR) for mortality (OR, 6.9; 95% CI, 4.0-11.8) compared with other RVD definitions. Different three-variable models had high diagnostic accuracy in identifying each of these latent subphenotypes.ConclusionsLCA of TTE parameters identified four cardiovascular subphenotypes in ARDS that more closely aligned with circulatory failure mechanisms and mortality than current RVD definitions.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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