ORIGINAL RESEARCH published: 31 May 2022 doi: 10.3389/fcvm.2022.830165 Edited by: Lucas Liaudet, Centre Hospitalier Universitaire Vaudois (CHUV), Switzerland Reviewed by: Andrew Conway Morris, University of Cambridge, United Kingdom Annagrazia Cecere, University of Padua, Italy *Correspondence: Charalampos Pierrakos charalampos_p@hotmail.com Specialty section: This article was submitted to Cardiovascular Imaging, a section of the journal Frontiers in Cardiovascular Medicine Received: 06 December 2021 Accepted: 20 April 2022 Published: 31 May 2022 Citation: Pierrakos C, Geke Algera A, Simonis F, Cherpanath TGV, Lagrand WK, Paulus F, Bos LDJ and Schultz MJ (2022) Abnormal Right Ventricular Myocardial Performance Index Is Not Associated With Outcomes in Invasively Ventilated Intensive Care Unit Patients Without Acute Respiratory Distress Syndrome—Post hoc Analysis of Two RCTs. Front. Cardiovasc. Med. 9:830165. doi: 10.3389/fcvm.2022.830165 Abnormal Right Ventricular Myocardial Performance Index Is Not Associated With Outcomes in Invasively Ventilated Intensive Care Unit Patients Without Acute Respiratory Distress Syndrome—Post hoc Analysis of Two RCTs Charalampos Pierrakos 1,2 * , Anna Geke Algera 1 , Fabienne Simonis 1 , Thomas G. V. Cherpanath 1 , Wim K. Lagrand 1 , Frederique Paulus 1 , Lieuwe D. J. Bos 1 , Marcus J. Schultz 1,3,4 the PReVENT– and RELAx–Investigators 1 Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, Netherlands, 2 Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium, 3 Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand, 4 Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom Background: The objective of the study was to determine the association between right ventricular (RV) myocardial performance index (MPI) and successful liberation from the ventilator and death within 28 days. Methods: Post hoc analysis of 2 ventilation studies in invasively ventilated patients not having ARDS. RV-MPI was collected through transthoracic echocardiography within 24–48 h from the start of invasive ventilation according to the study protocols. RV- MPI ≤ 0.54 was considered normal. The primary endpoint was successful liberation from the ventilator < 28 days; the secondary endpoint was 28-day mortality. Results: A total of 81 patients underwent transthoracic echocardiography at median 30 (24–42) h after the start of ventilation—in 73 (90%) patients, the RV-MPI could be collected. A total of 56 (77%) patients were successfully liberated from the ventilator < 28 days; A total of 22 (30%) patients had died before or at day 28. A total of 18 (25%) patients had an abnormal RV-MPI. RV-MPI was neither associated with successful liberation from the ventilator within 28 days [HR, 2.2 (95% CI 0.47–10.6); p = 0.31] nor with 28-day mortality [HR, 1.56 (95% CI 0.07–34.27);p = 0.7]. Conclusion: In invasively ventilated critically ill patients without ARDS, an abnormal RV-MPI indicative of RV dysfunction was not associated with time to liberation from invasive ventilation. Keywords: heart-lung interactions, echocardiography, hemodynamic monitoring, mechanical ventilation, mortality, successful extubation Frontiers in Cardiovascular Medicine | www.frontiersin.org 1 May 2022 | Volume 9 | Article 830165