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.