Respiratory variations of R-wave amplitude in lead II are correlated with stroke volume variations evaluated by transesophageal Doppler echocardiography.
J Cardiothorac Vasc Anesth 2012;
26:381-6. [PMID:
22459928 DOI:
10.1053/j.jvca.2012.01.048]
[Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE
The authors hypothesized that variations in electrocardiographically derived R-wave amplitude might be correlated with mechanical ventilation-induced variations in stroke volume as determined by transesophageal echocardiography.
DESIGN
Observational prospective study.
SETTING
Single university hospital.
PARTICIPANTS
Thirty-four patients undergoing coronary artery bypass surgery.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Respiratory R-wave variations in lead II (ΔRII) were correlated with aortic velocity time integral variations (r = 0.82, p < 0.0001). Respiratory R-wave variations in leads III and aVF and pulse pressure variation also were correlated with aortic velocity time integral variations (r = 0.49, p = 0.015; r = 0.61, p = 0.0016; and r = 0.72, p < 0.0001, respectively). R-wave respiratory variations in lead V(5) were not correlated with aortic velocity time integral variations. ΔRII was correlated with pulse pressure variation (r = 0.71, p < 0.0001). A ΔRII cutoff value of 15% accurately predicted stroke volume variations >15%, with a specificity of 92%, a sensitivity of 86%, a positive likelihood ratio of 11.1, a negative likelihood ratio of 0.15, a positive predictive value of 95%, and a negative predictive value of 80%.
CONCLUSIONS
ΔRII is correlated with stroke volume variations as determined by transesophageal echocardiography in mechanically ventilated patients and can identify the stroke volume variation cutoff of 15%, previously determined to be the cutoff for volume responsiveness.
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