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Keller K, Hobohm L, Münzel T, Ostad MA, Espinola-Klein C, Lavie CJ, Konstantinides S, Lankeit M. Survival Benefit of Obese Patients With Pulmonary Embolism. Mayo Clin Proc 2019; 94:1960-1973. [PMID: 31585580 DOI: 10.1016/j.mayocp.2019.04.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/15/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the impact of obesity and underweight on adverse in-hospital outcomes in pulmonary embolism (PE). PATIENTS AND METHODS Patients diagnosed as having PE based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification code I26 in the German nationwide inpatient database were stratified for obesity, underweight, and normal weight/overweight (reference group) and compared regarding adverse in-hospital outcomes. RESULTS From January 1, 2011, through December 31, 2014, 345,831 inpatients (53.3% females) 18 years and older were included in this analysis; 8.6% were obese and 0.5% were underweight. Obese patients were younger (67.0 vs 73.0 years), were more frequently female (60.2% vs 52.7%), had a lower cancer rate (13.6% vs 20.5%), and were more often treated with systemic thrombolysis (6.4% vs 4.3%) and surgical embolectomy (0.3% vs 0.1%) vs the reference group (P<.001 for all). Overall, 51,226 patients (14.8%) died during in-hospital stay. Obese patients had lower mortality (10.9% vs 15.2%; P<.001) vs the reference group and a reduced odds ratio (OR) for in-hospital mortality (OR, 0.74; 95% CI, 0.71-0.77; P<.001) independent of age, sex, comorbidities, and reperfusion therapies. This survival benefit of obese patients was more pronounced in obesity classes I (OR, 0.56; 95% CI, 0.52-0.60; P<.001) and II (OR, 0.63; 95% CI 0.58-0.69; P<.001). Underweight patients had higher prevalence of cancer and higher mortality rates (OR, 1.15; 95% CI, 1.00-1.31; P=.04). CONCLUSION Obesity is associated with decreased in-hospital mortality rates in patients with PE. Although obese patients were more often treated with reperfusion therapies, the survival benefit of obese patients occurred independently of age, sex, comorbidities, and reperfusion treatment.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine Main, Rhine Main, Germany
| | - Mir A Ostad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité-University Medicine, Berlin, Germany; Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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Cameli M, Bigio E, Lisi M, Righini FM, Galderisi M, Franchi F, Scolletta S, Mondillo S. Relationship between pulse pressure variation and echocardiographic indices of left ventricular filling pressure in critically ill patients. Clin Physiol Funct Imaging 2014; 35:344-50. [PMID: 24902871 DOI: 10.1111/cpf.12168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulse pressure variation (PPV) is a dynamic index of fluid responsiveness. This parameter helps clinicians in improving haemodynamic status while avoiding potential fluid overload. Echocardiographic indices, such as E/E' ratio and left atrial (LA) strain by speckle tracking echocardiography (STE), are used to estimate left ventricular (LV) filling pressures. This study aimed at exploring the relationship between PPV and echocardiographic indices of LV filling pressures in critically ill patients. METHODS Twenty-two patients (mean age of 50.9 ± 21.6, male/female = 15/7) admitted to intensive care unit, and requiring mechanical ventilation and invasive arterial pressure monitoring, were studied. In all patients, two independent operators assessed simultaneously PPV, using a pulse contour method, mean E/E' ratio and peak atrial longitudinal strain (PALS) by means of STE. PALS values were obtained by averaging LA segments measured in the 4-chamber and 2-chamber views (global PALS). RESULTS A significant negative correlation was found between mean E/E' ratio and PPV (R(2) = -0.76; P<0.001). A positive correlation between global PALS and PPV was found (R(2) = 0.80, P<0.001). Mean global PALS of 26.2% demonstrated excellent accuracy (Area Under Roc Curve = 0.86, P<0.001), and good sensitivity (92%) and specificity (86%) in predicting a PPV >15%. CONCLUSION In a group of mechanically ventilated patients PPV, derived from pulse contour analysis, and echocardiographic preload parameters were well correlated. Global PALS by STE provided better estimation of PPV than mean E/E' ratio. PALS seems a potential alternative to PPV in assessing fluid responsiveness in critically ill patients.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
| | - Elisa Bigio
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
| | - Matteo Lisi
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
| | - Francesca M Righini
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
| | - Maurizio Galderisi
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
| | - Sabino Scolletta
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
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Chemla D, Castelain V, Zhu K, Papelier Y, Creuzé N, Hoette S, Parent F, Simonneau G, Humbert M, Herve P. Estimating Right Ventricular Stroke Work and the Pulsatile Work Fraction in Pulmonary Hypertension. Chest 2013; 143:1343-1350. [DOI: 10.1378/chest.12-1880] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fabritz L, Fortmüller L, Yu TY, Paul M, Kirchhof P. Can preload-reducing therapy prevent disease progression in arrhythmogenic right ventricular cardiomyopathy? Experimental evidence and concept for a clinical trial. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2012; 110:340-6. [PMID: 22944071 DOI: 10.1016/j.pbiomolbio.2012.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/09/2012] [Indexed: 12/28/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy and a leading cause of sudden cardiac death in a young population. ARVC is especially common in young athletes. Mutations in different desmosomal genes have been identified causing dysfunctional cell-cell contacts. Reduced myocardial expression of plakoglobin in cell-cell contact complexes appears to associate with disease manifestation in patients harbouring mutations within other cell-cell contact genes. Experimental data suggest that preload reduction may be a simple and effective intervention to prevent disease progression and ventricular arrhythmias in ARVC. This review discusses the potential effects of this innovative approach and describes the design of the first controlled trial of preload-reducing therapy in patients with ARVC.
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Affiliation(s)
- Larissa Fabritz
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
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5
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Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness. Intensive Care Med 2010; 36:940-8. [DOI: 10.1007/s00134-010-1755-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 12/29/2009] [Indexed: 10/19/2022]
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Breukers RMBGE, Trof RJ, Groeneveld ABJ. Cardiac Filling Volumes and Pressures in Assessing Preload Responsiveness during Fluid Challenges. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hein M, Baumert JH, Roehl AB, Pasch L, Schnoor J, Coburn M, Rossaint R. Xenon alters right ventricular function. Acta Anaesthesiol Scand 2008; 52:1056-63. [PMID: 18840104 DOI: 10.1111/j.1399-6576.2008.01696.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND In contrast to other volatile anesthetics, xenon produces less cardiovascular depression with fewer fluctuations of various hemodynamic parameters, but reduces cardiac output (CO) in vivo. Besides an increase in left ventricular afterload and reduction of heart rate, an impairment of the right ventricular function might be an additional pathophysiological mechanism for the reduction of CO. Therefore, we used an animal model to study the effects of xenon as a supplemental anesthetic on right ventricular function, especially right ventricular afterload. METHODS Right ventricular function was monitored with a volumetric pulmonary artery catheter in 11 pigs during general anesthesia with thiopental. Six animals received additional 70% (volume) xenon (equivalent to 0.55 MAC minimum alveolar concentration). Parameters for systolic function, afterload, and preload were calculated at baseline and during 50 min of xenon application, and in a corresponding control group. Significant differences were detected by multivariate analyses of variance for repeated measures. RESULTS Xenon reduced CO on average by 30% and increased pulmonary arterial elastance by 60%, which led to a reduction of the right ventricular ejection fraction by 25%. Whereas right ventricular preload remained stable, maximal slope of pulmonary artery pressure and the right ventricular elastance increased. No effect on the ratio of stroke work and end-diastolic volume was found. CONCLUSION The reduction in CO during xenon anesthesia was partly due to an impairment of the right ventricular function, mainly caused by an increased afterload, without an impairment of systolic ventricular function.
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Affiliation(s)
- M Hein
- Department of Anesthesiology, University Hospital of Aken, Aachen, Germany.
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Renner J, Gruenewald M, Brand P, Steinfath M, Scholz J, Lutter G, Bein B. Global end-diastolic volume as a variable of fluid responsiveness during acute changing loading conditions. J Cardiothorac Vasc Anesth 2007; 21:650-4. [PMID: 17905268 DOI: 10.1053/j.jvca.2007.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Dynamic variables of preload such as stroke volume variation (SVV) have been shown to be good predictors of fluid responsiveness. They are, however, not applicable during spontaneous breathing and cardiac arrhythmias. Volumetric variables of preload, such as global end-diastolic volume (GEDV) and left ventricular end-diastolic area (LVEDA), might be alternative variables of preload to guide fluid administration. Therefore, the present study was designed to evaluate whether GEDV and LVEDA are suitable parameters of preload and fluid responsiveness during rapidly changing loading conditions. DESIGN Prospective animal study. SETTING Animal laboratory of a university hospital. PARTICIPANTS Fourteen pigs. INTERVENTIONS The pigs were studied during changing loading conditions as follows: normovolemia, after removal of 500 mL of blood, and after retransfusion plus an additional 500 mL of 6% hydroxyethyl starch. Cardiac output (CO), stroke volume index (SVI), and GEDV were obtained by transpulmonary thermodilution. Additionally, CO, SVI, and SVV were monitored continuously by pulse-contour analysis. MEASUREMENTS AND MAIN RESULTS Measurements of hemodynamic variables at each experimental stage were obtained after a period of stabilization. GEDV and LVEDA but not SVV, central venous pressure, and pulmonary capillary wedge pressure accurately reflected rapid changes in preload. When analyzing the correlation of percentage change of preload variables with the percentage change of SVI after fluid resuscitation, only SVV and GEDV showed a significant correlation with fluid responsiveness. CONCLUSIONS In this animal model, GEDV and LVEDA were superior to SVV in accurately reflecting hemorrhage. However, GEDV and SVV but not LVEDA were suitable to predict fluid responsiveness.
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Affiliation(s)
- Jochen Renner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.
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Brennan JM, Blair JEA, Hampole C, Goonewardena S, Vasaiwala S, Shah D, Spencer KT, Schmidt GA. Radial Artery Pulse Pressure Variation Correlates With Brachial Artery Peak Velocity Variation in Ventilated Subjects When Measured by Internal Medicine Residents Using Hand-Carried Ultrasound Devices. Chest 2007; 131:1301-7. [PMID: 17494781 DOI: 10.1378/chest.06-1768] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Rapid prediction of the effect of volume expansion is crucial in unstable patients receiving mechanical ventilation. Both radial artery pulse pressure variation (DeltaPP) and change of aortic blood flow peak velocity are accurate predictors but may be impractical point-of-care tools. PURPOSES We sought to determine whether respiratory changes in the brachial artery blood flow velocity (DeltaVpeak-BA) as measured by internal medicine residents using a hand-carried ultrasound (HCU) device could provide an accurate corollary to DeltaPP in patients receiving mechanical ventilation. METHODS Thirty patients passively receiving volume-control ventilation with preexisting radial artery catheters were enrolled. The brachial artery Doppler signal was recorded and analyzed by blinded internal medicine residents using a HCU device. Simultaneous radial artery pulse wave and central venous pressure recordings (when available) were analyzed by a blinded critical care physician. RESULTS A Doppler signal was obtained in all 30 subjects. The DeltaVpeak-BA correlated well with DeltaPP (r = 0.84) with excellent agreement (weighted kappa, 0.82) and limited intraobserver variability (2.8 +/- 2.8%) [mean +/- SD]. A DeltaVpeak-BA cutoff of 16% was highly predictive of DeltaPP > or = 13% (sensitivity, 91%; specificity, 95%). A poor correlation existed between the CVP and both DeltaVpeak-BA (r = - 0.21) and DeltaPP (r = - 0.16). CONCLUSIONS The HCU Doppler assessment of the DeltaVpeak-BA as performed by internal medicine residents is a rapid, noninvasive bedside correlate to DeltaPP, and a DeltaVpeak-BA cutoff of 16% may prove useful as a point-of-care tool for the prediction of volume responsiveness in patients receiving mechanical ventilation.
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Affiliation(s)
- J Matthew Brennan
- Division of Cardiovascular Diseases, Duke University Medical Center, 2300-2399 Erwin Road, Durham, NC 27710, USA.
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10
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Renner J, Cavus E, Meybohm P, Tonner P, Steinfath M, Scholz J, Lutter G, Bein B. Stroke volume variation during hemorrhage and after fluid loading: impact of different tidal volumes. Acta Anaesthesiol Scand 2007; 51:538-44. [PMID: 17430313 DOI: 10.1111/j.1399-6576.2007.01282.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have shown that stroke volume variation (SVV) may be used to assess preload and fluid responsiveness. It is currently under debate, if SVV reliably displays changes in preload during ventilation with clinically used tidal volumes. This study was designed to evaluate whether the predictive value of SVV depends on the tidal volume applied particularly during acute changes of preload. METHODS We studied 14 anesthetized pigs (35 +/- 2 kg) during changing tidal volumes (5, 10 and 15 ml/kg) at normovolemia (BL), after removal of 500 cc of blood (Hypo) and after retransfusion plus additional 500 cc 6% hydroxyethyl starch (Hyper). SVV was recorded continuously, and global end-diastolic volume (GEDV) was obtained by transpulmonary thermodilution at each experimental stage. RESULTS GEDV changed significantly comparing the different experimental stages (P < 0.0001). During ventilation with 5 ml/kg, SVV did not change significantly at the different loading conditions. In contrast, during ventilation with both 10 and 15 ml/kg, SVV changed significantly comparing hemorrhage to fluid loading. However, at 15 ml/kg SVV was above the recommended value throughout the experiment. CONCLUSIONS In this animal model, SVV was not sensitive to acute changes in preload during ventilation with a tidal volume of 5 ml/kg. Moreover, ventilation with high tidal volume may suggest volume loading even after sufficient volume resuscitation.
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Affiliation(s)
- J Renner
- Departments of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany.
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Anwar AM, Soliman OII, Nemes A, van Geuns RJM, Geleijnse ML, ten Cate FJ. Value of assessment of tricuspid annulus: real-time three-dimensional echocardiography and magnetic resonance imaging. Int J Cardiovasc Imaging 2007; 23:701-5. [PMID: 17295104 PMCID: PMC2048828 DOI: 10.1007/s10554-006-9206-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 12/28/2006] [Indexed: 11/30/2022]
Abstract
Aim To detect the accuracy of real-time three-dimensional echocardiography (RT3DE) and two-dimensional echocardiography (2DE) for tricuspid annulus (TA) assessment compared with magnetic resonance imaging (MRI). Methods Thirty patients (mean age 34 ± 13 years, 60% males) in sinus rhythm were examined by MRI, RT3DE, and 2DE for TA assessment. End-diastolic and end-systolic TA diameter (TAD) and TA fractional shortening (TAFS) were measured by RT3DE, 2DE, and MRI. End-diastolic and end-systolic TA area (TAA) and TA fractional area changes (TAFAC) were measured by RT3DE and MRI. End-diastolic and end-systolic right ventricular (RV) volumes and ejection fraction (RV-EF) were measured by MRI. Results The TA was clearly delineated in all patients and visualized as an oval-shaped by RT3DE and MRI. There was a good correlation between TADMRI and TAD3D (r = 0.75, P = 0.001), while TAD2D was fairly correlated with TAD3D and TADMRI (r = 0.5, P = 0.01 for both). There were no significant differences between RT3DE and MRI in TAD, TAA, TAFS, and TAFAC measurements, while TAD2D and TAFS2D were significantly underestimated (P < 0.001). TAFS2D was not correlated with RV-EF, while TAFS3D and TAFAC3D were fairly correlated with RV-EF (r = 0.49, P = 0.01, and r = 0.47, P = 0.02 respectively). Conclusion RT3DE helps in accurate assessment of TA comparable to MRI and may have an important implication in the TV surgical decision-making processes. RT3DE analysis of TA function could be used as a marker of RV function.
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Affiliation(s)
- Ashraf M. Anwar
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
| | - Osama I. I. Soliman
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
| | - Attila Nemes
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Second Department of Medicine and Cardiology center, University of Szeged, Szeged, Hungary
| | - Robert-Jan M. van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marcel L. Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Folkert J. ten Cate
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Ueti OM, Camargo EE, Ueti ADA, de Lima-Filho EC, Nogueira EA. Assessment of right ventricular function with Doppler echocardiographic indices derived from tricuspid annular motion: comparison with radionuclide angiography. Heart 2002; 88:244-8. [PMID: 12181215 PMCID: PMC1767344 DOI: 10.1136/heart.88.3.244] [Citation(s) in RCA: 200] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess right ventricular systolic function using indices derived from tricuspid annular motion, and to compare the results with right ventricular ejection fraction (RVEF) calculated from radionuclide angiography. DESIGN Pulsed Doppler echocardiography indices were obtained from 10 patients with a normal RVEF (group 1) and from 20 patients whose RVEF was less than 45% (group 2). RESULTS The patients in the two groups were similar in age, systolic blood pressure, and heart rate. There was a close correlation between the tricuspid annular motion derived indices (D wave integral (DWI), peak velocity of D wave (PVDW), and tricuspid plane systolic excursion (TPSE)) and RVEF (r = 0.72, 0.82, and 0.79, respectively). DWI was significantly higher in group 1 than in group 2. PVDW discriminated adequately between individuals with abnormal and normal right ventricular ejection fraction. The sensitivity and specificity of tricuspid annular motion derived indices were very good. CONCLUSIONS Indices derived from tricuspid annular motion appear to be important tools for assessing right ventricular systolic function.
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Affiliation(s)
- O M Ueti
- Department of Internal Medicine, Discipline of Cardiology, University of Campinas School of Medicine, Campus Universitario "Zeferino Vaz", 13083-970 Campinas, São Paulo, Brazil
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Pearlman JD, Gertz ZM, Wu Y, Simons M, Post MJ. Serial motion assessment by reference tracking (SMART): application to detection of local functional impact of chronic myocardial ischemia. J Comput Assist Tomogr 2001; 25:558-62. [PMID: 11473185 DOI: 10.1097/00004728-200107000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare measurements of wall motion and thickening with and without correcting for cardiac twisting and shortening. METHOD Inversion recovery Gd-DPTA perfusion and cine motion MRI were performed on 12 pigs with chronic ischemia induced by ameroid occluder. Analyses were based on conventional fixed plane imaging and serial motion assessment by reference tracking (SMART). RESULTS Normal motion was 31.3 +/- 1.9%, and normal wall thickening was 41.4 +/- 2.2%. At the maximum perfusion defect, SMART wall motion was 10.5 +/- 2.4% and fixed wall motion was 20.6 +/- 1.7% (p < 0.004), SMART wall thickening was 20.1 +/- 4.4%, and fixed wall thickening was 32 +/- 1.9% (p < 0.03). CONCLUSION SMART measurements of wall thickening and motion detect much smaller thickening and motion in ischemic myocardium than fixed radial metrics. SMART data, covering the entire heart, should prove twice as sensitive to abnormalities in motion and thickening, such as any produced by ischemic heart disease or improved by treatment.
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Affiliation(s)
- J D Pearlman
- Angiogenesis Research Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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14
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Michard F, Wolff MA, Herman B, Wysocki M. Right ventricular response to high-dose almitrine infusion in patients with severe hypoxemia related to acute respiratory distress syndrome. Crit Care Med 2001; 29:32-6. [PMID: 11176154 DOI: 10.1097/00003246-200101000-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effects of high-dose almitrine infusion on gas exchange and right ventricular function in patients with severe hypoxemia related to acute respiratory distress syndrome (ARDS). DESIGN Prospective study. SETTING Medicosurgical intensive care department (ten beds). PATIENTS Nine patients with ARDS and severe hypoxemia (PaO2/FIO2 ratio, <150 torr [20 kPa]). INTERVENTION High-dose almitrine infusion (16 microg/kg/min for 30 mins). MEASUREMENTS AND MAIN RESULTS Gas exchange and hemodynamic parameters were recorded before and after almitrine infusion. Right ventricular function was evaluated by using a fast response thermistor pulmonary artery catheter that allowed measurement of right ventricular ejection fraction and calculation of right ventricular end-diastolic and end-systolic volumes. Almitrine did not significantly alter arterial oxygenation and intrapulmonary shunt. Almitrine increased mean pulmonary arterial pressure (MPAP) from 31 +/- 4 to 33 +/- 4 mm Hg (p < .05), pulmonary vascular resistance index from 353 +/- 63 to 397 +/- 100 dyne x sec/ cm5 x m2 (p < .05), and right ventricular end-systolic volume index from 71 +/- 22 to 77 +/- 21 mL/m2 (p < .05); almitrine decreased right ventricular ejection fraction from 36% +/- 7% to 34% +/- 8% (p < .05). Stroke volume index and cardiac index did not change. The almitrine-induced changes in right ventricular ejection fraction were closely correlated with the baseline MPAP (r2 = .71, p < .01). CONCLUSION In patients with severe hypoxemia related to ARDS, high-dose almitrine infusion did not improve arterial oxygenation and impaired the loading conditions of the right ventricle. The decrease in right ventricular ejection fraction induced by almitrine was correlated with the baseline MPAP. Thus, high-dose almitrine infusion may be harmful in ARDS patients with severe hypoxemia and pulmonary hypertension.
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Affiliation(s)
- F Michard
- Service de réanimation polyvalente, Institut Mutualiste Montsouris, Paris, France
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15
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Michard F, Teboul JL. Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation. Crit Care 2000; 4:282-9. [PMID: 11094507 PMCID: PMC137257 DOI: 10.1186/cc710] [Citation(s) in RCA: 229] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2000] [Accepted: 07/24/2000] [Indexed: 12/11/2022] Open
Abstract
According to the Frank-Starling relationship, a patient is a 'responder' to volume expansion only if both ventricles are preload dependent. Mechanical ventilation induces cyclic changes in left ventricular (LV) stroke volume, which are mainly related to the expiratory decrease in LV preload due to the inspiratory decrease in right ventricular (RV) filling and ejection. In the present review, we detail the mechanisms by which mechanical ventilation should result in greater cyclic changes in LV stroke volume when both ventricles are 'preload dependent'. We also address recent clinical data demonstrating that respiratory changes in arterial pulse (or systolic) pressure and in Doppler aortic velocity (as surrogates of respiratory changes in LV stroke volume) can be used to detect biventricular preload dependence, and hence fluid responsiveness in critically ill patients.
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Affiliation(s)
- F Michard
- Service de Réanimation Medicale, CHU de Bicêtre, Université Paris XI, Kremlin Bicêtre, France.
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