Correlation Between Echocardiographic and Hemodynamic Variables in Cardiothoracic Intensive Care Unit

Tavazzi, Guido; Dammassa, Valentino; Corradi, Francesco; Klersy, Catherine; Patel, Brijesh; Pires, Ana Barradas; Vazir, Ali; Price, Susanna

doi:10.1053/j.jvca.2020.01.052

Cited by 5 publications

(9 citation statements)

References 35 publications

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“…Several studies have highlighted the complex relationship between ventricular dyssynchrony, aortic blood pressure, coronary flow, and myocardial contractility (32)(33)(34). Tavazzi et al (24) already demonstrated that the underlying disease (i.e., cardiovascular or respiratory) was not associated to ventricular dyssynchrony. As we did not find any association between the type of cardiac surgery and prevalence of ventricular dyssynchrony, we confirmed this point.…”

Section: Discussionmentioning

confidence: 99%

“…An association between t-IVT and macro-haemodynamic parameters (blood pressure, cardiac output) was observed in patients in the general ICU ( 24 ). Baseline t-IVT is able to predict further post-operative events ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…T-IVT was calculated using the formula t-IVT = 60 – (t-ET + t-FT), where t-ET is the total ejection time, and t-FT is the total filling time ( 19 ). A t-IVT higher than 12 s/min was classified as systolic electromechanical inefficiency (i.e., intraventricular dyssynchrony) ( 24 ). A 10% improvement in t-IVT after treatment was considered a positive response.…”

Section: Methodsmentioning

confidence: 99%

“…Reducing the echocardiographic measured time of isovolumic contraction-an indirect marker of electromechanical efficiency-has improved cardiac output and, consequently, heart energetics (22,23). A correlation between cardiac time intervals and the indicators of systolic function is found in patients admitted to cardiac ICU (24).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, validation of echocardiographic parameters in critically ill patients is in progress ( 24 ). Studies evaluating the effect of different haemodynamic ICU treatments (i.e., inotrope, vasopressor, fluid therapy) on cardiac time intervals in patients with acute cardiocirculatory failure are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Role of Electromechanical Dyssynchrony Assessment During Acute Circulatory Failure and Its Relation to Ventriculo-Arterial Coupling

Andrei

Popescu

Caruso

et al. 2022

Front. Cardiovasc. Med.

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IntroductionTwo parallel paradigms of cardiovascular efficiency and haemodynamic optimisation coexist in haemodynamic research. Targeting ventriculo-arterial (VA) coupling [i.e., the ratio between arterial and ventricular elastance (EV)] and electromechanical coupling are two promising approaches in acute circulatory failure. However, validation of the parameters of electromechanical coupling in critically ill patients is ongoing. Furthermore, a unifying link between VA and electromechanical coupling may exist, as EV is correlated with different times of the cardiac cycle.Materials and MethodsThis study was a retrospective analysis of a prospectively collected observational database from one tertiary center ICU. We analyzed the relationship between electromechanical dyssynchrony and acute circulatory failure hemodynamics before and after treatment (i.e., fluid expansion, dobutamine, or norepinephrine infusion). The relationship between electromechanical coupling and VA coupling was also investigated. Adult patients with haemodynamic instability were included. Haemodynamic parameters, including arterial pressure, cardiac index, VA coupling, stroke work index/pressure–volume area (SWI/PVA), t-IVT, and Tei's index, were collected before and after treatment. A t-IVT of >12 s/min was classified as intraventricular dyssynchrony.ResultsWe included 54 patients; 39 (72.2%) were classified as having intraventricular dyssynchrony at baseline. These patients with baseline dyssynchrony showed a statistically significant amelioration of t-IVT (from 18 ± 4 s to 14 ± 6 s, p = 0.001), left ventricular EV [from 1.1 (0.72–1.52) to 1.33 (0.84–1.67) mmHg mL−1, p = 0.001], VA coupling [from 2 (1.67–2.59) to 1.80 (1.40–2.21), p = 0.001], and SWI/PVA [from 0.58 (0.49–0.65) to 0.64 (0.51–0.68), p = 0.007]. Patients without baseline dyssynchrony showed no statistically significant results. The improvement in VA coupling was mediated by an amelioration of EV. All patients improved their arterial pressure and cardiac index with treatment. The haemodynamic treatment group exhibited no effect on changing t-IVT.ConclusionAcute circulatory failure is associated with electromechanical dyssynchrony. Cardiac electromechanical coupling was improved by haemodynamic treatment only if altered at baseline. The improvement of cardiac electromechanical coupling was associated with the improvement of markers of cardiocirculatory efficacy and efficiency (i.e., SWI/PVA and VA coupling). This study was the first to demonstrate a possible link between cardiac electromechanical coupling and VA coupling in patients with acute circulatory failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of Electromechanical Dyssynchrony Assessment During Acute Circulatory Failure and Its Relation to Ventriculo-Arterial Coupling

Andrei

Popescu

Caruso

et al. 2022

Front. Cardiovasc. Med.

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Echocardiographic parameters for weaning from extracorporeal membrane oxygenation—the role of longitudinal function and cardiac time intervals

Tavazzi,

Colombo,

Klersy

et al. 2024

European Heart Journal - Cardiovascular Imaging

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Aim Limited data exist on echocardiographic predictors of weaning from veno-arterial extracorporeal membrane oxygenation (V-A ECMO). We aimed to test the performance of different echocardiographic indices to predict weaning from V-A ECMO. and free survival after weaning Methods and results Observational study including patients with cardiogenic shock submitted to V-AECMO. Echocardiography was performed after V-AECMO placement and daily during the weaning trial to assess cardiac recovery. Echocardiography data after V-A ECMO implantation and during the last weaning-trial before V-A ECMO removal were analyzed. Besides traditional parameters, total isovolumic time (t-IVT, a left ventricular performance index) and mitral annular plane systolic excursion (MAPSE) were also tested. 76 patients were included. A greater ventricular velocity-time integral (LVOT VTI) at baseline was associated with a 5-fold increase in weaning success (p < 0.001) as MAPSE lateral >6.15 mm (p 0.001) did. TAPSE and S’ at tricuspid annulus showed an analogous association. During the weaning trial t-IVT, LVEF, MAPSE, LVOT VTI and TAPSE all improved significantly (p <0.001 for all). At regression analysis t-IVT <14.4second/minute (<0.001), LVOT VTI >12.3cm (p <0.001), MAPSE >8.9mm (p < 0.001), TAPSE> 16mm (<0.001) and E/e’ <15.5 (p 0.001) were associated with weaning success and free survival after weaning. LVEF did not predict the weaning success and survival at any time-point (p 0.230). Conclusions Longitudinal function, t-IVT and native ejection, measured with LVOT VTI, are reliable parameters to predict weaning success in V-A ECMO whereas the LVEF, although dynamically changing during weaning trial, it is not.

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Multimodality imaging in cardiogenic shock: state-of-the art

Tavazzi

Corradi

Vandenbriele

et al. 2023

Current Opinion in Critical Care

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Purpose of review There is emerging evidence on the role of the multimodality imaging in the setting of cardiogenic shock. The utility of different imaging modalities, along with their pitfalls and limitations, and their integration in a multiparametric approach are discussed in the current review. Recent findings The evaluation of congestion and perfusion in patients with shock has allowed a better understanding of the underlying physiopathological mechanisms. Integration of echocardiography, using more physiological parameters, with lung ultrasound, as well as the Doppler evaluation of abdominal blood flow dynamics, has led to a better stratification in patinas with hemodynamic instability. Summary Although validation of the integrated approaches and single parameters are needed, the physiopathological-driven approach using ultrasound in patients with cardiogenic shock on top of the clinical and biochemical evaluation, may aid to a quicker and more detailed evaluation of patient's phenotype.

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Correlation Between Echocardiographic and Hemodynamic Variables in Cardiothoracic Intensive Care Unit

Cited by 5 publications

References 35 publications

Role of Electromechanical Dyssynchrony Assessment During Acute Circulatory Failure and Its Relation to Ventriculo-Arterial Coupling

Role of Electromechanical Dyssynchrony Assessment During Acute Circulatory Failure and Its Relation to Ventriculo-Arterial Coupling

Echocardiographic parameters for weaning from extracorporeal membrane oxygenation—the role of longitudinal function and cardiac time intervals

Multimodality imaging in cardiogenic shock: state-of-the art

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