Echocardiographic and Hemodynamic Indexes of Left Ventricular Preload in Patients with Normal and Abnormal Ventricular Function

Cheung, Albert T.; Savino, Joseph S.; Weiss, Stuart J.; Aukburg, Stanley J.; Berlin, Jesse A.

doi:10.1097/00000542-199408000-00016

Cited by 286 publications

(115 citation statements)

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“…This suggests the increasing value of filling pressures over volumes for predicting fluid responsiveness in patients with left ventricular systolic dysfunction. Indeed, the suggestion that a low GEF reflects systolic dysfunction of the left ventricle is supported by the fact that changes in PAOP did not correlate with changes in CVP, as reported by others [29-31]. Furthermore, our data suggest that PAOP relates to systolic and not to diastolic function since distensibility did not differ between the low and near-normal GEF groups, both prior to and after fluid loading.…”

Section: Discussionsupporting

confidence: 84%

“…The often observed superiority of cardiac volumes over filling pressures in predicting and monitoring cardiac output responses, that is, fluid responsiveness, may indeed be overestimated by the phenomenon, as recently described by our group also [1,6-8,10-16,18,19,27]. In hearts with systolic dysfunction and dilatation, a right- and downward shift on the Frank-Starling curve and along the curvilinear pressure-volume relationship at end-diastole, preload recruitability may be more dependent on and thus predicted and monitored by pressures than by volumes [5,22]. Indeed, GEDVI was higher in patients with a low versus a near-normal GEF, suggesting cardiac dilatation.…”

Section: Discussionmentioning

confidence: 79%

“…Based on the curvilinear left ventricular pressure-volume relationship at end-diastole, volumes may increase more than pressures with fluid loading at low cardiac filling, while at higher cardiac filling, pressures may increase more than volumes [5]. At low cardiac filling, volumes may thus better predict fluid responsiveness than pressures, while in hearts with systolic dysfunction and dilatation, pressures may better predict and monitor fluid responsiveness than volumes [5,22]. …”

Section: Introductionmentioning

confidence: 99%

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Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

et al. 2011

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IntroductionStatic cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation. We evaluated the relative value of cardiac filling volume and pressures for predicting and monitoring fluid responsiveness, according to systolic cardiac function, estimated by global ejection fraction (GEF, normal 25 to 35%) from transpulmonary thermodilution.MethodsWe studied hypovolemic, mechanically ventilated patients after coronary (n = 18) or major vascular (n = 14) surgery in the intensive care unit. We evaluated 96 colloid fluid loading events (200 to 600 mL given in three consecutive 30-minute intervals, guided by increases in filling pressures), divided into groups of responding events (fluid responsiveness) and non-responding events, in patients with low GEF (<20%) or near-normal GEF (≥20%). Patients were monitored by transpulmonary dilution and central venous (n = 9)/pulmonary artery (n = 23) catheters to obtain cardiac index (CI), global end-diastolic volume index (GEDVI), central venous (CVP) and pulmonary artery occlusion pressure (PAOP).ResultsFluid responsiveness occurred in 8 (≥15% increase in CI) and 17 (≥10% increase in CI) of 36 fluid loading events when GEF was <20%, and 7 (≥15% increase in CI) and 17 (≥10% increase in CI) of 60 fluid loading events when GEF was ≥20%. Whereas a low baseline GEDVI predicted fluid responsiveness particularly when GEF was ≥20% (P = 0.002 or lower), a low PAOP was of predictive value particularly when GEF was <20% (P = 0.004 or lower). The baseline CVP was lower in responding events regardless of GEF. Changes in CVP and PAOP paralleled changes in CI particularly when GEF was <20%, whereas changes in GEDVI paralleled CI regardless of GEF.ConclusionsRegardless of GEF, CVP may be useful for predicting fluid responsiveness in patients after coronary and major vascular surgery provided that positive end-expiratory pressure is low. When GEF is low (<20%), PAOP is more useful than GEDVI for predicting fluid responsiveness, but when GEF is near-normal (≥20%) GEDVI is more useful than PAOP. This favors predicting and monitoring fluid responsiveness by pulmonary artery catheter-derived filling pressures in surgical patients with systolic left ventricular dysfunction and by transpulmonary thermodilution-derived GEDVI when systolic left ventricular function is relatively normal.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

et al. 2011

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“…La ETE puede cuantifi car el volumen ventricular y medir débito cardiaco. Como se observó en este caso, existe buena correlación con la termodilución [11][12][13][14] . Esto, sin embargo, requiere un operador entrenado.…”

Section: Discussionunclassified

Casos clínicos: ecocardiografía transesofágica y monitorización hemodinámica en cirugía no cardiaca

2011

Rev. méd. Chile

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“…[19][20][21] TEE has been shown to be an appropriate means to estimate cardiovascular hemodynamics including atrial pressure, ventricular filling and cardiac output. [22][23][24][25][26][27] TEE is also a sensitive indicator of myocardial ischemia and is advocated for the routine monitoring of high risk cardiac surgery patients. 28,29 In one small study in critically ill patients with unexplained hypotension TEE diagnostic variables were shown to predict mortality.…”

Section: Objectifmentioning

confidence: 99%

Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care

Sawchuk

Wong

Kavanagh

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the hypothesis that transthoracic echocardiographic findings predict mortality in critically ill patients.M Me et th ho od ds s: : A retrospective analysis of concurrently collected data for consecutive patients from May 1996 to May 1998 who had transthoracic echocardiography on or within six months of admission to the medical surgical intensive care (MSICU). We examined the role of physiologic, clinical, and echocardiography variables in predicting the mortality of patients admitted to the MSICU. Three logistic regression models were developed: 1) clinical; 2) echocardiographic; and 3) combined clinical with echocardiographic. Univariate and multivariate analyses were performed and the relative strength of clinical and echocardiographic predictors was compared using odds ratio (OR) and receiver-operator-characteristic (ROC).

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Echocardiographic and Hemodynamic Indexes of Left Ventricular Preload in Patients with Normal and Abnormal Ventricular Function

Cited by 286 publications

References 0 publications

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

Casos clínicos: ecocardiografía transesofágica y monitorización hemodinámica en cirugía no cardiaca

Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care

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