Albers Jörg, Ister Dilek, Kayhan Nalan, Vahl Christian F
Department of Cardiothoracic and Vascular Surgery, University of Mainz, Langenbeckstr 1, 55131 Mainz, Germany.
Interact Cardiovasc Thorac Surg. 2011 Dec;13(6):579-84. doi: 10.1510/icvts.2011.271619. Epub 2011 Jul 5.
Non-invasive monitoring of pulmonary vascular resistance (PVR) in postoperative cardiac surgery patients might be useful, particularly for management of pulmonary hypertension. For this purpose, we sought to assess Doppler echocardiography in the intensive care setting. In 73 patients, hemodynamics was measured using both, invasive gold standard (pulmonary artery catheter), and non-invasively by Doppler echocardiography. Four Doppler parameters: (1) tricuspid regurgitant velocity/time-velocity-integral of right ventricular outflow tract (TRV/VTI(RVOT)), (2) tricuspid annular systolic velocity (S'), (3) tricuspid annular strain, and (4) tricuspid annular strain rate, were compared with invasive PVR, using linear regression analysis and receiver-operating-characteristics. Patients without (n = 25, group 1) and patients with elevated left ventricular filling pressure (wedge pressure ≥ 15 mmHg, group 2, n = 48) were compared. Correlations were (1) R = 0.874, P < 0.0001, (2) R = -0.765, P < 0.0001, (3) R = 0.279, P = 0.009, (4) R = 0.378, P = 0.001. TRV/VTI(RVOT) showed prediction of PVR >300 dyns/cm(5) (area-under-curve 0.975, cut-off 0.245, sensitivity 100%, specificity 91%). Strain correlated with PVR in group 2 patients only. TRV/VTI(RVOT) and tricuspid annular systolic velocity (S'), are useful for non-invasive monitoring of PVR in postoperative cardiac surgery patients with or without elevated left ventricular filling pressure. Strain may be used in patients with elevated filling pressure.
对心脏手术后患者进行肺血管阻力（PVR）的无创监测可能会有帮助，特别是对于肺动脉高压的管理。为此，我们试图在重症监护环境中评估多普勒超声心动图。在73例患者中，使用侵入性金标准（肺动脉导管）和多普勒超声心动图进行无创血流动力学测量。将四个多普勒参数：（1）三尖瓣反流速度/右心室流出道时间速度积分（TRV/VTI(RVOT)）、（2）三尖瓣环收缩速度（S'）、（3）三尖瓣环应变和（4）三尖瓣环应变率，与侵入性PVR进行比较，采用线性回归分析和受试者工作特征分析。比较了无左心室充盈压升高的患者（n = 25，第1组）和左心室充盈压升高（楔压≥15 mmHg，第2组，n = 48）的患者。相关性分别为：（1）R = 0.874，P < 0.0001；（2）R = -0.765，P < 0.0001；（3）R = 0.279，P = 0.009；（4）R = 0.378，P = 0.001。TRV/VTI(RVOT)显示对PVR>300 dyns/cm(5)有预测作用（曲线下面积0.975，截断值0.245，敏感性100%，特异性91%）。应变仅在第2组患者中与PVR相关。TRV/VTI(RVOT)和三尖瓣环收缩速度（S'），对于左心室充盈压升高或未升高的心脏手术后患者的PVR无创监测有用。应变可用于充盈压升高的患者。
