Department of Anaesthesiology, Institution of Clinical Sciences, Entrance 42, Skåne University Hospital, Lund University, Södra Förstadsgatan 101, S-20502 Malmö, Sweden.
Crit Care. 2011 Aug 16;15(4):R200. doi: 10.1186/cc10368.
Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).
Fifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI).
EBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively).
EBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.
在危重病患者中，快速而可靠地评估左心室（LV）收缩功能可能具有挑战性。本研究的目的是通过连续经胸超声心动图（TTE）评估常用的 LV 收缩功能参数的可行性、可靠性和相关性。
纳入 50 例休克和机械通气的患者。TTE 检查每天进行一次，共进行 7 天。评估 LV 收缩功能的方法包括目测估计、“眼球”射血分数（EBEF）、辛普森单平面法、房室平面位移平均值（AVPDm）、室间隔组织速度成像（TDIs）和左心室流出道速度时间积分（VTI）。
EBEF、AVPDm、TDIs、VTI 和辛普森分别在所有可能检查中的 100%、100%、99%、95%和 93%中获得。辛普森与 EBEF 的相关性在所有 7 天的 r 值范围为 0.79 至 0.95（P < 0.01）。辛普森与其他 LV 参数的相关性随时间变化较大，TDIs 和 AVPDm 的结果最差。VTI 的重复性最好（观察者间变异系数（CV）为 4.8%，观察者内 CV 为 3.1%），AVPDm 的重复性最好（分别为 5.3%和 4.4%），辛普森方法的重复性最差（分别为 8.2%和 10.6%）。
在机械通气、血流动力学不稳定的患者人群中评估 LV 收缩功能时，EBEF 和 AVPDm 的可行性最佳，而辛普森法的可行性最差。此外，辛普森法的重复性最差。我们建议，在评估此类患者的 LV 射血分数时，可以用 EBEF 代替单平面辛普森法。TDIs 和 AVPDm 作为 LV 纵向功能的标志物，与 LV 射血分数不能互换。
