Martina Jerson R, Westerhof Berend E, de Jonge Nicolaas, van Goudoever Jeroen, Westers Paul, Chamuleau Steven, van Dijk Diederik, Rodermans Ben F M, de Mol Bas A J M, Lahpor Jaap R
From the *Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; †Laboratory for Clinical Cardiovascular Physiology, AMC Center for Heart Failure Research, Amsterdam, The Netherlands; ‡BMEYE BV, Amsterdam, The Netherlands; §Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; ¶Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands; ‖Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands; #Department of Medical Technology, University Medical Center Utrecht, Utrecht, The Netherlands; **Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
ASAIO J. 2014 Mar-Apr;60(2):154-61. doi: 10.1097/MAT.0000000000000033.
Arterial blood pressure and echocardiography may provide useful physiological information regarding cardiac support in patients with continuous-flow left ventricular assist devices (cf-LVADs). We investigated the accuracy and characteristics of noninvasive blood pressure during cf-LVAD support. Noninvasive arterial pressure waveforms were recorded with Nexfin (BMEYE, Amsterdam, The Netherlands). First, these measurements were validated simultaneously with invasive arterial pressures in 29 intensive care unit patients. Next, the association between blood pressure responses and measures derived by echocardiography, including left ventricular end-diastolic dimensions (LVEDDs), left ventricular end-systolic dimensions (LVESDs), and left ventricular shortening fraction (LVSF) were determined during pump speed change procedures in 30 outpatients. Noninvasive arterial blood pressure waveforms by the Nexfin monitor slightly underestimated invasive measures during cf-LVAD support. Differences between noninvasive and invasive measures (mean ± SD) of systolic, diastolic, mean, and pulse pressures were -7.6 ± 5.8, -7.0 ± 5.2, -6.9 ± 5.1, and -0.6 ± 4.5 mm Hg, respectively (all <10%). These blood pressure responses did not correlate with LVEDD, LVESD, or LVSF, while LVSF correlated weakly with both pulse pressure (r = 0.24; p = 0.005) and (dP(art)/dt)max (r = 0.25; p = 0.004). The dicrotic notch in the pressure waveform was a better predictor of aortic valve opening (area under the curve [AUC] = 0.87) than pulse pressure (AUC = 0.64) and (dP(art)/dt)max (AUC = 0.61). Patients with partial support rather than full support at 9,000 rpm had a significant change in systolic pressure, pulse pressure, and (dP(art)/dt)max during ramp studies, while echocardiographic measures did not change. Blood pressure measurements by Nexfin were reliable and may thereby act as a compliment to the assessment of the cf-LVAD patient.
动脉血压和超声心动图检查可为使用连续血流左心室辅助装置（cf-LVAD）的患者提供有关心脏支持的有用生理信息。我们研究了cf-LVAD支持期间无创血压的准确性和特征。使用Nexfin（荷兰阿姆斯特丹BMEYE公司）记录无创动脉压波形。首先，在29例重症监护病房患者中，将这些测量结果与有创动脉压同时进行验证。接下来，在30例门诊患者的泵速变化过程中，确定血压反应与超声心动图测量指标之间的关联，这些指标包括左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）和左心室缩短分数（LVSF）。在cf-LVAD支持期间，Nexfin监测仪测得的无创动脉血压波形略低于有创测量值。收缩压、舒张压、平均压和脉压的无创与有创测量值之差（均值±标准差）分别为-7.6±5.8、-7.0±5.2、-6.9±5.1和-0.6±4.5 mmHg（均<10%）。这些血压反应与LVEDD、LVESD或LVSF均无相关性，而LVSF与脉压（r = 0.24；p = 0.005）和（dP(art)/dt）max（r = 0.25；p = 0.004）均呈弱相关。压力波形中的重搏波切迹比脉压（曲线下面积[AUC]=0.64）和（dP(art)/dt）max（AUC = 0.61）更能预测主动脉瓣开放（AUC = 0.87）。在转速为9000转/分钟时接受部分支持而非完全支持的患者，在斜坡研究期间收缩压、脉压和（dP(art)/dt）max有显著变化，而超声心动图测量指标未改变。Nexfin进行的血压测量是可靠的，因此可作为对cf-LVAD患者评估的补充。
