Liang Huan, Vårtun Åse, Acharya Ganesh
Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Arch Gynecol Obstet. 2018 Jul;298(1):59-66. doi: 10.1007/s00404-018-4773-x. Epub 2018 Apr 5.
Accurate assessment of cardiac function is important during pregnancy. Echocardiography and impedance cardiography (ICG) are commonly used noninvasive methods to measure stroke volume (SV) and cardiac output (CO). The difference in stroke volume (ΔSV) or cardiac output (ΔCO) measured at baseline and after passive leg raising (PLR) is a measure of preload reserve that predicts volume responsiveness. However, the agreement between these two methods in measuring preload reserve during pregnancy is unclear. The aim of our study was to investigate the correlation and the agreement between Doppler echocardiography and ICG in assessing preload reserve in pregnant women.
In this prospective observational cross-sectional study, preload reserve was assessed by measuring the SV and CO during baseline and 90 s after PLR simultaneously by Doppler echocardiography and ICG in healthy pregnant women during the second and third trimesters. Bland-Altman analysis was used to determine the agreement between the two methods. Bias was calculated as the mean difference between two methods and precision as 1.96 SD of the difference.
A total of 53 pregnant women were included. We found a statistically significant correlation between ΔSV (R = 0.56, p < 0.0001) and ΔCO (R = 0.39, p = 0.004) measured by ICG and Doppler echocardiography. The mean bias for ΔSV was 2.52 ml, with a precision of 18.19 ml. The mean bias for ΔCO was 0.21 l/min, with a precision of 1.51 l/min.
There was a good agreement and a statistically significant correlation between ICG and Doppler echocardiography for measuring preload reserve.
孕期准确评估心功能很重要。超声心动图和阻抗心动图（ICG）是常用的非侵入性测量每搏输出量（SV）和心输出量（CO）的方法。基线时和被动抬腿（PLR）后测量的每搏输出量差异（ΔSV）或心输出量差异（ΔCO）是预测容量反应性的前负荷储备指标。然而，这两种方法在孕期测量前负荷储备时的一致性尚不清楚。我们研究的目的是探讨多普勒超声心动图和ICG在评估孕妇前负荷储备方面的相关性和一致性。
在这项前瞻性观察性横断面研究中，通过在妊娠中期和晚期对健康孕妇同时采用多普勒超声心动图和ICG测量基线时以及PLR后90秒的SV和CO来评估前负荷储备。采用Bland-Altman分析确定两种方法之间的一致性。偏差计算为两种方法之间的平均差异，精密度计算为差异的1.96倍标准差。
共纳入53名孕妇。我们发现ICG和多普勒超声心动图测量的ΔSV（R = 0.56，p < 0.0001）和ΔCO（R = 0.39，p = 0.004）之间存在统计学显著相关性。ΔSV的平均偏差为2.52 ml，精密度为18.19 ml。ΔCO的平均偏差为0.21 l/min，精密度为1.51 l/min。
ICG和多普勒超声心动图在测量前负荷储备方面具有良好的一致性和统计学显著相关性。
