Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, C/ Circunvalación, s/n, 11407, Jerez de la Frontera, Spain.
Edwards Lifesciences, Irvine, California, USA.
Crit Care. 2018 Nov 29;22(1):325. doi: 10.1186/s13054-018-2260-1.
Maximal left ventricular (LV) pressure rise (LV dP/dt), a classical marker of LV systolic function, requires LV catheterization, thus surrogate arterial pressure waveform measures have been proposed. We compared LV and arterial (femoral and radial) dP/dt to the slope of the LV end-systolic pressure-volume relationship (Ees), a load-independent measure of LV contractility, to determine the interactions between dP/dt and Ees as loading and LV contractility varied.
We measured LV pressure-volume data using a conductance catheter and femoral and radial arterial pressures using a fluid-filled catheter in 10 anesthetized pigs. Ees was calculated as the slope of the end-systolic pressure-volume relationship during a transient inferior vena cava occlusion. Afterload was assessed by the effective arterial elastance. The experimental protocol consisted of sequentially changing afterload (phenylephrine/nitroprusside), preload (bleeding/fluid bolus), and contractility (esmolol/dobutamine). A linear-mixed analysis was used to assess the contribution of cardiac (Ees, end-diastolic volume, effective arterial elastance, heart rate, preload-dependency) and arterial factors (total vascular resistance and arterial compliance) to LV and arterial dP/dt.
Both LV and arterial dP/dt allowed the tracking of Ees changes, especially during afterload and contractility changes, although arterial dP/dt was lower compared to LV dP/dt (bias 732 ± 539 mmHg⋅s for femoral dP/dt, and 625 ± 501 mmHg⋅s for radial dP/dt). Changes in cardiac contractility (Ees) were the main determinant of LV and arterial dP/dt changes.
Although arterial dP/dt is a complex function of central and peripheral arterial factors, radial and particularly femoral dP/dt allowed reasonably good tracking of LV contractility changes as loading and inotropic conditions varied.
左心室（LV）最大压力上升（LV dP/dt）是 LV 收缩功能的经典标志物，需要进行 LV 导管插入术，因此提出了替代的动脉压力波形测量方法。我们比较了 LV 和动脉（股动脉和桡动脉）dP/dt 与 LV 收缩末期压力-容积关系（Ees）的斜率，Ees 是一种独立于负荷的 LV 收缩力的测量指标，以确定在 LV 前负荷和收缩力变化时 dP/dt 和 Ees 之间的相互作用。
我们使用传导导管测量了 10 只麻醉猪的 LV 压力-容积数据，并使用充满液体的导管测量了股动脉和桡动脉压力。Ees 通过短暂的下腔静脉闭塞计算得出收缩末期压力-容积关系的斜率。后负荷由有效动脉弹性评估。实验方案包括顺序改变后负荷（去氧肾上腺素/硝普钠）、前负荷（放血/输液）和收缩力（艾司洛尔/多巴酚丁胺）。线性混合分析用于评估心脏因素（Ees、舒张末期容积、有效动脉弹性、心率、前负荷依赖性）和动脉因素（总血管阻力和动脉顺应性）对 LV 和动脉 dP/dt 的贡献。
LV 和动脉 dP/dt 均允许跟踪 Ees 的变化，尤其是在后负荷和收缩力变化期间，尽管动脉 dP/dt 低于 LV dP/dt（股动脉 dP/dt 的偏差为 732 ± 539 mmHg·s，桡动脉 dP/dt 的偏差为 625 ± 501 mmHg·s）。心脏收缩力（Ees）的变化是 LV 和动脉 dP/dt 变化的主要决定因素。
尽管动脉 dP/dt 是中心和外周动脉因素的复杂函数，但桡动脉和特别是股动脉 dP/dt 允许在负荷和变力条件变化时对 LV 收缩力变化进行合理的良好跟踪。
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