Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, C/ Circunvalación, s/n, 11407, Jerez de la Frontera, Spain.
Edwards Lifesciences, Irvine, CA, USA.
J Clin Monit Comput. 2019 Oct;33(5):803-813. doi: 10.1007/s10877-018-0236-y. Epub 2018 Dec 14.
To compare the effective arterial elastance (Ea) obtained from the arterial pressure with Ea calculated from left-ventricular (LV) pressure-volume analysis. Experimental study. LV pressure-volume data was obtained with a conductance catheter and arterial pressures were measured via a fluid-filled catheter placed in the proximal aorta, femoral and radial arteries. Ea was calculated as LV end-systolic pressure (ESP)/stroke volume (SV). Experimental protocol consisted sequentially changing afterload (phenylephrine/nitroprusside), preload (bleeding/fluid), and contractility (esmolol/dobutamine). 90% of systolic pressure (Ea_SYS, Ea_SYS, Ea_SYS), mean arterial pressure (Ea_MAP, Ea_MAP, Ea_MAP), and dicrotic notch pressure (Ea_DIC, Ea_DIC, Ea_DIC) were used as surrogates for LV ESP. SV was calculated from the LV pressure-volume data. When Ea was compared with estimations based on 90% SAP, the relationship was r = 0.95, 0.94 and 0.92; and the bias and limits of agreement (LOA): - 0.01 ± 0.12, - 0.09 ± 0.12, - 0.05 ± 0.15 mmHg ml, for Ea_SYS, Ea_SYS and Ea_SYS, respectively. For estimates using dicrotic notch, the relationship was r = 0.94, 0.95 and 0.94 for Ea_DIC, Ea_DIC and Ea_DIC, respectively; with a bias and LOA: 0.05 ± 0.11, 0.06 ± 0.12, 0.10 ± 0.12 mmHg ml, respectively. When Ea was compared with estimates using MAP, the relationship was r = 0.95, 0.96 and 0.95 for Ea_MAP, Ea_MAP and Ea_MAP, respectively; with a bias and LOA: 0.05 ± 0.11, 0.06 ± 0.11, 0.06 ± 0.11 mmHg ml, respectively. LV ESP can be estimated from the arterial pressure. Provided that the SV measurement is reliable, the ratio MAP/SV provides a robust Ea surrogate over a wide range of hemodynamic conditions and is interchangeably in any peripheral artery, so it should be recommended as an arterial estimate of Ea in further research.
比较通过动脉压力获得的有效动脉弹性(Ea)与通过左心室(LV)压力-容积分析计算的 Ea。实验研究。通过传导导管获得 LV 压力-容积数据，并通过放置在升主动脉、股动脉和桡动脉近端的充满液体的导管测量动脉压力。Ea 计算为 LV 收缩末期压力(ESP)/每搏量(SV)。实验方案依次改变后负荷(苯肾上腺素/硝普钠)、前负荷(放血/补液)和收缩性(艾司洛尔/多巴酚丁胺)。90%的收缩压(Ea_SYS、Ea_SYS、Ea_SYS)、平均动脉压(Ea_MAP、Ea_MAP、Ea_MAP)和双尖波切迹压(Ea_DIC、Ea_DIC、Ea_DIC)用作 LV ESP 的替代指标。SV 从 LV 压力-容积数据中计算得出。当将 Ea 与基于 90%SAP 的估计值进行比较时，关系分别为 r=0.95、0.94 和 0.92；以及偏差和一致性限(LOA)：-0.01±0.12、-0.09±0.12、-0.05±0.15mmHgml，用于 Ea_SYS、Ea_SYS 和 Ea_SYS，分别。对于使用双尖波切迹的估计值，关系分别为 r=0.94、0.95 和 0.94，用于 Ea_DIC、Ea_DIC 和 Ea_DIC；具有偏差和 LOA：0.05±0.11、0.06±0.12、0.10±0.12mmHgml，分别。当将 Ea 与 MAP 估计值进行比较时，关系分别为 r=0.95、0.96 和 0.95，用于 Ea_MAP、Ea_MAP 和 Ea_MAP；具有偏差和 LOA：0.05±0.11、0.06±0.11、0.06±0.11mmHgml，分别。可以从动脉压力估算 LV ESP。只要 SV 测量可靠，MAP/SV 的比值在广泛的血流动力学条件下提供了一个稳健的 Ea 替代物，并且可以在任何外周动脉中互换使用，因此应该作为进一步研究中 Ea 的动脉估计值推荐。
