Nguyen Maxime, Berhoud Vivien, Bartamian Loïc, Martin Audrey, Ellouze Omar, Bouhemad Bélaïd, Guinot Pierre-Grégoire
Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France.
Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.
J Clin Monit Comput. 2020 Oct;34(5):893-901. doi: 10.1007/s10877-019-00397-7. Epub 2019 Oct 10.
Ventricular-arterial coupling is calculated as the arterial elastance to end systolic elastance ratio (E/Ees). Although the gold standard is invasive pressure volume loop analysis, Chen method is the clinical reference non-invasive method for estimating end systolic elastance (Ees). Several simplified methods calculate Ees from the end systolic pressure to volume ratio (ESP/ESV). The objective of the present study was to determine whether ESP/ESV simplification can be used instead of the Chen formula to measure ventricular-arterial coupling and to monitor changes following therapeutic intervention. In this retrospective, single-center study, 3 non-invasive E/Ees calculation methods were applied to 86 cardiac ICU patients. The Chen method was used as the reference method. Ees was also calculated according to method 1: Ees = 0.9 × SAP/ESV and method 2: Ees= E/(1/LVEF) - 1. E was estimated as 0.9 × SAP/SV (mmHg ml). After simplification: E/Ees1 = E/Ees2 = (1/LVEF) - 1, with the stroke volume estimated as the product of the aortic velocity-time integral (VTIAo) and the aortic area or as the difference between the end diastolic volume (EDV) and the ESV. All patients received fluid infusion, norepinephrine, or dobutamine. At baseline, the concordance correlation coefficient with E/Ees was 0.13 [- 0.07; 0.31] for E/Ees and 0.32 [0.19; 0.44] for E/Ees. Bias and limit of agreement were 0.28 [- 0.02; 0.36] and [- 5.8; 2.6] for E/Ees and of 0.44 [0.31; 0.53] and [- 3.2; 2.6] for E/Ees. When used to follow variations in E/Ees following therapeutic interventions, only 65% (for E/Ees) and 70% (for E/Ees) of measures followed the same trend as E/Ees. Our results do not support the use of ESP/ESV based method as substitute for Chen method to measure and assess changes in ventriculo-arterial coupling (E/Ees) in cardiac intensive care patients. Further investigations are needed to establish the most reliable non-invasive method.
心室 - 动脉耦合通过动脉弹性与收缩末期弹性比值（E/Ees）来计算。虽然金标准是有创压力 - 容积环分析，但陈方法是用于估计收缩末期弹性（Ees）的临床参考无创方法。有几种简化方法可根据收缩末期压力与容积比值（ESP/ESV）来计算Ees。本研究的目的是确定ESP/ESV简化方法是否可替代陈公式用于测量心室 - 动脉耦合并监测治疗干预后的变化。在这项回顾性单中心研究中，对86例心脏重症监护病房患者应用了3种无创E/Ees计算方法。以陈方法作为参考方法。Ees还根据方法1计算：Ees = 0.9×收缩压/ESV，以及方法2计算：Ees = E/(1/左心室射血分数) - 1。E估计为0.9×收缩压/每搏输出量（mmHg/ml）。简化后：E/Ees1 = E/Ees2 = (1/左心室射血分数) - 1，每搏输出量估计为主动脉速度 - 时间积分（VTIAo）与主动脉面积的乘积，或舒张末期容积（EDV）与ESV之差。所有患者均接受了液体输注、去甲肾上腺素或多巴酚丁胺治疗。基线时，E/Ees与E/Ees的一致性相关系数为0.13 [-0.07; 0.31]，E/Ees与E/Ees的一致性相关系数为0.32 [0.19; 0.44]。E/Ees的偏差和一致性界限为0.28 [-0.02; 0.36]和[-5.8; 2.6]，E/Ees的偏差和一致性界限为0.44 [0.31; 0.53]和[-3.2; 2.6]。当用于跟踪治疗干预后E/Ees的变化时，只有65%（对于E/Ees）和70%（对于E/Ees）的测量结果与E/Ees遵循相同趋势。我们的结果不支持使用基于ESP/ESV的方法替代陈方法来测量和评估心脏重症监护患者心室 - 动脉耦合（E/Ees）的变化。需要进一步研究以确定最可靠的无创方法。
