Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 150 00, Prague, Czech Republic.
Crit Care. 2019 Nov 21;23(1):364. doi: 10.1186/s13054-019-2654-8.
Continuous, reliable evaluation of left ventricular (LV) contractile function in patients with advanced heart failure requiring intensive care remains challenging. Continual monitoring of dP/dt from the arterial line has recently become available in hemodynamic monitoring. However, the relationship between arterial dP/dt and LV dP/dt remains unclear. This study aimed to determine the relationship between arterial dP/dt and LV dP/dt assessed using echocardiography in patients with acute heart failure.
Forty-eight patients (mean age 70.4 years [65% male]) with acute heart failure requiring intensive care and hemodynamic monitoring were recruited. Hemodynamic variables, including arterial dP/dt, were continually monitored using arterial line pressure waveform analysis. LV dP/dt was assessed using continuous-wave Doppler analysis of mitral regurgitation flow.
Values from continual arterial dP/dt monitoring were significantly correlated with LV dP/dt assessed using echocardiography (r = 0.70 [95% confidence interval (CI) 0.51-0.82]; P < 0.0001). Linear regression analysis revealed that LV dP/dt = 1.25 × (arterial dP/dt) (P < 0.0001). Arterial dP/dt was also significantly correlated with stroke volume (SV) (r = 0.63; P < 0.0001) and cardiac output (CO) (r = 0.42; P = 0.0289). In contrast, arterial dP/dt was not correlated with SV variation, dynamic arterial elastance, heart rate, systemic vascular resistance (SVR), or mean arterial pressure. Markedly stronger agreement between arterial and LV dP/dt was observed in subgroups with higher SVR (N = 28; r = 0.91; P < 0.0001), lower CO (N = 26; r = 0.81; P < 0.0001), and lower SV (N = 25; r = 0.60; P = 0.0014). A weak correlation was observed in the subjects with lower SVR (N = 20; r = 0.61; P = 0.0004); in the subgroups with higher CO (N = 22) and higher SV (N = 23), no significant correlation was found.
Our results suggest that in patients with acute heart failure requiring intensive care with an arterial line, continuous calculation of arterial dP/dt may be used for monitoring LV contractility, especially in those with higher SVR, lower CO, and lower SV, such as in patients experiencing cardiogenic shock. On the other hand, there was only a weak or no significant correlation in the subgroups with higher CO, higher SV, and lower SVR.
在需要重症监护的晚期心力衰竭患者中，持续、可靠地评估左心室（LV）收缩功能仍然具有挑战性。最近，在血流动力学监测中可以从动脉压线上连续监测 dP/dt。然而，动脉 dP/dt 与 LV dP/dt 之间的关系尚不清楚。本研究旨在确定急性心力衰竭患者中使用超声心动图评估的动脉 dP/dt 与 LV dP/dt 之间的关系。
招募了 48 名（平均年龄 70.4 岁[65%为男性]）需要重症监护和血流动力学监测的急性心力衰竭患者。使用动脉线压力波形分析连续监测血流动力学变量，包括动脉 dP/dt。使用二尖瓣反流流量的连续波多普勒分析评估 LV dP/dt。
持续动脉 dP/dt 监测的值与使用超声心动图评估的 LV dP/dt 显著相关（r=0.70[95%置信区间（CI）0.51-0.82]；P<0.0001）。线性回归分析显示 LV dP/dt=1.25×（动脉 dP/dt）（P<0.0001）。动脉 dP/dt 还与每搏量（SV）（r=0.63；P<0.0001）和心输出量（CO）（r=0.42；P=0.0289）显著相关。相比之下，动脉 dP/dt 与 SV 变化、动态动脉弹性、心率、全身血管阻力（SVR）或平均动脉压均无相关性。在 SVR 较高（N=28；r=0.91；P<0.0001）、CO 较低（N=26；r=0.81；P<0.0001）和 SV 较低（N=25；r=0.60；P=0.0014）的亚组中，动脉与 LV dP/dt 之间的一致性更强。在 SVR 较低（N=20；r=0.61；P=0.0004）的受试者中观察到较弱的相关性；在 CO 较高（N=22）和 SV 较高（N=23）的亚组中，未发现显著相关性。
我们的结果表明，在需要重症监护且有动脉线的急性心力衰竭患者中，连续计算动脉 dP/dt 可能用于监测 LV 收缩性，尤其是在 SVR 较高、CO 较低和 SV 较低的患者中，例如发生心源性休克的患者。另一方面，在 CO 较高、SV 较高和 SVR 较低的亚组中，相关性较弱或无显著相关性。
