From the Clario CV imaging and Cardiac Safety, Philadelphia, PA.
Denver Health Medical Center, Denver, CO.
Crit Pathw Cardiol. 2022 Jun 1;21(2):93-95. doi: 10.1097/HPC.0000000000000288. Epub 2022 Apr 14.
Ascertainment of the left ventricular ejection fraction is the primary reason for ordering echocardiography in the acute care setting; however, this parameter does not provide information regarding a patient's volume status. As such, it cannot be reliably used to inform decisions regarding intravenous fluid resuscitation or diuresis, particularly in undifferentiated dyspnea and hypotension. This is relevant given a national quality improvement exhortation to provide aggressive fluid resuscitation as part of a "sepsis bundle." This initiative must be tempered by the well-established increase in hospital mortality from providing intravenous fluid to patients with unrecognized heart failure, which may occur if sepsis is misdiagnosed. We describe herein, what is to our knowledge, the first description of a critically elevated Doppler ratio of mitral inflow peak E-wave velocity to the mean mitral annular velocity as a harbinger of sudden death from pulmonary edema in a patient treated with aggressive intravenous fluids as part of the "sepsis bundle." This is utilized as a springboard for proposing a clinical algorithm focused on expedited echocardiography. It emphasized the potential value of advancing markedly the diastolic assessment of filling pressure (ratio of mitral inflow peak E-wave velocity to the mean mitral annular velocity) in the acute care setting to a level of import comparable to the left ventricular ejection fraction.
确定左心室射血分数是在急性护理环境中下令进行超声心动图的主要原因；然而，该参数不能提供有关患者容量状态的信息。因此，它不能可靠地用于告知关于静脉补液复苏或利尿的决策，特别是在未分化的呼吸困难和低血压情况下。鉴于国家质量改进的强烈要求，提供积极的液体复苏作为“脓毒症包”的一部分，这一点很重要。如果脓毒症被误诊，那么为未被识别的心力衰竭患者提供静脉输液会增加医院死亡率，这一事实必须要加以考虑。在此，我们描述了据我们所知，首例患者接受积极静脉补液治疗作为“脓毒症包”的一部分，多普勒比值显著升高，即二尖瓣口血流速度峰值 E 波与二尖瓣环速度的平均比值，预示肺水肿导致猝死的情况。这为提出一种专注于加速超声心动图的临床算法提供了一个契机。它强调了在急性护理环境中，将充盈压的舒张评估（二尖瓣口血流速度峰值 E 波与二尖瓣环速度的平均比值）显著推进到与左心室射血分数相当的重要程度的潜在价值。
