一种用于估计重症监护病房心脏指数的简化超声心动图公式。

A simplified echocardiographic formula to estimate cardiac index in the intensive care unit.

作者信息

Gaspardone Carlo, Romagnolo Davide, Baldetti Luca, Fasolino Alessandro, Peveri Beatrice, Calvo Francesco, Gramegna Mario, Pazzanese Vittorio, Sacchi Stefania, Beneduce Alessandro, Falasconi Giulio, Fiore Giorgio, Rampa Lorenzo, Ajello Silvia, Scandroglio Anna Mara

机构信息

Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.

出版信息

Int J Cardiol. 2023 Feb 1;372:76-79. doi: 10.1016/j.ijcard.2022.12.010. Epub 2022 Dec 7.

DOI:10.1016/j.ijcard.2022.12.010

PMID:36496041

Abstract

BACKGROUND AND AIM

Measurement of cardiac index (CI) is crucial in the hemodynamic assessment of critically ill patients in the intensive care unit (ICU). The most reliable trans-thoracic echocardiography (TTE) technique for CI estimation is the left ventricular outflow tract (LVOT) Doppler method that requires, among other parameters, the LVOT cross-sectional area (CSA) measurement. However, inherent and practical disadvantages, mostly related to the ICU setting, hamper LVOT-CSA assessment. In this study, we aimed to validate a simplified formula, leveraging on LVOT-velocity time integral (VTI) and heart rate (HR) only, for non-invasive estimation of CI in ICU patients.

METHODS AND RESULTS

We prospectively enrolled 50 consecutive patients admitted to our ICU requiring pulmonary artery catheterization (PAC) over a one-year period. For each patient we measured the CI by PAC (CI) and TTE. The latter was obtained both with the "traditional formula" (traditional CI), requiring LVOT-CSA assessment, and our new "simplified formula" (simplified CI). The correlation between the simplified CI and CI was strong (r = 0.81) and resulted significantly greater than the traditional CI and CI correlation (r = 0.70; p < 0.05 for Pearson r coefficients comparison). Both TTE-based CI showed an acceptable agreement (+0.19 ± 0.48 L/min/m for simplified CI and - 0.18 ± 0.58 L/min/m for traditional CI) with the reference CI.

CONCLUSION

In this study, we validated a practical approach, leveraging on TTE LVOT-VTI and HR only, for non-invasive estimation of CI in ICU patients.

摘要

背景与目的

在重症监护病房（ICU）对危重症患者进行血流动力学评估时，测量心脏指数（CI）至关重要。估算CI最可靠的经胸超声心动图（TTE）技术是左心室流出道（LVOT）多普勒法，该方法除其他参数外，还需要测量LVOT横截面积（CSA）。然而，主要与ICU环境相关的固有和实际缺点阻碍了LVOT-CSA评估。在本研究中，我们旨在验证一个仅利用LVOT速度时间积分（VTI）和心率（HR）的简化公式，用于ICU患者CI的无创估算。

方法与结果

我们前瞻性地纳入了连续50例在一年期间入住我院ICU且需要进行肺动脉导管插入术（PAC）的患者。对于每位患者，我们通过PAC测量CI（CI）以及通过TTE测量CI。后者通过需要评估LVOT-CSA的“传统公式”（传统CI）和我们新的“简化公式”（简化CI）获得。简化CI与CI之间的相关性很强（r = 0.81），且显著大于传统CI与CI之间的相关性（r = 0.70；Pearson r系数比较，p < 0.05）。两种基于TTE的CI与参考CI均显示出可接受的一致性（简化CI为+0.19±0.48 L/min/m²，传统CI为 - 0.18±0.58 L/min/m²）。