Li Wenjuan, Peng Yongxuan, Li Zhihao, Huang Jihong
Department of Pediatric Cardiology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pediatric Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, China.
Interdiscip Cardiovasc Thorac Surg. 2023 Sep 2;37(3). doi: 10.1093/icvts/ivad064.
The aim of this study was to test the ability of ventriculo-arterial coupling (VAC) to predict cardiac index (CI) response after milrinone infusion.
This was a retrospective, observational study. We measured arterial blood pressure and echocardiography-derived variables, including CI, systemic vascular resistance index, arterial elastance (Ea) and end-systolic ventricular elastance before and after 18-24 h of milrinone infusion. VAC was calculated as the ratio of Ea to end-systolic elastance. Infants with over 15% increase in the CI were defined as CI responders. Logistical regression was used to evaluate predictors of CI responders.
We enrolled 92 infants who underwent cardiac surgery and received milrinone infusion, of whom 45 infants were CI responders. High VAC (odds ratio = 5.534, 95% confidence interval 2.339-13.090) and high Ea (odds ratio = 3.035, 95% confidence interval 1.459-6.310) were independently associated with cardiac index responders. Pre-milrinone VAC predicted CI responsiveness with a cut-off value of 1.12 (area under the curve = 0.900, 95% confidence interval 0.819-0.953, P < 0.0001). Furthermore, we observed a decrease in the infant's VAC, Ea and systemic vascular resistance index after milrinone infusion.
In infants with congenital heart disease after surgery, a pre-milrinone VAC >1.12 can predict the increase in the CI following milrinone infusion.
本研究旨在测试心室-动脉耦合（VAC）预测米力农输注后心脏指数（CI）反应的能力。
这是一项回顾性观察研究。我们在米力农输注18 - 24小时前后测量动脉血压和超声心动图衍生变量，包括CI、全身血管阻力指数、动脉弹性（Ea）和收缩末期心室弹性。VAC计算为Ea与收缩末期弹性的比值。CI增加超过15%的婴儿被定义为CI反应者。采用逻辑回归评估CI反应者的预测因素。
我们纳入了92例接受心脏手术并接受米力农输注的婴儿，其中45例为CI反应者。高VAC（比值比 = 5.534，95%置信区间2.339 - 13.090）和高Ea（比值比 = 3.035，95%置信区间1.459 - 6.310）与心脏指数反应者独立相关。米力农输注前的VAC预测CI反应性，截断值为1.12（曲线下面积 = 0.900，95%置信区间0.819 - 0.953，P < 0.0001）。此外，我们观察到米力农输注后婴儿的VAC、Ea和全身血管阻力指数下降。
在先天性心脏病术后婴儿中，米力农输注前VAC >1.12可预测米力农输注后CI的增加。
