经胸超声心动图和经食管多普勒与肺动脉热稀释法在麻醉猫中心输出量估计的相关性、一致性和符合率。
Correlation, agreement and concordance of cardiac output estimated by transthoracic ultrasound and transesophageal Doppler with pulmonary artery thermodilution in anesthetized cats.
机构信息
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA.
Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA; Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
出版信息
Vet Anaesth Analg. 2024 Nov-Dec;51(6):641-649. doi: 10.1016/j.vaa.2024.08.006. Epub 2024 Aug 14.
OBJECTIVE
To characterize the correlation, agreement and concordance of cardiac output (CO) measured with transthoracic ultrasound and the correlation and concordance of aortic blood flow (ABF) minute distance (MD) measured by transesophageal Doppler with CO measured by pulmonary artery thermodilution (PATD) in cats.
STUDY DESIGN
Experimental study.
ANIMALS
A group of six healthy male neutered cats, aged 2-8 years and weighing 5.3 ± 0.3 kg.
METHODS
Cats were anesthetized with isoflurane in oxygen. CO was measured by PATD (CO) and transthoracic echocardiography (CO). ABF MD was measured using an esophageal Doppler flow probe aligned with descending ABF. All measurements were made under three conditions: dexmedetomidine (20 μg kg) intravenously; atipamezole (200 μg kg) intramuscularly and atropine (20 μg kg) intravenously as needed to achieve a minimum heart rate of 140 beats minute; and dopamine (20 μg kg minute) intravenously in that order. Correlation between CO and CO, and CO and Doppler MD was evaluated using repeated measures correlation. Agreement between CO and CO was evaluated using Bland-Altman method. Differences between consecutive pairs of CO measurements were calculated for concordance analysis.
RESULTS
Correlation between CO and CO and between CO and MD was significant (p < 0.001), with correlation coefficients greater than 0.92. A bias of > 27% and upper limits of agreement of 66% were found between CO and CO. Concordance rate with CO was 76-80% for CO and 72% for MD.
CONCLUSIONS AND CLINICAL RELEVANCE
Echocardiographic methods for the measurement of CO showed poor agreement and concordance with PATD. MD showed poor concordance with PATD. As such, these methods cannot be used as an alternative to PATD nor can they appropriately track changes in CO in anesthetized cats.
目的
描述经胸超声心动图测量心输出量（CO）与经食管多普勒测量主动脉血流（ABF）分钟距离（MD）与肺动脉热稀释法（PATD）测量 CO 的相关性、一致性和符合率。
研究设计
实验研究。
动物
一组 6 只健康雄性去势猫，年龄 2-8 岁，体重 5.3 ± 0.3kg。
方法
猫在氧气中用异氟烷麻醉。CO 通过 PATD（CO）和经胸超声心动图（CO）进行测量。ABF MD 使用与 ABF 下降方向对齐的食管多普勒流量探头进行测量。所有测量均在三种情况下进行：静脉注射右美托咪定（20μg/kg）；肌肉注射阿替美唑（200μg/kg），必要时静脉注射阿托品（20μg/kg），以达到最低心率 140 次/分钟；顺序静脉注射多巴胺（20μg/kg·min）。使用重复测量相关评估 CO 与 CO 之间以及 CO 与多普勒 MD 之间的相关性。使用 Bland-Altman 方法评估 CO 与 CO 之间的一致性。为了进行一致性分析，计算了 CO 与 CO 之间连续对之间的差异。
结果
CO 与 CO 之间以及 CO 与 MD 之间的相关性显著（p<0.001），相关系数大于 0.92。CO 与 CO 之间存在>27%的偏倚和 66%的上下限一致性。CO 与 CO 的一致性率为 76-80%，MD 为 72%。
结论和临床相关性
超声心动图方法测量 CO 与 PATD 之间显示出较差的一致性和符合率。MD 与 PATD 之间的一致性较差。因此，这些方法不能替代 PATD，也不能适当地跟踪麻醉猫 CO 的变化。
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