Dabaghi S F, Rokey R, Rivera J M, Saliba W I, Majid P A
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Am J Cardiol. 1995 Aug 15;76(5):392-5. doi: 10.1016/s0002-9149(99)80107-6.
Estimation of left ventricular filling pressure and cardiac index is important in the management of patients requiring right heart catheterization. Doppler echocardiography can provide a noninvasive measure of these parameters, but its accuracy in individual measurements, predicting hemodynamic subgroups, and in tracking serial changes in critically ill patients remains to be elucidated. Left ventricular filling pressure and cardiac index were assessed in 49 critically ill patients requiring right heart catheterization and Doppler echocardiographic studies. Two or more serial studies were performed in 18 of these subjects. Patients were placed into 1 of 4 hemodynamic subgroups for each technique based on the acquired hemodynamic parameters. Left ventricular filling pressure and cardiac index by Doppler echocardiography and right heart catheterization were similar (21 +/- 8 vs 20 +/- 8 mm Hg; 3.0 +/- 1.2 vs 2.9 +/- 1.2 L/min/m2, respectively) and correlated well with each other (left ventricular filling pressure, r = 0.88; cardiac index, r = 0.92). The Doppler technique accurately placed 73 of 76 studies into the correct hemodynamic subgroup. The noninvasive technique also reliably tracked serial hemodynamic measurements. We conclude that Doppler echocardiography accurately assesses left heart hemodynamics in critically ill patients. Since this technique can be readily acquired, it can be ideal for the rapid assessment of hemodynamic parameters in critically ill patients, especially when right heart catheterization is delayed or is problematic.
评估左心室充盈压和心脏指数对于需要进行右心导管检查的患者的管理非常重要。多普勒超声心动图可以提供这些参数的非侵入性测量方法，但其在个体测量、预测血流动力学亚组以及追踪重症患者的连续变化方面的准确性仍有待阐明。对49例需要进行右心导管检查和多普勒超声心动图研究的重症患者评估了左心室充盈压和心脏指数。其中18例患者进行了两项或更多次连续研究。根据获得的血流动力学参数，每种技术将患者分为4个血流动力学亚组之一。通过多普勒超声心动图和右心导管检查测得的左心室充盈压和心脏指数相似（分别为21±8 vs 20±8 mmHg；3.0±1.2 vs 2.9±1.2 L/min/m²），且两者相关性良好（左心室充盈压，r = 0.88；心脏指数，r = 0.92）。多普勒技术在76项研究中有73项准确地归入了正确的血流动力学亚组。这种非侵入性技术还可靠地追踪了连续的血流动力学测量结果。我们得出结论，多普勒超声心动图能够准确评估重症患者的左心血流动力学。由于该技术易于掌握，因此对于快速评估重症患者的血流动力学参数非常理想，尤其是在右心导管检查延迟或存在问题时。
