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Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved.

Morimont P, Lambermont B, Desaive T, Janssen N, Chase G, D'Orio V - BMC Cardiovasc Disord (2012)

Bottom Line: Overall, significant correlation (r=0.51; p<0.001) but low agreement between the two methods were observed.However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV)≤11% (r=0.77; p<0.001).While arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV≤11%, was achieved.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Intensive Care Unit, Emergency Department, University Hospital of Liège, and Faculty of Sciences, University of Liège, Liège, Belgium. ph.morimont@chu.ulg.ac.be

ABSTRACT

Background: Peak first derivative of femoral artery pressure (arterial dP/dtmax) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dtmax is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.

Methods: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dtmax was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.

Results: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r=0.51; p<0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV)≤11% (r=0.77; p<0.001).

Conclusion: While arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV≤11%, was achieved.

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Linear regression between arterial dP/dtmax and Ees.
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Figure 2: Linear regression between arterial dP/dtmax and Ees.

Mentions: Overall, arterial dP/dtmax and Ees were significantly correlated (r = 0.51, p < 0.001) but there was low agreement (Figures 2 and 3). LV dP/dtmax and arterial dP/dtmax were significantly correlated (r = 0.58, p < 0.001) but arterial dP/dtmax systematically underestimated LV dP/dtmax. (bias = 1018 ± 364 mmHg/sec). LV dP/dtmax and Ees were significantly correlated (r = 0.78, p < 0.001) (Figure 4).


Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved.

Morimont P, Lambermont B, Desaive T, Janssen N, Chase G, D'Orio V - BMC Cardiovasc Disord (2012)

Linear regression between arterial dP/dtmax and Ees.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3313844&req=5

Figure 2: Linear regression between arterial dP/dtmax and Ees.
Mentions: Overall, arterial dP/dtmax and Ees were significantly correlated (r = 0.51, p < 0.001) but there was low agreement (Figures 2 and 3). LV dP/dtmax and arterial dP/dtmax were significantly correlated (r = 0.58, p < 0.001) but arterial dP/dtmax systematically underestimated LV dP/dtmax. (bias = 1018 ± 364 mmHg/sec). LV dP/dtmax and Ees were significantly correlated (r = 0.78, p < 0.001) (Figure 4).

Bottom Line: Overall, significant correlation (r=0.51; p<0.001) but low agreement between the two methods were observed.However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV)≤11% (r=0.77; p<0.001).While arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV≤11%, was achieved.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Intensive Care Unit, Emergency Department, University Hospital of Liège, and Faculty of Sciences, University of Liège, Liège, Belgium. ph.morimont@chu.ulg.ac.be

ABSTRACT

Background: Peak first derivative of femoral artery pressure (arterial dP/dtmax) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dtmax is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.

Methods: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dtmax was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.

Results: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r=0.51; p<0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV)≤11% (r=0.77; p<0.001).

Conclusion: While arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV≤11%, was achieved.

Show MeSH
Related in: MedlinePlus