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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 left ventricular (LV) dP/dtmax and arterial dP/dtmax.
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Figure 5: Linear regression between left ventricular (LV) dP/dtmax and arterial dP/dtmax.

Mentions: When adequate filling (PPV ≤ 11%) was obtained, a far better correlation between arterial dP/dtmax and Ees was found (r = 0.77, p < 0.001) (Figure 2). In that case, normalized Bland-Altman analysis revealed a good agreement between the two methods (Figure 3). Correlation between LV dP/dtmax and arterial dP/dtmax was also improved when adequate filling was achieved (r = 0.66, p < 0.001) while correlation between LV dP/dtmax and Ees did not significantly changed (r = 0.76, p < 0.001) (Figure 5).


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 left ventricular (LV) dP/dtmax and arterial dP/dtmax.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Linear regression between left ventricular (LV) dP/dtmax and arterial dP/dtmax.
Mentions: When adequate filling (PPV ≤ 11%) was obtained, a far better correlation between arterial dP/dtmax and Ees was found (r = 0.77, p < 0.001) (Figure 2). In that case, normalized Bland-Altman analysis revealed a good agreement between the two methods (Figure 3). Correlation between LV dP/dtmax and arterial dP/dtmax was also improved when adequate filling was achieved (r = 0.66, p < 0.001) while correlation between LV dP/dtmax and Ees did not significantly changed (r = 0.76, p < 0.001) (Figure 5).

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