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The Utility of 3D Left Atrial Volume and Mitral Flow Velocities as Guides for Acute Volume Resuscitation.

Santosa CM, Rose DD, Fleming NW - Biomed Res Int (2015)

Bottom Line: Left ventricular end-diastolic pressure (LVEDP) is the foundation of cardiac function assessment.Because of difficulties and risks associated with its direct measurement, correlates of LVEDP derived by pulmonary artery (PA) catheterization or transesophageal echocardiography (TEE) are commonly adopted.The clinical applicability of peak E wave velocity and LAEDV still needs to be validated during uncontrolled resuscitation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, UC Davis School of Medicine, 4150 V Street, PSSB Suite 1200, Sacramento, CA 95817, USA.

ABSTRACT
Left ventricular end-diastolic pressure (LVEDP) is the foundation of cardiac function assessment. Because of difficulties and risks associated with its direct measurement, correlates of LVEDP derived by pulmonary artery (PA) catheterization or transesophageal echocardiography (TEE) are commonly adopted. TEE has the advantage of being less invasive; however TEE-based estimation of LVEDP using correlates such as left ventricular end-diastolic volume (LVEDV) has technical difficulties that limit its clinical usefulness. Using intraoperative acute normovolemic hemodilution (ANH) as a controlled hemorrhagic model, we examined various mitral flow parameters and three-dimensional reconstructions of left atrial volume as surrogates of LVEDP. Our results demonstrate that peak E wave velocity and left atrial end-diastolic volume (LAEDV) correlated with known changes in intravascular volume associated with ANH. Although left atrial volumetric analysis was done offline in our study, recent advances in echocardiographic software may allow for continuous display and real-time calculation of LAEDV. Along with the ease and reproducibility of acquiring Doppler images of flow across the mitral valve, these two correlates of LVEDP may justify a more widespread use of TEE to optimize intraoperative fluid management. The clinical applicability of peak E wave velocity and LAEDV still needs to be validated during uncontrolled resuscitation.

No MeSH data available.


Changes versus baseline (%); “∗” indicates P < 0.05 versus baseline, E Peak: peak E wave velocity, LAEDV: left atrial end-diastolic volume.
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fig2: Changes versus baseline (%); “∗” indicates P < 0.05 versus baseline, E Peak: peak E wave velocity, LAEDV: left atrial end-diastolic volume.

Mentions: No clinically significant changes in heart rate or blood pressure were observed during the ANH protocol (Figure 1). The measurements of left atrial volume and mitral flow parameters during each of the seven measurement points are collated in Table 1. Only the LAEDV and peak E wave velocity demonstrated statistically significant changes that correlated with the known changes in intravascular volume associated with ANH. At the −15% of EBV time point the LAEDV was −10 ± 21.4% of the baseline value while the peak E wave velocity was −9 ± 25.4% of baseline (Figure 2). Similar changes were also seen at the final study point when the EBV had been restored with Hextend. LAEDV actually overcorrected to 20 ± 37.5% greater than baseline and the peak E wave velocity similarly increased to 19 ± 22.8% greater than baseline.


The Utility of 3D Left Atrial Volume and Mitral Flow Velocities as Guides for Acute Volume Resuscitation.

Santosa CM, Rose DD, Fleming NW - Biomed Res Int (2015)

Changes versus baseline (%); “∗” indicates P < 0.05 versus baseline, E Peak: peak E wave velocity, LAEDV: left atrial end-diastolic volume.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4508382&req=5

fig2: Changes versus baseline (%); “∗” indicates P < 0.05 versus baseline, E Peak: peak E wave velocity, LAEDV: left atrial end-diastolic volume.
Mentions: No clinically significant changes in heart rate or blood pressure were observed during the ANH protocol (Figure 1). The measurements of left atrial volume and mitral flow parameters during each of the seven measurement points are collated in Table 1. Only the LAEDV and peak E wave velocity demonstrated statistically significant changes that correlated with the known changes in intravascular volume associated with ANH. At the −15% of EBV time point the LAEDV was −10 ± 21.4% of the baseline value while the peak E wave velocity was −9 ± 25.4% of baseline (Figure 2). Similar changes were also seen at the final study point when the EBV had been restored with Hextend. LAEDV actually overcorrected to 20 ± 37.5% greater than baseline and the peak E wave velocity similarly increased to 19 ± 22.8% greater than baseline.

Bottom Line: Left ventricular end-diastolic pressure (LVEDP) is the foundation of cardiac function assessment.Because of difficulties and risks associated with its direct measurement, correlates of LVEDP derived by pulmonary artery (PA) catheterization or transesophageal echocardiography (TEE) are commonly adopted.The clinical applicability of peak E wave velocity and LAEDV still needs to be validated during uncontrolled resuscitation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, UC Davis School of Medicine, 4150 V Street, PSSB Suite 1200, Sacramento, CA 95817, USA.

ABSTRACT
Left ventricular end-diastolic pressure (LVEDP) is the foundation of cardiac function assessment. Because of difficulties and risks associated with its direct measurement, correlates of LVEDP derived by pulmonary artery (PA) catheterization or transesophageal echocardiography (TEE) are commonly adopted. TEE has the advantage of being less invasive; however TEE-based estimation of LVEDP using correlates such as left ventricular end-diastolic volume (LVEDV) has technical difficulties that limit its clinical usefulness. Using intraoperative acute normovolemic hemodilution (ANH) as a controlled hemorrhagic model, we examined various mitral flow parameters and three-dimensional reconstructions of left atrial volume as surrogates of LVEDP. Our results demonstrate that peak E wave velocity and left atrial end-diastolic volume (LAEDV) correlated with known changes in intravascular volume associated with ANH. Although left atrial volumetric analysis was done offline in our study, recent advances in echocardiographic software may allow for continuous display and real-time calculation of LAEDV. Along with the ease and reproducibility of acquiring Doppler images of flow across the mitral valve, these two correlates of LVEDP may justify a more widespread use of TEE to optimize intraoperative fluid management. The clinical applicability of peak E wave velocity and LAEDV still needs to be validated during uncontrolled resuscitation.

No MeSH data available.