Relationship between pulse pressure variation and echocardiographic indices of left ventricular filling pressure in critically ill patients
Corresponding Author
Matteo Cameli
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Correspondence
Matteo Cameli, Department of Cardiovascular Diseases, University of Siena, Policlinico ‘Le Scotte’, Viale Bracci 1, 53100 Siena, Italy
E-mail: [email protected]
Search for more papers by this authorElisa Bigio
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
Search for more papers by this authorMatteo Lisi
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Search for more papers by this authorFrancesca M. Righini
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Search for more papers by this authorMaurizio Galderisi
Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
Search for more papers by this authorFederico Franchi
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
Search for more papers by this authorSabino Scolletta
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
Search for more papers by this authorSergio Mondillo
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Search for more papers by this authorCorresponding Author
Matteo Cameli
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Correspondence
Matteo Cameli, Department of Cardiovascular Diseases, University of Siena, Policlinico ‘Le Scotte’, Viale Bracci 1, 53100 Siena, Italy
E-mail: [email protected]
Search for more papers by this authorElisa Bigio
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
Search for more papers by this authorMatteo Lisi
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Search for more papers by this authorFrancesca M. Righini
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Search for more papers by this authorMaurizio Galderisi
Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
Search for more papers by this authorFederico Franchi
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
Search for more papers by this authorSabino Scolletta
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
Search for more papers by this authorSergio Mondillo
Department of Medical Biotechnologies, University of Siena, Italy
Unit of Cardiovascular Diseases, University of Siena, Italy
Search for more papers by this authorSummary
Background
Pulse pressure variation (PPV) is a dynamic index of fluid responsiveness. This parameter helps clinicians in improving haemodynamic status while avoiding potential fluid overload. Echocardiographic indices, such as E/E' ratio and left atrial (LA) strain by speckle tracking echocardiography (STE), are used to estimate left ventricular (LV) filling pressures. This study aimed at exploring the relationship between PPV and echocardiographic indices of LV filling pressures in critically ill patients.
Methods
Twenty-two patients (mean age of 50·9 ± 21·6, male/female = 15/7) admitted to intensive care unit, and requiring mechanical ventilation and invasive arterial pressure monitoring, were studied. In all patients, two independent operators assessed simultaneously PPV, using a pulse contour method, mean E/E' ratio and peak atrial longitudinal strain (PALS) by means of STE. PALS values were obtained by averaging LA segments measured in the 4-chamber and 2-chamber views (global PALS).
Results
A significant negative correlation was found between mean E/E' ratio and PPV (R2 = −0·76; P<0·001). A positive correlation between global PALS and PPV was found (R2 = 0·80, P<0·001). Mean global PALS of 26·2% demonstrated excellent accuracy (Area Under Roc Curve = 0·86, P<0·001), and good sensitivity (92%) and specificity (86%) in predicting a PPV >15%.
Conclusion
In a group of mechanically ventilated patients PPV, derived from pulse contour analysis, and echocardiographic preload parameters were well correlated. Global PALS by STE provided better estimation of PPV than mean E/E' ratio. PALS seems a potential alternative to PPV in assessing fluid responsiveness in critically ill patients.
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