Cor Vasa 2006, 48(5):180-185 | DOI: 10.33678/cor.2006.056

Predicting left ventricular filling pressure by tissue Doppler echocardiography in inten-sive care.

Martin Hutyra^*, Tomáš Skála, Jiří Ostřanský, Dan Marek, Vladimíra Baslerová, Hana Grofková

I. interní klinika, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

Background:
Based on published results of meta-analyses of large studies, hemodynamic monitoring using pulmonary artery catheters is not associated with improved prognosis of critically ill patients treated this way at resuscitation departments and intensive care units (ICU). Moreover, this examination is invasive and may be associated with some specific complications. This method is therefore recently being abandoned and there has been an effort to develop some other semi-invasive and non-invasive techniques of hemodynamic monitoring of critically ill patients.

Aim:
The aim of this study was to compare the examined echocardiographic parameters E/Em, t, (E/Em)/log t in predicting pulmonary capillary wedge pressure (PCWP).


Patients, methods and results:
Throughout 1/2005-10/2005, a total of 29 patients with various indications underwent routine right heart catheterization using a Swan-Ganz catheter combined with transthoracic echocardiography. The patients were subsequently divided, according to PCWP, for statistical analysis into Group 1 (PCWP ≤ 15 mm Hg, n = 11) and Group 2 (PCWP > 15 mm Hg, n = 18). Right heart catheterization with the Swan-Ganz catheter (Corodyn TD Braun) and simultaneous transthoracic echocardiography (Vivid 7 GE) were performed at the department s ICU and cath lab. Analysis of patients data demonstrated significant correlations of PCWP with E/Em (r = 0.888; p ≤ 0.01), t (r = 0.581; p < 0.01), and (E/Em)/log t (r = 0.875; p ≤ 0.01). Significant differences were found in E/Em (8.13 ± 2.92 vs. 23.67 ± 6.49, p < 0.0001), t (51.98 ± 15.02 vs. 31.46 ± 12.93, p = 0.001) and (E/Em)/log t (4.82 ± 1.83 vs. 16.63 ± 5.71, p < 0.0001) when comparing Groups 1 and 2. Linear regression analysis resulted in a regression model for predicting PCWP = 6.17 + 0.801*E/Em, ex-plaining 78.9% of the variability of invasively measured PCWP. In this model, E/Em > 15 showed 100% sensitivity and 100% specificity in predicting PCWP > 15 mm Hg.

Conclusions:
Based on results of this pilot study, tissue Doppler echocardiography is capable of predicting, with a rela-tively high degree of accuracy, invasively measured left ventricular filling pressures. The E/Em ratio and the composite parameter (E/Em)/log t seem to be the most useful parameters. Given the comprehensive nature of acquired data, echocardiography should be a procedure routinely available at intensive care units.

Keywords: Hemodynamic monitoring; Left ventricle filling pressures; Tissue Doppler echocardiography; Intensive care

Published: May 1, 2006  Show citation