Objective This study attempted to seek a new Doppler-derived index for estimating ventricularsystolic function. Methods With custom - made software the aortic and pulmonic flow profiles were digitized andconverted to ...Objective This study attempted to seek a new Doppler-derived index for estimating ventricularsystolic function. Methods With custom - made software the aortic and pulmonic flow profiles were digitized andconverted to their 4V2 curves, their maximum value of the first derivative, max (dk/dt) were obtained separately in23 and 25patients with congenital heart disease (mean age 4.5 years). Aortic max(dk/dt) and pulmonic max(dk/dt)measured by Doppler were compared with left ventricular max(dp/dt) and right ventricular max(dp/dt) measuredby cardiac catheterization. Results Aortic max(dk/dt) correlated well with LV max(dp/dt) (r=0.817, P<0.001).An excellent correlation of pulmonic max(dk/dt) with RV max(dp/dt) was established (r=0.926, P<0.0001). Therewas a significant correlation between RVSP and RV max(dp/dt) (r= 0.839, P<0.0001). Conclusion Doppler - derived aortic max(dk/dt) and pulmonic max(dk/dt) could be reliable index of left ventricular contractility and rightventricular contractility respectively. When max(dp/dt) is used for assessing RV systolic function, the impact ofRVSP on that should be taken into consideration.展开更多
Purpose: To study the significance of impaired positive peak rate of left ventricular (LV) pressure development (MR + dp/dt) and global systolic strain (GLPSS) values in patients presented with significant mitral inco...Purpose: To study the significance of impaired positive peak rate of left ventricular (LV) pressure development (MR + dp/dt) and global systolic strain (GLPSS) values in patients presented with significant mitral incompetence (MR) in coronary artery disease (CAD) and early dilated cardiomyopathy (DCM) with normal ejection fraction (EF). Methods: A description of LV contractile behavior requires measurement of the ability of the ventricle to develop force (pressure) and to shorten. Hence, performance of the ventricle as a pump assessed in the present study by measuring the pressure developed by the ventricle (Left ventricular +dP/dt is estimated from MR jet as the rate of pressure rise from 1 to 3 m/sec) and shortening assessed by GLPSS (this Doppler technology allowed measurement of LV systolic strain for the entire length of LV myocardium). GLPSS and MR + dp/dt were calculated in 30 consecutive patients (mean age was 55 ± 12 years) characterized by echocardiographic evidence of moderate or severe MR (in CAD and DCM patients) and normal EF (mean LV Ejection Fraction of 50.9% ± 5.9%) and compared with those obtained in 35 consecutive controls (age 54.7 ± 11.4 years) with normal echocardiographic study of the heart. Results: The mean values of MR +dp/dt and GLPSS averaged from the 3 apical views, differed significantly in DCM and CAD patients (characterized by significant MR with normal EF) compared with control group, (MR + dp/dt = 733 ± 170 mmhg/s and GLPSS –13% ± 1.3%) versus (1420 ± 210 mmhg/s and -19.5% ± 3.3%) for patients versus control, respectively, p < 0.001. A depressed values of MR + dp/dt were highly correlated with GLPSS values in patients with CAD and DCM, r = 0.78. The combined use of 2D Strain (<-13%) and MR dp/dt (<900 mmhg/s) in the presence of MR (grade II or more) had 89% sensitivity and 92% specificity for detection of patients at risk of post-operative major cardiac events after MR and coronary artery bypass surgery. Conclusions: Latent LV systolic dysfunction could be defined noninvasively by depressed peak MR + dp/dt and GLPSS in the echocardiography laboratories.展开更多
Background Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to im...Background Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to improve post-surgical outcome. We aimed to measure cardiac index (CI) and maximal rate of the increase of left ventricular pressure dp/dt(max) with the pressure recording analytic method (PRAM, MostCare?) and compared it with transthoracic echocardiographic cardiac index estimation in infants with transposition of the great arteries (TGA) undergoing surgical correction. Methods We enrolled 74 infants with TGA consecutively into this study. CI and dp/dt(max) were measured with PRAM and echocardiography at 0, 4, 8, 12, 24 and 48 h postoperatively. Blood brain natriuretic peptide (BNP) and blood lactate (Lac) were measured at baseline and after operation. Results The median age at surgery was 13 days (range 1–25 days) with an average weight of 3.24 kg (range 2.31–4.17 kg). CI esti-mated by PRAM was 1.11 ± 0.12 L/min/m2 (range 0.69–1.36) and by Doppler echocardiography was 1.13 ± 0.13 L/min/m2 (range 0.76–1.40). dp/dt(max) estimated by PRAM was 1.31 ± 0.03 mmHg/s (range 1.23–1.43) and by Doppler echocardiography was 1.31 ± 0.04 L/min/m2 (range 1.25–1.47). CI (r = 0.817,P< 0.001) and dp/dt(max) (r = 0.794,P< 0.001) measured by two meth-ods were highly correlated with a linear relation. Blood BNP and lactate increased to the highest level at 8–12 h post-operatively. Conclusions In the early post-operative period, PRAM provides reliable estimates of cardiac index and dp/dt(max) value compared with echocardiographic measurements. PRAM through mostcare? is a reliable continuous monitoring method for peri-operative management in children with congenital heart disease.展开更多
文摘Objective This study attempted to seek a new Doppler-derived index for estimating ventricularsystolic function. Methods With custom - made software the aortic and pulmonic flow profiles were digitized andconverted to their 4V2 curves, their maximum value of the first derivative, max (dk/dt) were obtained separately in23 and 25patients with congenital heart disease (mean age 4.5 years). Aortic max(dk/dt) and pulmonic max(dk/dt)measured by Doppler were compared with left ventricular max(dp/dt) and right ventricular max(dp/dt) measuredby cardiac catheterization. Results Aortic max(dk/dt) correlated well with LV max(dp/dt) (r=0.817, P<0.001).An excellent correlation of pulmonic max(dk/dt) with RV max(dp/dt) was established (r=0.926, P<0.0001). Therewas a significant correlation between RVSP and RV max(dp/dt) (r= 0.839, P<0.0001). Conclusion Doppler - derived aortic max(dk/dt) and pulmonic max(dk/dt) could be reliable index of left ventricular contractility and rightventricular contractility respectively. When max(dp/dt) is used for assessing RV systolic function, the impact ofRVSP on that should be taken into consideration.
文摘Purpose: To study the significance of impaired positive peak rate of left ventricular (LV) pressure development (MR + dp/dt) and global systolic strain (GLPSS) values in patients presented with significant mitral incompetence (MR) in coronary artery disease (CAD) and early dilated cardiomyopathy (DCM) with normal ejection fraction (EF). Methods: A description of LV contractile behavior requires measurement of the ability of the ventricle to develop force (pressure) and to shorten. Hence, performance of the ventricle as a pump assessed in the present study by measuring the pressure developed by the ventricle (Left ventricular +dP/dt is estimated from MR jet as the rate of pressure rise from 1 to 3 m/sec) and shortening assessed by GLPSS (this Doppler technology allowed measurement of LV systolic strain for the entire length of LV myocardium). GLPSS and MR + dp/dt were calculated in 30 consecutive patients (mean age was 55 ± 12 years) characterized by echocardiographic evidence of moderate or severe MR (in CAD and DCM patients) and normal EF (mean LV Ejection Fraction of 50.9% ± 5.9%) and compared with those obtained in 35 consecutive controls (age 54.7 ± 11.4 years) with normal echocardiographic study of the heart. Results: The mean values of MR +dp/dt and GLPSS averaged from the 3 apical views, differed significantly in DCM and CAD patients (characterized by significant MR with normal EF) compared with control group, (MR + dp/dt = 733 ± 170 mmhg/s and GLPSS –13% ± 1.3%) versus (1420 ± 210 mmhg/s and -19.5% ± 3.3%) for patients versus control, respectively, p < 0.001. A depressed values of MR + dp/dt were highly correlated with GLPSS values in patients with CAD and DCM, r = 0.78. The combined use of 2D Strain (<-13%) and MR dp/dt (<900 mmhg/s) in the presence of MR (grade II or more) had 89% sensitivity and 92% specificity for detection of patients at risk of post-operative major cardiac events after MR and coronary artery bypass surgery. Conclusions: Latent LV systolic dysfunction could be defined noninvasively by depressed peak MR + dp/dt and GLPSS in the echocardiography laboratories.
文摘Background Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to improve post-surgical outcome. We aimed to measure cardiac index (CI) and maximal rate of the increase of left ventricular pressure dp/dt(max) with the pressure recording analytic method (PRAM, MostCare?) and compared it with transthoracic echocardiographic cardiac index estimation in infants with transposition of the great arteries (TGA) undergoing surgical correction. Methods We enrolled 74 infants with TGA consecutively into this study. CI and dp/dt(max) were measured with PRAM and echocardiography at 0, 4, 8, 12, 24 and 48 h postoperatively. Blood brain natriuretic peptide (BNP) and blood lactate (Lac) were measured at baseline and after operation. Results The median age at surgery was 13 days (range 1–25 days) with an average weight of 3.24 kg (range 2.31–4.17 kg). CI esti-mated by PRAM was 1.11 ± 0.12 L/min/m2 (range 0.69–1.36) and by Doppler echocardiography was 1.13 ± 0.13 L/min/m2 (range 0.76–1.40). dp/dt(max) estimated by PRAM was 1.31 ± 0.03 mmHg/s (range 1.23–1.43) and by Doppler echocardiography was 1.31 ± 0.04 L/min/m2 (range 1.25–1.47). CI (r = 0.817,P< 0.001) and dp/dt(max) (r = 0.794,P< 0.001) measured by two meth-ods were highly correlated with a linear relation. Blood BNP and lactate increased to the highest level at 8–12 h post-operatively. Conclusions In the early post-operative period, PRAM provides reliable estimates of cardiac index and dp/dt(max) value compared with echocardiographic measurements. PRAM through mostcare? is a reliable continuous monitoring method for peri-operative management in children with congenital heart disease.
