The American journal of cardiology
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of echocardiographic assessment of cardiac hemodynamics in the intensive care unit with right-sided cardiac catheterization.
Estimation of left ventricular filling pressure and cardiac index is important in the management of patients requiring right heart catheterization. Doppler echocardiography can provide a noninvasive measure of these parameters, but its accuracy in individual measurements, predicting hemodynamic subgroups, and in tracking serial changes in critically ill patients remains to be elucidated. Left ventricular filling pressure and cardiac index were assessed in 49 critically ill patients requiring right heart catheterization and Doppler echocardiographic studies. ⋯ The noninvasive technique also reliably tracked serial hemodynamic measurements. We conclude that Doppler echocardiography accurately assesses left heart hemodynamics in critically ill patients. Since this technique can be readily acquired, it can be ideal for the rapid assessment of hemodynamic parameters in critically ill patients, especially when right heart catheterization is delayed or is problematic.
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It has recently been suggested that mean arterial pressure provides a reliable estimate of dicrotic notch pressure in infants and children. The aim of the present study was twofold: (1) to investigate the relation existing between aortic dicrotic notch pressure and both the steady and pulsed component of aortic pressure in adults (i.e., mean and pulse aortic pressures, respectively); and (2) to evaluate mean aortic pressure as an estimate of aortic dicrotic notch pressure. High-fidelity pressure recordings were obtained at the aortic root level in 17 men (52 +/- 13 years). ⋯ Both at rest and during the Valsalva maneuver, mean pressure underestimated dicrotic notch pressure, and the higher the dicrotic notch pressure, the more negative the percent error (each p = 0.0001). In conclusion, aortic dicrotic notch pressure was mainly related to the steady component of aortic pressure. The mean aortic pressure slightly but significantly underestimated aortic dicrotic notch pressure, and thus should be used with greater caution in adults than in young patients as an estimate of end-systolic pressure.
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This study reports that an improvement in systolic blood pressure of > 10 mm Hg after PTCA in patients with cardiogenic shock was associated with in-hospital survival (8 of 8 patients). Failure to achieve infarct artery patency (6 of 6) or technically successful PTCA, unaccompanied by improved systolic blood pressure in the catheterization laboratory, was associated with in-hospital mortality in this series.
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Comparative Study
Hemodynamic criteria for diagnosis of right ventricular ischemia associated with inferior wall left ventricular acute myocardial infarction.
To test the diagnostic value of different hemodynamic indexes for the diagnosis of acute right ventricular (RV) ischemic dysfunction, we studied 2 groups of consecutive patients admitted for an acute left ventricular inferior wall myocardial infarction: 51 patients with (group 1) and 32 patients without (group 2) RV ischemia as determined by coronary angiography. In both groups, we analyzed by right-sided cardiac catheterization right-sided heart pressures, pulmonary capillary wedge pressure, and cardiac index. We also calculated pressure ratios (mean right atrial pressure or RV end-diastolic over pulmonary capillary wedge pressures), pulmonary vascular resistance, and RV stroke work index. ⋯ Right heart pressures and RV stroke work index increased significantly and similarly in both groups. Cardiac index increased significantly only in patients without RV ischemia (p = 0.02). However, volume loading did not significantly modify the diagnostic value of the different hemodynamic criteria studied.(ABSTRACT TRUNCATED AT 250 WORDS)