A novel echocardiographic parameter considering left ventricular afterload during V-A ECMO support

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-06-07 DOI:10.1111/eci.14263

Kei Sato, Silver Heinsar, Jonathan Chan, Samia M. Farah, Karin Wildi, Nchafatso G. Obonyo, Keibun Liu, Carmen Ainola, Noriko Sato, Gabriella Abbate, Emily S. Wilson, Mahé Bouquet, Kieran Hyslop, Margaret R. Passmore, Shinichi Ijuin, Sun Kyun Ro, Gabriele Fior, Lucia Gandini, Brooke Lundon, David G. Platts, Jacky Y. Suen, Gianluigi Li Bassi, John F. Fraser

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引用次数: 0

Abstract

Background

Left ventricular stroke work index (LVSWI) and cardiac power index (CPI) account for the haemodynamic load of the left ventricle and are promising prognostic values in cardiogenic shock. However, accurately and non-invasively measuring these parameters during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is challenging and potentially biased by the extracorporeal circulation. This study aimed to investigate, in an ovine model of cardiogenic shock, whether Pressure-Strain Product (PSP), a novel speckle-tracking echocardiography parameter, (1) can correlate with pressure-volume catheter-based LVSWI and CPI, and (2) can be load-independent during the flow modification of V-A ECMO.

Methods

Nine Dorset-cross ewes (51 ± 4 kg) were included. After cardiogenic shock was induced, full support V-A ECMO (X L/min based on 60 mL/kg/min) commenced. At seven time points during 24-h observation, echocardiographic parameters as well as pressure-volume catheter-based LVSWI and CPI were simultaneously measured with X and following X-1 L/min of ECMO flow. PSP was calculated by multiplying global circumferential strain or global radial strain, and mean arterial pressure, for PSPcirc or PSPrad, respectively.

Results

PSPcirc showed a stronger correlation with LVSWI (correlation coefficient, CC = .360, p < .001) and CPI (CC = .283, p < .001) than other echocardiographic parameters. The predictability of PSPcirc for pressure-volume catheter-based LVSWI (AUC .82) and CPI (AUC .80) was also higher than other echocardiographic parameters. No statistically significant differences were identified between the two ECMO flow variations in PSPcirc (p = .558).

Conclusions

A novel echocardiographic parameter, PSP, may non-invasively predict pressure-volume catheter-based LVSWI and CPI in a load-independent manner in a cardiogenic shock supported by V-A ECMO.

Abstract Image

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考虑 V-A ECMO 支持期间左心室后负荷的新型超声心动图参数。

背景：左心室搏动功指数（LVSWI）和心脏动力指数（CPI）反映了左心室的血流动力学负荷，是心源性休克的预后值。然而，在静脉-动脉体外膜肺氧合（V-A ECMO）过程中准确、无创地测量这些参数具有挑战性，而且可能会受到体外循环的影响。本研究的目的是在心源性休克的绵羊模型中研究压力-应变积（PSP）这一新型斑点追踪超声心动图参数是否（1）能与基于压力-容积导管的左心室舒张功能指数（LVSWI）和心肌舒张功能指数（CPI）相关，以及（2）在 V-A ECMO 的血流改变过程中是否与负荷无关：方法：纳入 9 只多塞特杂交母羊（51 ± 4 千克）。诱发心源性休克后，开始全支持 V-A ECMO（X 升/分钟，基于 60 毫升/千克/分钟）。在 24 小时观察期间的七个时间点，同时测量了 X 和 X-1 L/min ECMO 流量时的超声心动图参数以及基于压力-容积导管的 LVSWI 和 CPI。PSP 的计算方法是将全周应变或全径向应变与平均动脉压相乘，分别表示 PSPcirc 或 PSPrad：结果：PSPcirc 与 LVSWI 的相关性更强（相关系数，CC = 0.360，P在 V-A ECMO 支持的心源性休克患者中，一个新的超声心动图参数 PSP 可以无创预测基于压力-容积导管的 LVSWI 和 CPI，且与负荷无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

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