Relationship between tricuspid annular plane systolic excursion, fluid responsiveness and volume status in hospitalised dogs with circulatory abnormalities.
P A Donati, L Tarragona, I Sandez Cordero, D Alzate, P E Otero
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引用次数: 0
Abstract
Aims: To evaluate the echocardiographic variable tricuspid annular plane systolic excursion normalised to body weight (TAPSEnorm) as a predictor of fluid responsiveness in hospitalised dogs with haemodynamic and tissue perfusion alterations and to investigate the association of left ventricular internal diameter in diastole normalised to body weight (LVIDdN) and aortic velocity time integral (VTIAo) with TAPSEnorm.
Methods: A single-centre, prospective study was carried out in a cohort of spontaneously breathing dogs, hospitalised for any reason, with severe haemodynamic and tissue perfusion alterations. The echocardiographic variables TAPSEnorm, LVIDdN, and VTIAO were measured. A bolus of 30 mL/kg of lactated Ringer's solution was administered and then VTIAo was subsequently remeasured. Patients were classified as fluid responsive if VTIAo increased by ≥15% after fluid expansion, or non-responsive if VTIAo increased by <15% after fluid expansion. The area under the receiver operating characteristic (AUROC) curve was generated to evaluate the ability of TAPSE to predict fluid responsiveness. Simple regression models were used to assess the linear relationship between TAPSEnorm and LVIDdN or VTIAO.
Results: TAPSEnorm was lower in fluid responsive dogs (mean 0.57 (95% CI = 0.50-0.64) cm/kg) compared to non-responsive dogs (mean 0.76 (95% CI = 0.62-0.90) cm/kg). The AUROC for TAPSEnorm was 0.827 (95% CI = 0.65-1.00). The optimal cut-off point was 0.76 with sensitivity of 80 (95% CI = 28.4-99.5)% and specificity of 86.7 (95% CI = 69.3-99.2)%, positive predictive value of 50 (95% CI = 15.7-84.3)% and negative predictive value of 96.3 (95% CI = 81-99.9)%. A monotonic linear relationship was observed between TAPSEnorm and LVIDdN (p<0.001) and between TAPSEnorm and VTIAo (p=0.001).
Conclusions and clinical relevance: TAPSEnorm could be useful in determining those dogs that are likely to respond to a fluid bolus from those that are likely to be non-responsive. Additionally, a positive linear association between the LVIDdN and the TAPSEnorm suggests that TAPSEnorm decreases at lower preload values. The present study results suggest that TAPSEnorm could be a valuable tool for evaluating blood volume status and fluid responsiveness in hospitalised dogs.Abbreviations: AUROC: Area under the receiver operating characteristic; CO: Cardiac output; ICC: Intraclass correlation coefficient; LVIDd: Left ventricular internal diameter in diastole; LVIDdN: Left ventricular internal diameter in diastole normalised to body weight; TAPSE: Tricuspid annular plane systolic excursion; TAPSEnorm: Tricuspid annular plane systolic excursion normalised to body weight; VTIAo: Aortic velocity time integral.
目的:评价超声心动图变量三尖瓣环平面收缩期偏移与体重的关系(TAPSEnorm)作为血流动力学和组织灌注改变的住院犬的液体反应性预测指标,并探讨与体重关系的舒张期左心室内径(LVIDdN)和主动脉速度时间积分(VTIAo)与TAPSEnorm的关系。方法:在一组自发呼吸的狗中进行了一项单中心前瞻性研究,这些狗因任何原因住院,有严重的血流动力学和组织灌注改变。测量超声心动图变量TAPSEnorm、LVIDdN和VTIAO。给药30 mL/kg乳酸林格氏液,然后重新测量VTIAo。如果液体膨胀后VTIAo增加≥15%,则将患者分类为液体反应性,如果VTIAo因AO而增加,则将患者分类为无反应性。结果:液体反应犬的TAPSEnorm(平均0.57 (95% CI = 0.50-0.64) cm/kg)低于无反应犬(平均0.76 (95% CI = 0.62-0.90) cm/kg)。TAPSEnorm的AUROC为0.827 (95% CI = 0.65-1.00)。最佳分界点为0.76,敏感性80 (95% CI = 28.4-99.5)%,特异性86.7 (95% CI = 69.3-99.2)%,阳性预测值50 (95% CI = 15.7-84.3)%,阴性预测值96.3 (95% CI = 81-99.9)%。TAPSEnorm与LVIDdN呈单调线性关系(p=0.001)。结论和临床意义:TAPSEnorm可用于确定哪些犬可能对液体丸有反应,哪些犬可能无反应。此外,LVIDdN和TAPSEnorm之间的正线性关系表明,TAPSEnorm在较低的预载值下降低。目前的研究结果表明,TAPSEnorm可能是评估住院犬的血容量状态和液体反应性的有价值的工具。缩写:AUROC:接收机工作特性下的面积;CO:心输出量;ICC:类内相关系数;LVIDd:舒张时左心室内径;LVIDdN:舒张期左心室内径与体重关系正常化;TAPSE:三尖瓣环状平面收缩偏移;TAPSEnorm:三尖瓣环状平面收缩偏移与体重归一化;VTIAo:主动脉速度积分。
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The New Zealand Veterinary Journal (NZVJ) is an international journal publishing high quality peer-reviewed articles covering all aspects of veterinary science, including clinical practice, animal welfare and animal health.
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