Assessment of changes in left ventricular systolic function with oesophageal Doppler.

Abstract

BACKGROUND:

We tested the ability of mean acceleration (Acc) and peak velocity (V peak) of the aortic velocity signal measured by oesophageal Doppler to reflect left ventricular (LV) systolic performance.

METHODS:

We included critically ill patients in whom a fluid challenge (n=25) or the introduction of dobutamine, 5 µg kg(-1) min(-1) (n=25), was planned by the attending physician. Before and after therapeutic interventions, we measured Acc and V peak (CardioQ device) and LV ejection fraction (LVEF) using echocardiography.

RESULTS:

For all pairs of measurements, the absolute values of Acc and V peak correlated with LVEF (r=0.36 and 0.57, respectively). The correlation was significantly higher for V peak than for Acc. Volume expansion did not significantly change LVEF and Acc, but significantly increased V peak by 7 (8)%. Dobutamine increased LVEF by 30 (15)%, Acc by 33 (25)%, and V peak by 20 (10)%. Considering the pooled effects of volume expansion and dobutamine, changes in Acc and V peak and those of LVEF were correlated (r=0.53 and 0.67, respectively). When excluding changes <18% (i.e. the least significant change for LVEF), the concordance rate was 96% for Acc and 100% for V peak.

CONCLUSIONS:

V peak and, to a lesser extent, Acc measured by oesophageal Doppler behaved as markers of LV systolic performance as they were almost insensitive to fluid administration and changed to a much larger extent with dobutamine. These indices could be used to estimate LV systolic performance and to assess the effects of inotropic therapy.

• Authors: X Monnet, J-M Robert, M Jozwiak, C Richard, J-L Teboul
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 111 Issue 5 Pg. 743-9 (Nov 2013) ISSN: 1471-6771 [Electronic] England
• PMID: 23798745 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Agonists
• Vasoconstrictor Agents
• Dobutamine
• Norepinephrine

Topics

• Adrenergic beta-Agonists
• Aged
• Cardiac Output (physiology)
• Confidence Intervals
• Dobutamine
• Esophagus (diagnostic imaging)
• Female
• Hemodynamics (physiology)
• Humans
• Male
• Norepinephrine (therapeutic use)
• ROC Curve
• Respiratory Distress Syndrome (physiopathology)
• Stroke Volume (physiology)
• Ultrasonography, Doppler
• Vasoconstrictor Agents (therapeutic use)
• Ventricular Function, Left (physiology)