Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit

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Abstract

Objectives

To compare hemodynamic and echocardiographic indexes of left ventricular performance.

Design

Retrospective database analysis of four clinical trials.

Setting

University hospital.

Patients

Cardiac surgery patients.

Intervention

Left ventricular performance was evaluated using left ventricular stroke work index (LVSWI) calculated from the pulmonary artery catheter and both fractional area change and regional wall motion score index (RWMSI) measured from transesophageal echocardiography. Measures of left ventricular performance were obtained before and after bypass (group 1, n = 30), during acute increase and decrease in preload (group 2, n = 14), after administration of inhaled prostacyclin or placebo in patients with pulmonary hypertension (group 3, n = 20), and in hemodynamically unstable patients in the intensive care unit at admission and at 2 and 4 hrs (group 4, n = 20).

Main Results

A total of 186 simultaneous LVSWI, fractional area change, and RWMSI were analyzed and compared. Patients with RWMSI <1.3 had a LVSWI of 23.4 ± 10.3 g·m−1·m−2 compared with 18.4 ± 7.2 g·m−1·m−2 in those with RWMSI >1.3 (p = .0349). Subdividing fractional area change into three different groups (≥50%, 25% to 49%, and ≤24%), the corresponding values of LVSWI were 22.3 ± 9.7 g·m−1·m−2, 22.2 ± 10.8 g·m−1·m−2, and 17.7 ± 5.5 g·m−1·m−2, respectively (p = .5114). Correlations between LVSWI and RWMSI changes ranged from −0.28 to 0.16 (p values from .31 to .94). Correlations between LVSWI and fractional area change changes ranged from −0.62 to 0.22 (p values from .07 to .95).

Conclusion

There is a significant discrepancy and limited relationship between the hemodynamic and echocardiographic evaluation of left ventricular performance.

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