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Assessment of left ventricular systolic function during acute myocardial ischemia: A comparison of transpulmonary thermodilution and transesophageal echocardiography.
MedLine Citation:
PMID:  21242954     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The PiCCO system provides different variables of cardiac function: the cardiac function index (CFI), the global ejection fraction (GEF) and the maximal pressure developed by the left ventricle (dP/dtMax). The purpose of this study was to investigate the ability of these variables to predict impaired left ventricular ejection fraction (LVEF) derived by transesophageal echocardiography during acute myocardial ischemia. METHODS: In this prospective experimental study, fifteen pigs (28-34 kg) were anesthetized, mechanically ventilated and subjected to left anterior descending (LAD) coronary artery occlusion. PiCCO-derived variables and LVEF were obtained 5, 10, 15, and 20 minutes after LAD occlusion. Receiver operating characteristics analysis was performed to assess the ability of PiCCO-derived parameters to estimate LVEF ≤40% and ≤50%. RESULTS: LAD occlusion induced a decrease in PiCCO-derived variables and LVEF (P<0.001 for each). Significant correlations were found between LVEF and CFI (r=0.59, P<0.001), GEF (r=0.64, P<0.001), dP/dtMax (r=0.36, P<0.001), and cardiac output (r=0.25, P=0.028). The area under the receiver operating characteristics curve for the estimation of LVEF ≤40% and ≤50% was 0.80 and 0.79 for CFI (P=0.009, P<0.001), 0.86 and 0.78 for GEF (P=0.002, P<0.001), 0.76 and 0.68 for dP/dtMax (P=0.033, P=0.012), and 0.57 and 0.58 for cardiac output (P=0.554, P=0.259). CONCLUSION: Cardiac function indices permit the bedside quantification of left ventricular systolic function during acute myocardial ischemia in pigs. Therefore, the PiCCO system may represent a valuable technique for cardiovascular monitoring, particularly for detecting acute left ventricular systolic dysfunction due to myocardial ischemia.
Authors:
P Meybohm; M Gruenewald; J Renner; M Maracke; S Rossee; J Höcker; S Hagelsteins; K Zacharowski; B Bein
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-18
Journal Detail:
Title:  Minerva anestesiologica     Volume:  -     ISSN:  1827-1596     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany - meybohm@anaesthesie.uni-kiel.de.
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