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Medicina crítica (Colegio Mexicano de Medicina Crítica)

versão impressa ISSN 2448-8909

Resumo

PEREZ NIETO, Orlando Rubén et al. Ventricular-arterial coupling at the patient’s bedside. Is it possible? Is it useful?. Med. crít. (Col. Mex. Med. Crít.) [online]. 2017, vol.31, n.1, pp.20-24. ISSN 2448-8909.

Introduction:

The best way to assess myocardial efficiency is by analyzing arterial-ventricular coupling. This complex analysis can be performed noninvasively by Doppler echocardiography.

Material and methods:

A longitudinal, prospective, analytical study was performed with patients hospitalized in the Intensive Care Unit of the Hospital San Ángel Inn Universidad admitted in shock (defined as a heart rate > 120 beats per minute or venous lactate > 4 mmol/L or lactate > 2 mmol/L plus one of the following: heart rate > systolic pressure, systolic pressure < 90 mmHg). The following variables were recorded: age, gender, admission diagnosis, systolic and diastolic blood pressure, mean arterial pressure, heart rate and serum lactate; an expert cardiologist performed the echocardiographic measurements required for calculating the ventricular-arterial coupling. A resident of intensive therapy obtained after a four-hour training the following values by the ultrasonic cardiac output monitor USCOM: SMII, FTC and PKR.

Results:

We studied n = 47 patients diagnosed with shock; male n = 23 (48.9%), age n = 59 (41-73); n = 22 patients had septic shock (53.7%), n = 11 coronary syndromes (26.8%), n = 7 cor pulmonale (17.1%), n = 1 pulmonary embolism (2.4%). The arterial- ventricular coupling was measured by echocardiography: 0.74 (0.63-1.1). The arterial-ventricular coupling by USCOM was 0.72 (0.63 to 0.9), with a correlation of r of 0.8, an error rate of 24% and a p < 0.002. The arterial-ventricular coupling by echocardiography with a cutoff of ≤ 0.7 predicts mortality with a sensitivity of 100% and specificity of 50%, with an area under the curve of 0.75 (from 0.59 to 0.96), p = 0.46. The arterial-ventricular coupling by USCOM with a cutoff of 0.7 predicts mortality with an 80% of sensitivity, specificity of 60%, with an area under the curve of 0.79 (0.64 to 0.95) p = 0.02.

Conclusions:

It is possible to have the arterial-ventricular coupling measured in critically ill patients at their bedside by medical personnel with a four-hour training in a manner comparable to that of an expert echocardiographer. This allows the use of these complex hemodynamic analysis in a non-invasive way in the day-to-day care of the seriously ill.

Palavras-chave : Ventricular arterial coupling; shock; doppler ultrasound; echocardiography.

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