Arterial dP/dt(max) accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

作者：Morimont Philippe^*; Lambermont Bernard; Desaive Thomas; Janssen Nathalie; Chase Geoffrey; D' Orio Vincent

来源：BMC Cardiovascular Disorders, 2012, 12: 13.

DOI：10.1186/1471-2261-12-13

• Left ventricular function
• Aortic pressure
• Septic cardiomyopathy
• Preload responsiveness
• Endotoxin-induced shock

Background: Peak first derivative of femoral artery pressure (arterial dP/dt(max)) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dt(max) is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion. %26lt;br%26gt;Methods: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dt(max) was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility. %26lt;br%26gt;Results: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r = 0.51; p %26lt; 0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV) %26lt;= 11% (r = 0.77; p %26lt; 0.001). %26lt;br%26gt;Conclusion: While arterial dP/dt(max) and Ees were significantly correlated during various hemodynamic conditions, arterial dP/d(tmax) was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV %26lt;= 11%, was achieved.

• 出版日期2012-3-1