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Jafari-Giv Z, Vajhi A, Farzad-Mohajeri S, Hassankhani M, Alian Samakkhah S, Hemmati A, Mohammadzade-Akbari A, Noroozzadegan M. Positive correlation between echocardiographic tricuspid E peak velocity and central venous pressure in dogs: A preliminary study. Vet Radiol Ultrasound 2024; 65:294-302. [PMID: 38513141 DOI: 10.1111/vru.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
In the absence of vascular obstruction, central venous pressure (CVP) is a hydrostatic pressure in the cranial and caudal vena cava, providing valuable information about cardiac function and intravascular volume status. It is also a component in evaluating volume resuscitation in patients with septic shock and monitoring patients with right heart disease, pericardial disease, or volume depletion. Central venous pressure is calculated in dogs by invasive central venous catheterization, which is considered high-risk and impractical in critically ill patients. This study aimed to investigate the feasibility of using echocardiographic tricuspid E/E' as a noninvasive method to estimate CVP in anesthetized healthy dogs under controlled hypovolemic conditions. Ten male mixed-breed dogs were included in the study after a thorough health assessment. For hypovolemia induction, blood withdrawal was performed, and echocardiographic factors of the tricuspid valve, including peak E and E' velocities, were measured during CVP reduction. Repeated measures analysis of variance and Bonferroni post hoc tests were employed to compare the average difference between measured echocardiographic indices and CVP values derived from catheterization and intermittent measurement methods. Spearman's ρ correlation coefficient was used to evaluate the correlation between echocardiographic indices and CVP. E peak velocity had a significant negative correlation with venous blood pressure phases (r = -0.44, P = .001), indicating a decrease in peak E velocity with progressive CVP reduction. However, tricuspid valve E' peak velocity and E/E' did not correlate with CVP, suggesting that these parameters are not reliable for CVP estimation in dogs.
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Affiliation(s)
- Zahra Jafari-Giv
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Alireza Vajhi
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Saeed Farzad-Mohajeri
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
- Department of Regenerative Medicine, Institute of Biomedical Research, University of Tehran, Tehran, Iran
| | - Mahdi Hassankhani
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Shohreh Alian Samakkhah
- Department of Food Hygiene, Faculty of Veterinary Medicine, Amol University of Special Modern Technologies (AUSMT), Amol, Iran
| | - Amin Hemmati
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Mohsin M, Farooq MU, Akhtar W, Mustafa W, Rehman TU, Malik J, Zahid T. Echocardiography in a critical care unit: A contemporary review. Expert Rev Cardiovasc Ther 2022; 20:55-63. [PMID: 35098852 DOI: 10.1080/14779072.2022.2036124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Echocardiography is a rapid, noninvasive, and complete cardiac assessment tool for patients with hemodynamic instability. This review provides an overview of the evidence for current practices in critical care units (CCUs), incorporating the use of echocardiography in different etiologies of shock. AREAS COVERED : Relevant articles were extracted after searching on databases by two reviewers and incorporated in this review in a narrative style. EXPERT OPINION : In an acute scenario, a basic echocardiographic study yields prompt diagnosis, allowing for the initiation of treatment. The most common pathologies in shocked patients are identified promptly using two-dimensional (2D) and M-mode echocardiography. A more comprehensive assessment can follow after patients have been stabilized. There are four types of shock: (i) cardiogenic shock, (ii) hypovolemic shock, (iii) obstructive shock, and (iv) septic shock. All of them can be readily identified by echocardiography. As echocardiography is increasingly being used in an intensive care setting, its applications and evidence base should be expanded by randomized controlled trials to demonstrate patient outcomes in critical care.
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Affiliation(s)
- Muhammad Mohsin
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Muhammad Umar Farooq
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, 13190, Pakistan
| | - Waqar Mustafa
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, 13190, Pakistan
| | - Tanzeel Ur Rehman
- Department of Cardiology, Benazir Bhutto Hospital, Rawalpindi, 46000, Pakistan
| | - Jahanzeb Malik
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Taimoor Zahid
- Department of Medicine, Warwick Hospital, Warwickshire, United Kingdom
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Fletcher AJ, Robinson S, Rana BS. Echocardiographic RV-E/e' for predicting right atrial pressure: a review. Echo Res Pract 2020; 7:R11-R20. [PMID: 33293465 PMCID: PMC7923036 DOI: 10.1530/erp-19-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/27/2020] [Indexed: 01/10/2023] Open
Abstract
Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e′ ratio – a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e′ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operating characteristic analyses showed reasonable diagnostic ability of RV-E/e′ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e′ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland–Altman analyses showed good accuracy but poor precision of RV-E/e′ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e′ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e′, nor about the independent prognostic ability of RV-E/e′ . Recommended areas for future research concerning RV-E/e′ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.
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Affiliation(s)
- A J Fletcher
- Department of Cardiac Physiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - S Robinson
- Department of Cardiac Investigations, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterborough, UK
| | - B S Rana
- Department of Cardiology, Imperial College London NHS Foundation Trust, London, UK
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Echocardiographic RV-E/e′ for predicting right atrial pressure: a review. Echo Res Pract 2020. [DOI: 10.1007/bf03651759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractRight atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e′ ratio–a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e′ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operating characteristic analyses showed reasonable diagnostic ability of RV-E/e′ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e′ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland–Altman analyses showed good accuracy but poor precision of RV-E/e′ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e′ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e′, nor about the independent prognostic ability of RV-E/e′. Recommended areas for future research concerning RV-E/e′ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.
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Ivey-Miranda J, Posada-Martínez E, Almeida-Gutierrez E, Flores-Umanzor E, Borrayo-Sanchez G, Saturno-Chiu G. Assessment of right atrial pressure with two-dimensional, Doppler and speckle tracking echocardiography in patients with acute right ventricular myocardial infarction. Med Intensiva 2019; 43:444-446. [DOI: 10.1016/j.medin.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/13/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
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Abstract
Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied. In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. A more comprehensive diagnosis can be achieved with advanced levels of competency, for which practice guidelines are also now available. Hemodynamic evaluation and ongoing monitoring are possible with advanced levels of competency, which includes the use of colour Doppler, spectral Doppler, and tissue Doppler imaging and occasionally the use of more recent technological advances such as 3D or speckled tracking. The four core types of shock—cardiogenic, hypovolemic, obstructive, and vasoplegic—can readily be identified by echocardiography. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Increasingly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock or hypovolemia and ventricular outflow obstruction. The diagnostic benefit of echocardiography in the shocked patient is obvious. The increasing prevalence of critical care physicians experienced in advanced techniques means echocardiography often supplants the need for more invasive hemodynamic assessment and monitoring in shock.
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Said K, Shehata A, Ashour Z, El-Tobgi S. Value of conventional and tissue Doppler echocardiography in the noninvasive measurement of right atrial pressure. Echocardiography 2012; 29:779-84. [PMID: 22494067 DOI: 10.1111/j.1540-8175.2012.01700.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evaluation of right atrial pressure (RAP) provides useful diagnostic, therapeutic, and prognostic information. AIM To assess the utility of several conventional and tissue Doppler parameters in the estimation of RAP. METHODS Among 50 consecutive patients (median age: 50 years; all in sinus rhythm), invasively measured RAP was simultaneously correlated with pulsed Doppler of tricuspid inflow (peak E and A velocities, E-wave deceleration time) and pulsed tissue Doppler of lateral tricuspid annulus (peak E' and A' velocities, isovolumic relaxation time [IVRT], acceleration time and rate of E'-wave, deceleration time and rate of E'-wave). These ratios were calculated: E/A, E'/A', E/E', and E/IVRT. RESULTS The median RAP was 14 mmHg (range 1-27 mmHg) with 29 patients (58%) having an elevated RAP (>10 mmHg). Among all studied Doppler variables, E/E' ratio showed the strongest correlation with RAP (r = 0.84, P < 0.001) with the following regression equations: RAP = 1.24 + (1.69 × E/E'). The mean difference between Doppler and invasively measured RAP was 0.21 ± 2.6 mmHg. E/ E' ratio ≥ 4.5 provides 89% sensitivity and 100% specificity for detection of elevated RAP (receiver operating characteristic area 0.95; P < 0.001). CONCLUSION Of all echocardiographic variables investigated, tricuspid annular E/E' ratio is identified as the best index for noninvasive determination of RAP.
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Affiliation(s)
- Karim Said
- Cardiovascular Department, Cairo University, Cairo, Egypt.
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Yildirimturk O, Tayyareci Y, Erdim R, Ozen E, Yurdakul S, Aytekin V, Demiroglu IC, Aytekin S. Assessment of right atrial pressure using echocardiography and correlation with catheterization. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:337-343. [PMID: 21544830 DOI: 10.1002/jcu.20837] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 03/16/2011] [Indexed: 05/30/2023]
Abstract
PURPOSE Right ventricular systolic pressure is crucial for both treatment and prognosis of cardiovascular and pulmonary diseases. The proper measurement of right ventricular systolic pressure depends on an accurate estimation of right atrial pressure (RAP). There is no standard method for estimating RAP noninvasively. The purpose of this study was to compare different noninvasive methods, namely, inferior vena cava (IVC) size and inspiratory collapse, tissue Doppler derived E/E' (TV E/E') for estimating RAP, and their correlation with catheter-based measurements in patients with mitral valve stenosis with atrial fibrillation (AF) or normal sinus rhythm (NSR). METHODS The study group consisted of 39 patients (13 men, mean age 58.9 ± 11.8 years) with rheumatic mitral valve stenosis. We performed cardiac catheterization and transthoracic echocardiography on all patients. RESULTS Mean RAP measured by catheterization was 9.7 ± 3.8 mmHg. No correlation was found between RAP and TV E/E' ratio, but there was a significant correlation between RAP and IVC diameter (r = 0.51, p < 0.05). Seventeen patients (43.6%) were in AF and 22 patients (56.4%) were in NSR. There was no correlation between TV E/E' ratio and RAP in patients with AF and in patients with NSR. RAP was correlated with collapsibility index in patients with AF (r = 0.56, p < 0.05). RAP was significantly correlated with IVC diameter (r = 0.62, p < 0.005) and collapsibility index (r = 0.49, p < 0.05) in patients with NSR. CONCLUSIONS The combination of IVC diameter and collapsibility index is a simple a semiquantitative approach that might provide a better estimation of RAP.
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Affiliation(s)
- Ozlem Yildirimturk
- Florence Nightingale Hospital, Division of Cardiology, Abide-i Hurriyet cad. No 290, 34381, Caglayan, Istanbul, Turkey
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Echocardiographic Indexes for the Non-Invasive Evaluation of Pulmonary Hemodynamics. J Am Soc Echocardiogr 2010; 23:225-39; quiz 332-4. [DOI: 10.1016/j.echo.2010.01.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Indexed: 11/20/2022]
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Haddad F, Tousignant CP, Couture P, Denault A. Are Normal Echocardiographic Values Obtained by Transthoracic Echocardiography in Awake Patients Suitable for Evaluation of Cardiac Function in Anesthetized and Mechanically Ventilated Patients? Anesth Analg 2009. [DOI: 10.1213/ane.0b013e3181b54ade] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Skubas N. Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists’ Armamentarium: A Core Review. Anesth Analg 2009; 108:48-66. [DOI: 10.1213/ane.0b013e31818a6c4c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Innelli P, Esposito R, Olibet M, Nistri S, Galderisi M. The impact of ageing on right ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 10:491-8. [DOI: 10.1093/ejechocard/jen313] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Yates AR, Welty SE, Gest AL, Cua CL. Myocardial tissue Doppler changes in patients with bronchopulmonary dysplasia. J Pediatr 2008; 152:766-70, 770.e1. [PMID: 18492512 DOI: 10.1016/j.jpeds.2007.11.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 10/24/2007] [Accepted: 11/28/2007] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether tissue Doppler measurements provide sensitive measures of right ventricular function that correlate with the severity of bronchopulmonary dysplasia (BPD). STUDY DESIGN 21 subjects (6 control subjects with no/mild BPD, 7 patients with moderate BPD, and 8 patients with severe BPD) underwent limited echocardiograms with standard M-mode, mitral and tricuspid inflow velocities, and tissue Doppler features measured. BPD severity was scored by using the NICHD/NHLBI/ORD workshop rating scale by physicians blinded to the echocardiogram results. Groups were compared by using 1-way analysis of variance with post-hoc testing and linear regression. RESULTS Patients with moderate BPD had a higher early Doppler inflow velocity to the early tissue Doppler velocity ratio (E/E' ratio; P = .03), corresponding to increased end diastolic pressure, compared with patients with no/mild BPD. Patients with severe BPD had a higher E/E' ratio (P = .004) than patients with no/mild BPD. Linear regression demonstrated a correlation between BPD category and right ventricle E/E' (P = .007, R(2) = 0.33) and left ventricular myocardial performance index (P = .02, R(2) = 0.28). CONCLUSION Increasing right ventricle E/E' ratio correlates with clinical severity of BPD. Abnormal left ventricular myocardial performance index was noted to correlate with the grade of BPD. Further longitudinal studies of tissue Doppler echocardiographic assessment of cardiac function in premature infants with BPD are needed.
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Affiliation(s)
- Andrew R Yates
- Department of Pediatrics, Ohio State University, and Columbus Children's Hospital Heart Center, Columbus, Ohio 43205, USA.
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