Noninvasive assessment of left ventricular contractility in pediatric patients using the maximum rate of pressure rise in peripheral arteries
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Hidenori Kawasaki Mitsuru Seki Hirofumi Saiki Satoshi Masutani Hideaki Senzaki
- چاپ و سال / کشور: 2011
Description
The maximum rate of left ventricular pressure rise (LV dp/dtmax) is a good indicator of ventricular contractility. However, its measurement requires invasive cardiac catheterization. By applying the relationship between the ratio of aorta (Ao) dp/dtmax to LV dp/dtmax and the mean artery pressure (MAP), we tested the possible noninvasive estimation of LV dp/dtmax by the maximum rate of pressure rise in peripheral arteries, as measured by tonometry. The study subjects were 31 children with cardiovascular disease. The LV and Ao pressures were measured during cardiac catheterization, with simultaneous recording of the brachial (BrA) or radial (RaA) artery pressure. The relationships between BrA dp/dtmax and Ao dp/dtmax and between RaA dp/dtmax and Ao dp/dtmax were determined (Ao dp/dtmax = 0.299 9 BrA dp/dtmax ? 210.6, n = 17, r = 0.78, SEE = 74.0, P = 0.0002, and Ao dp/dtmax = 1.442 9 RaA dp/dtmax ? 165.9, n = 14, r = 0.87, SEE = 66.1, P = 0.0001). Using these relationships and the equation Ao dp/dtmax/LV dp/dtmax = 0.694 - 4.00 9 10-3 9 MAP, LV dp/dtmax was estimated from BrA dp/dtmax or RaA dp/dtmax. The estimated LV dp/dtmax correlated well with the measured LV dp/dtmax independent of the site of measurement (y = 0.912 9 x ? 112.9, r = 0.91, P\0.0001). Furthermore, there was excellent correlation between the measured and estimated LV dp/ dtmax after changes in contractility with dobutamine in 10 randomly selected patients (y = 0.86 9 x ? 34.2, r = 0.77, P = 0.01). It is possible to estimate LV dp/dtmax noninvasively in children using tonometry. This procedure can be useful for bedside assessment of LV contractility and the clinical management of patients with cardiovascular disease.
Heart Vessels DOI 10.1007/s00380-011-0162-0 Received: 7 October 2010 / Accepted: 20 May 2011
