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Estimating the effective arterial elastance at bedside: a reply to a rebuttal

  • Denis ChemlaEmail author
  • Jean-Louis Teboul
  • Mathieu Jozwiak
Letter to the Editor
  • 9 Downloads

We are sorry to report that we do not find Monge Garcia et al. rebuttal [1] to our letter [2] convincing. Some of their points seem warranted, but so many of their claims demand challenge and are not evidence-based.

Claim 1 “Ignoring stroke volume, any peripheral estimation of Ea [the effective arterial elastance] will be valid as long as the arterial surrogate is close to Pes [the left ventricular end-systolic pressure LVESP]. In this regard, MAP [the mean arterial pressure], dicrotic notch pressure and 90% of aortic systolic pressure offer similar performance. But aortic, not femoral or radial pressure [ 1]”. As far as aortic pressure is concerned, this claim is not evidence-based. The opposite has been documented by two independent studies using high-fidelity pressure recordings and showing that MAP markedly underestimates LVESP while 90% aortic systolic arterial pressure (SAP) matches LVESP [ 3, 4] (Table  1). The important point is that in humans, particularly those with stiff or...

Notes

Compliance with ethical standards

Conflict of interest

None declared for all authors in the subject matter (pathophysiology).

References

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Denis Chemla
    • 1
    • 2
    Email author
  • Jean-Louis Teboul
    • 2
    • 3
  • Mathieu Jozwiak
    • 4
  1. 1.Service de Physiologie-Explorations FonctionnellesHôpitaux universitaires Paris Sud, Faculté de médecineLe Kremlin BicêtreFrance
  2. 2.INSERM UMR_S 999Hôpital Marie LannelongueLe Plessis RobinsonFrance
  3. 3.Service de Médecine Intensive-RéanimationHôpitaux universitaires Paris Sud, Faculté de médecineLe Kremlin BicêtreFrance
  4. 4.Service de Médecine Intensive-RéanimationHôpitaux universitaires Paris Centre - Hôpital CochinParisFrance

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