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Intensive Care Medicine

, Volume 30, Issue 1, pp 75–81 | Cite as

Tissue Doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients

  • Alain CombesEmail author
  • Florence Arnoult
  • Jean-Louis Trouillet
Original

Abstract

Objective

Earlier reports suggested that transthoracic (TTE) determination of the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/E’) measured by tissue Doppler imaging (TDI) closely approximates PAOP in cardiac patients. However, the value of E/E’ for PAOP assessment in ICU patients has not been evaluated. This study assessed whether the E/E’ ratio provides an accurate estimation of pulmonary artery occlusion pressure (PAOP) in mechanically ventilated ICU patients.

Design and setting

Prospective, open, clinical study in the ICU of a university hospital.

Patients

Twenty-three consecutive mechanically ventilated patients.

Interventions

Volume expansion in 14 patients.

Measurements and results

Doppler TTE or TEE mitral inflow and TDI mitral annulus velocities were determined and compared with PAOP measured using a Swan-Ganz catheter. Of all the Doppler variables studied the best correlations were observed between PAOP and the lateral (r=0.84) and medial (r=0.76) annulus E/E’ ratio and remained highly significant when the analysis was restricted to TEE (r=0.91 and 0.86) or TTE (r=0.73 and 0.61). The sensitivities and specificities of estimating PAOP at 15 mmHg or higher were, respectively, 86% and 81% for lateral E/E’ above 7.5 and 76% and 80% for medial E/E’ above 9. PAOP changes after volume expansion (700±230 ml) were limited and accurately assessed by repeated E/E’ determinations.

Conclusions

In mechanically ventilated ICU patients TTE or TEE E/E’ determinations using TDI closely approximate PAOP.

Keywords

Echocardiography, Doppler Ventricular function, left Pulmonary wedge pressure Intensive care units Respiration, artificial Prospective studies 

Notes

Acknowledgements

The authors thank Dr. Dominique De Zuttere for his careful advises and critical review of the manuscript and Thierry Scheerlink (Toshiba Corp.) for providing the Toshiba Ultrasound Workstation UIWS-300A.

References

  1. 1.
    Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D (1970) Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 283:447–451PubMedGoogle Scholar
  2. 2.
    Pulmonary Artery Catheter Consensus Conference (1997) Consensus statement. Crit Care Med 25:910–925PubMedGoogle Scholar
  3. 3.
    Bernard GR, Sopko G, Cerra F, Demling R, Edmunds H, Kaplan S, Kessler L, Masur H, Parsons P, Shure D, Webb C, Weidemann H, Weinmann G, Williams D (2000) Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement. JAMA 283:2568–2572PubMedGoogle Scholar
  4. 4.
    Chastre J, Cornud F, Bouchama A, Viau F, Benacerraf R, Gibert C (1982) Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein: prospective evaluation by phlebography. N Engl J Med 306:278–281Google Scholar
  5. 5.
    Robin ED (1987) Death by pulmonary artery flow-directed catheter. Time for a moratorium? Chest 92:727–731PubMedGoogle Scholar
  6. 6.
    Foote GA, Schabel SI, Hodges M (1974) Pulmonary complications of the flow-directed balloon-tipped catheter. N Engl J Med 290:927–931PubMedGoogle Scholar
  7. 7.
    Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, Desbiens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ Jr, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 276:889–897PubMedGoogle Scholar
  8. 8.
    Nagueh SF, Kopelen HA, Zoghbi WA (1995) Feasibility and accuracy of Doppler echocardiographic estimation of pulmonary artery occlusive pressure in the intensive care unit. Am J Cardiol 75:1256–1262CrossRefPubMedGoogle Scholar
  9. 9.
    Giannuzzi P, Imparato A, Temporelli PL, de Vito F, Silva PL, Scapellato F, Giordano A (1994) Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol 23:1630–1637PubMedGoogle Scholar
  10. 10.
    Kuecherer HF, Muhiudeen IA, Kusumoto FM, Lee E, Moulinier LE, Cahalan MK, Schiller NB (1990) Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 82:1127–1139PubMedGoogle Scholar
  11. 11.
    Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533CrossRefPubMedGoogle Scholar
  12. 12.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedGoogle Scholar
  13. 13.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedGoogle Scholar
  14. 14.
    Wahr DW, Wang YS, Schiller NB (1983) Left ventricular volumes determined by two-dimensional echocardiography in a normal adult population. J Am Coll Cardiol 1:863–868Google Scholar
  15. 15.
    Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW (1997) Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 30:474–480CrossRefPubMedGoogle Scholar
  16. 16.
    Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794PubMedGoogle Scholar
  17. 17.
    Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quinones MA, Zoghbi WA (1998) Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue Doppler imaging. Circulation 98:1644–1650PubMedGoogle Scholar
  18. 18.
    Nagueh SF, Lakkis NM, Middleton KJ, Spencer WH, Zoghbi WA, Quinones MA (1999) Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation 99:254–261PubMedGoogle Scholar
  19. 19.
    Sundereswaran L, Nagueh SF, Vardan S, Middleton KJ, Zoghbi WA, Quinones MA, Torre-Amione G (1998) Estimation of left and right ventricular filling pressures after heart transplantation by tissue Doppler imaging. Am J Cardiol 82:352–357CrossRefPubMedGoogle Scholar
  20. 20.
    Garcia MJ, Ares MA, Asher C, Rodriguez L, Vandervoort P, Thomas JD (1997) An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol 29:448–454PubMedGoogle Scholar
  21. 21.
    Gonzalez-Vilchez F, Ares M, Ayuela J, Alonso L (1999) Combined use of pulsed and color M-mode Doppler echocardiography for the estimation of pulmonary capillary wedge pressure: an empirical approach based on an analytical relation. J Am Coll Cardiol 34:515–523CrossRefPubMedGoogle Scholar
  22. 22.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  23. 23.
    Tousignant CP, Walsh F, Mazer CD (2000) The use of transesophageal echocardiography for preload assessment in critically ill patients. Anesth Analg 90:351–355PubMedGoogle Scholar
  24. 24.
    Axler O, Tousignant C, Thompson CR, Dalla’va-Santucci J, Drummond A, Phang PT, Russell JA, Walley KR (1997) Small hemodynamic effect of typical rapid volume infusions in critically ill patients. Crit Care Med 25:965–970Google Scholar
  25. 25.
    Yamada E, Garcia M, Thomas JD, Marwick TH (1998) Myocardial Doppler velocity imaging-a quantitative technique for interpretation of dobutamine echocardiography. Am J Cardiol 82:806–810CrossRefPubMedGoogle Scholar
  26. 26.
    Najos-Valencia O, Cain P, Case C, Wahi S, Marwick TH (2002) Determinants of tissue Doppler measures of regional diastolic function during dobutamine stress echocardiography. Am Heart J 144:516–523CrossRefPubMedGoogle Scholar
  27. 27.
    Nagueh SF, Kopelen HA, Quinones MA (1996) Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation 94:2138–2145PubMedGoogle Scholar
  28. 28.
    Temporelli PL, Scapellato F, Corra U, Eleuteri E, Imparato A, Giannuzzi P (1999) Estimation of pulmonary wedge pressure by transmitral Doppler in patients with chronic heart failure and atrial fibrillation. Am J Cardiol 83:724–727CrossRefPubMedGoogle Scholar
  29. 29.
    Pinsky M, Vincent JL, De Smet JM (1991) Estimating left ventricular filling pressure during positive end-expiratory pressure in humans. Am Rev Respir Dis 143:25–31PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Alain Combes
    • 1
    Email author
  • Florence Arnoult
    • 2
  • Jean-Louis Trouillet
    • 1
  1. 1.Réanimation Médicale,Institut de CardiologieAP-HP, Hôpital Pitié-SalpêtrièreParisFrance
  2. 2.Explorations fonctionnellesAP-HP, Hôpital BichatParisFrance

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