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Reliability of effective arterial elastance using peripheral arterial pressure as surrogate for left ventricular end-systolic pressure

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A Letter to the Editor to this article was published on 18 February 2019

Abstract

To compare the effective arterial elastance (Ea) obtained from the arterial pressure with Ea calculated from left-ventricular (LV) pressure–volume analysis. Experimental study. LV pressure–volume data was obtained with a conductance catheter and arterial pressures were measured via a fluid-filled catheter placed in the proximal aorta, femoral and radial arteries. Ea was calculated as LV end-systolic pressure (ESP)/stroke volume (SV). Experimental protocol consisted sequentially changing afterload (phenylephrine/nitroprusside), preload (bleeding/fluid), and contractility (esmolol/dobutamine). 90% of systolic pressure (Eaao_SYS, Eafem_SYS, Earad_SYS), mean arterial pressure (Eaao_MAP, Eafem_MAP, Earad_MAP), and dicrotic notch pressure (Eaao_DIC, Eafem_DIC, Earad_DIC) were used as surrogates for LV ESP. SV was calculated from the LV pressure–volume data. When Ea was compared with estimations based on 90% SAP, the relationship was r2 = 0.95, 0.94 and 0.92; and the bias and limits of agreement (LOA): − 0.01 ± 0.12, − 0.09 ± 0.12, − 0.05 ± 0.15 mmHg ml−1, for Eaao_SYS, Eafem_SYS and Earad_SYS, respectively. For estimates using dicrotic notch, the relationship was r2 = 0.94, 0.95 and 0.94 for Eaao_DIC, Eafem_DIC and Earad_DIC, respectively; with a bias and LOA: 0.05 ± 0.11, 0.06 ± 0.12, 0.10 ± 0.12 mmHg ml−1, respectively. When Ea was compared with estimates using MAP, the relationship was r2 = 0.95, 0.96 and 0.95 for Eaao_MAP, Eafem_MAP and Earad_MAP, respectively; with a bias and LOA: 0.05 ± 0.11, 0.06 ± 0.11, 0.06 ± 0.11 mmHg ml−1, respectively. LV ESP can be estimated from the arterial pressure. Provided that the SV measurement is reliable, the ratio MAP/SV provides a robust Ea surrogate over a wide range of hemodynamic conditions and is interchangeably in any peripheral artery, so it should be recommended as an arterial estimate of Ea in further research.

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Acknowledgements

We are grateful to all laboratory staff of the Edwards Research Center for their help in this work.

Funding

Edwards Lifesciences provided the software, hardware, and animals for the study.

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Authors and Affiliations

  1. Unidad de Cuidados Intensivos, Hospital Universitario SAS de Jerez, C/ Circunvalación, s/n, 11407, Jerez de la Frontera, Spain

    Manuel Ignacio Monge Garcia

  2. Edwards Lifesciences, Irvine, CA, USA

    Zhongping Jian, Jos J. Settels & Feras Hatib

  3. Department Anaesthesia and Intensive Care Units, Humanitas Research Hospital, Humanitas University, Milan, Italy

    Maurizio Cecconi & Michael R. Pinsky

  4. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Michael R. Pinsky

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  1. Manuel Ignacio Monge Garcia
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Contributions

Study conception: MIMG, MRP and MC. Study design: MIMG, ZJ, MRP. Performed experimental research: MIMG, ZJ, FH. Analyzed and interpreted the data: MIMG, ZJ, MRP, FH. Drafted the manuscript: MIMG, ZJ, JJS and FH. All authors reviewed it, contributed significantly to its critical review, and approved the final version of the manuscript. All authors ensure the accuracy or integrity of the results of this study and will be accountable for any question related with this work.

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Correspondence to Manuel Ignacio Monge Garcia.

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Conflict of interest

MIMG is a consultant to Edwards Lifesciences and received honoraria and/or travel expenses from Deltex Medical. MRP is a consultant to Edwards LifeSciences, LiDCO Ltd., and Cheetah. MC has received honoraria and/or travel expenses from Edwards Lifesciences, LiDCO, Cheetah, Bmeye, Masimo and Deltex Medical. ZJ, JJS, and FH are Edwards Lifesciences employees.

Ethical approval

The study was approved for the use of Yorkshire crossbred pigs by the Institutional Animal Care and Use Committee (IACUC) at the Edwards Research Center, and all experimentation was performed in accordance with the USDA Animal Welfare Act regulations (AWArs), and the Guide for the Care and Use of Laboratory Animals (ILAR, NAP, Washington, DC, 2010, 8th edition). The Test Facility is accredited by the Association for the Assessment and Accreditation of Laboratory Animal Care, International (AAALACi) and registered with the United States Department of Agriculture to conduct research with laboratory animals. The ARRIVE guidelines were used for the elaboration of this manuscript.

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Monge Garcia, M.I., Jian, Z., Settels, J.J. et al. Reliability of effective arterial elastance using peripheral arterial pressure as surrogate for left ventricular end-systolic pressure. J Clin Monit Comput 33, 803–813 (2019). https://doi.org/10.1007/s10877-018-0236-y

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  • DOI: https://doi.org/10.1007/s10877-018-0236-y

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