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Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index.

Authors
  • Mehmood, Muddassir1
  • Biederman, Robert W W2
  • Markert, Ronald J3
  • McCarthy, Mary C4
  • Tchorz, Kathryn M4
  • 1 Wright State University, Boonshoft School of Medicine, Dept. of Internal Medicine, Dayton, OH, USA. Electronic address: [email protected]
  • 2 Allegheny General Hospital, Division of Cardiology, Center for Cardiac MRI, Pittsburgh, PA, USA.
  • 3 Wright State University, Boonshoft School of Medicine, Dept. of Internal Medicine, Dayton, OH, USA.
  • 4 Wright State University, Boonshoft School of Medicine, Dept. of Surgery, Dayton, OH, USA.
Type
Published Article
Journal
Heart, lung & circulation
Publication Date
Jun 01, 2020
Volume
29
Issue
6
Pages
867–873
Identifiers
DOI: 10.1016/j.hlc.2019.05.186
PMID: 31257001
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The gold standard for right heart function is the assessment of right ventricular-pulmonary arterial coupling defined as the ratio of arterial to end-systolic elastance (Ea/Emax). This study demonstrates the use of the volumetric pulmonary artery (PA) catheter for estimation of Ea/Emax and describes trends of Ea/Emax, right ventricular ejection fraction (RVEF), and pulmonary artery pulsatility index (PAPi) during initial 48hours of resuscitation in the trauma surgical intensive care unit (ICU). Review of prospectively collected data for 32 mechanically ventilated adult trauma and emergency general surgery patients enrolled within 6hours of admission to the ICU. Haemodynamics, recorded every 12hours for 48hours, were compared among survivors and non-survivors to hospital discharge. Mean age was 49±20 years, 69% were male, and 84% were trauma patients. Estimated Ea/Emax was associated with pulmonary vascular resistance and inversely related to pulmonary arterial capacitance and PA catheter derived RVEF. Seven (7) trauma patients did not survive to hospital discharge. Non-survivors had higher estimated Ea/Emax, suggesting right ventricular-pulmonary arterial uncoupling, with a statistically significant difference at 48hours (2.3±1.7 vs 1.0±0.58, p=0.018). RVEF was significantly lower in non-survivors at study initiation and at 48hours. PAPi did not show a consistent trend. Estimation of Ea/Emax using volumetric PA catheter is feasible. Serial assessment of RVEF and Ea/Emax may help in early identification of right heart dysfunction in critically ill mechanically ventilated patients at risk for acute right heart failure. Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

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