4 Non-invasive assessment of left ventricular contractility by means of transoesophageal echocardiography

MD Christoph Schmidt (Staff anaesthesiologist), MD Franc Hinder (Staff anaesthesiologist), MD, PhD Hugo Van Aken (Director), MD, PhD, FCCP Jan I. Poelaert (Clinical Director, Postoperative Cardiac Surgical ICU)
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引用次数: 1

Abstract

While assessment of ventricular loading conditions is readily accessible at the patient's bedside, evaluation of contractile function is remarkably more complicated. The difficulty in obtaining contractility measurements in patients is directly related to the intimate interrelation between inotropic state and ventricular loads at the level of the intact organism. Despite the inherent problems in measuring contractility, it is of crucial importance in experimental research as well as in clinical medicine to separate the effects of a primary change in load from a primary change in contractility, whenever a clinical situation with severe left ventricular dysfunction presents itself. The most useful approaches for assessing contractility in clinical medicine involve transoesophageal echocardiography. By providing estimations of clinically important but previously inaccessible physiological parameters, this technology paved the way for a more quantitative assessment of cardiac function. Three different non-invasive techniques to measure left ventricular contractility by means of echocardiography have been applied in humans: (1) the reconstruction of the end-systolic pressure-volume relation; (2) the end-systolic meridional wall stress-rate-corrected mean velocity of fibre shortening relation; and (3) the pre-concept of preload-adjusted maximal power.

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经食管超声心动图无创评价左心室收缩力
虽然在病人床边可以很容易地评估心室负荷状况,但对收缩功能的评估要复杂得多。获得患者收缩力测量的困难与肌力状态和完整机体水平上心室负荷之间的密切相互关系直接相关。尽管测量收缩力存在固有的问题,但在实验研究和临床医学中,每当出现严重左心室功能障碍的临床情况时,将原发性负荷变化的影响与原发性收缩力变化的影响分开是至关重要的。在临床医学中评估收缩力最有用的方法是经食管超声心动图。通过提供临床重要但以前无法获得的生理参数的估计,该技术为更定量的心功能评估铺平了道路。三种不同的无创超声心动图技术已经应用于人类左心室收缩力测量:(1)重建收缩期末压力-容积关系;(2)收缩末期经子午壁应力-速率校正的纤维缩短平均速度关系;(3)预载荷调整最大功率的预概念。
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