From a cardio-vascular reserve hypothesis to a proposed measurable index: A pilot empirical validation

Uri Gabbay , Ben-Zion Bobrovsky , Issahar Ben-Dov , Ronen Durst , Itay E. Gabbay , Michael J. Segel
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引用次数: 6

Abstract

Background

Cardiovascular reserve index (CVRI) was previously proposed as an estimate of the assumed (momentary) cardiovascular reserve as a function of stroke volume (SV), systemic vascular resistance (SVR), respiratory rate (RR) and body surface area (BSA). Conversion through conventional hemodynamic equations reveals an equivalent, simpler, vital signs based function. We evaluated the association between CVRI and diverse conditions along the hemodynamic spectrum.

Methods

CVRI was retrospectively computed for each subject of 3 existing patient databases. 1) Acute severe hospital admissions [N = 333] classified by disease course to: “shock on arrival”, “developing shock” and “non-shock”. 2) Heart failure (HF) patients [N = 71] classified by HF severity to: mild, moderate and severe HF. 3) Cardio-pulmonary exercise testing (CPX) [n = 387] classified by exercise capacity (EC) to: normal, mildly decrease, moderately decrease and severely decreased EC. CVRI association with these hemodynamic conditions was evaluated through ANOVA.

Results

‘Normal EC’ has the highest CVRI of 0.97 (0.88, 1.06), and in decreasing CVRI order ‘mildly decrease EC’, ‘moderately decrease EC’, ‘mild HF’ which was similar to ‘severely decrease EC’, ‘moderate HF’ which was similar to acute severe admission of ‘non-shock’, ‘severe heart failure’ which was similar to ‘developing shock’ and the lowest CVRI was observed in ‘shock on arrival’ with mean CVRI of 0.20 (0.19, 0.22), ANOVA p < 0.001.

Conclusions

Mean CVRI exhibited consistent inverse association with the severity of the hemodynamic condition. However, CVRI clinical utility of an individual patient requires further studies.

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从心血管储备假说到提议的可测量指数:试点经验验证
心血管储备指数(CVRI)是先前提出的假设(瞬时)心血管储备的函数,它是脑卒中容量(SV)、全身血管阻力(SVR)、呼吸频率(RR)和体表面积(BSA)的函数。通过传统的血流动力学方程的转换揭示了一个等效的、更简单的、基于生命体征的函数。我们评估了CVRI与血流动力学谱上不同情况之间的关系。方法回顾性计算3个现有患者数据库中每个受试者的scvri。1)急性重症住院病例[N = 333],按病程分为:“到达时休克”、“发展中休克”和“非休克”。2)心力衰竭(HF)患者[N = 71],按HF严重程度分为:轻度、中度和重度HF。3)心肺运动试验(CPX) [n = 387],按运动能力(EC)分为:正常、轻度降低、中度降低和严重降低。通过方差分析评估CVRI与这些血流动力学状况的关系。结果“正常心衰”的CVRI最高,为0.97 (0.88,1.06),CVRI递减顺序依次为“轻度降低心衰”、“中度降低心衰”、“轻度降低心衰”与“严重降低心衰”相似、“中度心力衰竭”与“急性重症非休克”相似、“重度心衰”与“发展性休克”相似,“到达休克”的CVRI最低,平均CVRI为0.20(0.19,0.22),方差分析p <0.001.结论平均CVRI与血流动力学状况的严重程度呈一致的负相关。然而,CVRI在个体患者的临床应用还需要进一步的研究。
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