{"title":"二尖瓣速度时间积分和被动抬高腿作为体积反应性的测量。","authors":"Ralphe Bou Chebl, Gilbert Abou Dagher, Jeffrey Wuhantu, Rana Bachir, Jennifer Carnell","doi":"10.1186/s13089-018-0114-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness.</p><p><strong>Methods: </strong>This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled. A focused echocardiogram was done on enrolled patients. Two sets of measurements were obtained before and after hemodialysis. During each scanning session, the left ventricular outflow tract and the mitral valve VTI were obtained before and after a passive leg raise maneuver.</p><p><strong>Results: </strong>54 patients were enrolled, of which, 30 (55%) were male. The mean age was 47.4 years. The mean volume of fluid removed was 3.89 ± 0.91 L. All patients had a diagnosis of hypertension, 22 (41%) patients were diabetic, 14 (26%) patients had coronary artery disease, and 19 (35%) patients had congestive heart failure. The mean change in LVOT VTI was 1.83% (95% CI 0.12-3.55) in the pre-dialysis group and 15.05% (95% CI 12.76-17.34) in the post-hemodialysis cohort. The mean change in MV VTI was 3.74% (95% CI 2.84-4.65) in the pre-dialysis cohort and 12.95% (95% CI 11.50-14.39) in the post-dialysis cohort. For patients who had < 4 L removed, the mean delta LVOT VTI post-hemodialysis was 12.64% (95% CI 9.79-15.49) and the mean delta MV VTI was 10.48% (95% CI 8.28-12.69). For patients who had > 4 L removed, the mean delta LVOT VTI was 16.84% (95% CI 13.47-20.22) and the mean MV VTI was 14.77% (95% CI 13.03-16.51). Mitral valve VTI with PLR was found to have a sensitivity of 89.18% and a specificity of 94.11% in detecting volume responsiveness.</p><p><strong>Conclusion: </strong>Mitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients.</p>","PeriodicalId":46598,"journal":{"name":"Critical Ultrasound Journal","volume":"10 1","pages":"32"},"PeriodicalIF":3.6000,"publicationDate":"2018-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13089-018-0114-3","citationCount":"4","resultStr":"{\"title\":\"Mitral valve velocity time integral and passive leg raise as a measure of volume responsiveness.\",\"authors\":\"Ralphe Bou Chebl, Gilbert Abou Dagher, Jeffrey Wuhantu, Rana Bachir, Jennifer Carnell\",\"doi\":\"10.1186/s13089-018-0114-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness.</p><p><strong>Methods: </strong>This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled. A focused echocardiogram was done on enrolled patients. Two sets of measurements were obtained before and after hemodialysis. During each scanning session, the left ventricular outflow tract and the mitral valve VTI were obtained before and after a passive leg raise maneuver.</p><p><strong>Results: </strong>54 patients were enrolled, of which, 30 (55%) were male. The mean age was 47.4 years. The mean volume of fluid removed was 3.89 ± 0.91 L. All patients had a diagnosis of hypertension, 22 (41%) patients were diabetic, 14 (26%) patients had coronary artery disease, and 19 (35%) patients had congestive heart failure. The mean change in LVOT VTI was 1.83% (95% CI 0.12-3.55) in the pre-dialysis group and 15.05% (95% CI 12.76-17.34) in the post-hemodialysis cohort. The mean change in MV VTI was 3.74% (95% CI 2.84-4.65) in the pre-dialysis cohort and 12.95% (95% CI 11.50-14.39) in the post-dialysis cohort. For patients who had < 4 L removed, the mean delta LVOT VTI post-hemodialysis was 12.64% (95% CI 9.79-15.49) and the mean delta MV VTI was 10.48% (95% CI 8.28-12.69). For patients who had > 4 L removed, the mean delta LVOT VTI was 16.84% (95% CI 13.47-20.22) and the mean MV VTI was 14.77% (95% CI 13.03-16.51). Mitral valve VTI with PLR was found to have a sensitivity of 89.18% and a specificity of 94.11% in detecting volume responsiveness.</p><p><strong>Conclusion: </strong>Mitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients.</p>\",\"PeriodicalId\":46598,\"journal\":{\"name\":\"Critical Ultrasound Journal\",\"volume\":\"10 1\",\"pages\":\"32\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2018-12-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1186/s13089-018-0114-3\",\"citationCount\":\"4\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Ultrasound Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s13089-018-0114-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Ultrasound Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s13089-018-0114-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 4
摘要
背景:液体反应是临床医生的一个重要课题。过度补水已被证明会导致更糟糕的结果。本研究的目的是探讨二尖瓣(MV)速度时间积分(VTI)作为容量反应性的非侵入性标志物的敏感性和特异性。方法:这是一项在三级急诊科进行的前瞻性观察研究。到急诊科就诊需要紧急血液透析的终末期肾病患者被纳入研究对象。对入组患者进行了聚焦超声心动图检查。分别在血液透析前后进行两组测量。在每次扫描过程中，在被动抬腿操作前后分别获得左心室流出道和二尖瓣VTI。结果:入组患者54例，其中男性30例(55%)。平均年龄47.4岁。平均取液量为3.89±0.91 l，所有患者均诊断为高血压，22例(41%)为糖尿病，14例(26%)为冠状动脉疾病，19例(35%)为充血性心力衰竭。透析前组LVOT VTI的平均变化为1.83% (95% CI 0.12-3.55)，血液透析后组为15.05% (95% CI 12.76-17.34)。透析前队列中MV VTI的平均变化为3.74% (95% CI 2.84-4.65)，透析后队列中为12.95% (95% CI 11.50-14.39)。对于切除4l的患者，平均δ LVOT VTI为16.84% (95% CI 13.47-20.22)，平均MV VTI为14.77% (95% CI 13.03-16.51)。二尖瓣VTI伴PLR检测体积反应性的灵敏度为89.18%，特异性为94.11%。结论:二尖瓣速度积分与被动抬腿似乎与血液透析患者的容量反应性相关。
Mitral valve velocity time integral and passive leg raise as a measure of volume responsiveness.
Background: Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness.
Methods: This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled. A focused echocardiogram was done on enrolled patients. Two sets of measurements were obtained before and after hemodialysis. During each scanning session, the left ventricular outflow tract and the mitral valve VTI were obtained before and after a passive leg raise maneuver.
Results: 54 patients were enrolled, of which, 30 (55%) were male. The mean age was 47.4 years. The mean volume of fluid removed was 3.89 ± 0.91 L. All patients had a diagnosis of hypertension, 22 (41%) patients were diabetic, 14 (26%) patients had coronary artery disease, and 19 (35%) patients had congestive heart failure. The mean change in LVOT VTI was 1.83% (95% CI 0.12-3.55) in the pre-dialysis group and 15.05% (95% CI 12.76-17.34) in the post-hemodialysis cohort. The mean change in MV VTI was 3.74% (95% CI 2.84-4.65) in the pre-dialysis cohort and 12.95% (95% CI 11.50-14.39) in the post-dialysis cohort. For patients who had < 4 L removed, the mean delta LVOT VTI post-hemodialysis was 12.64% (95% CI 9.79-15.49) and the mean delta MV VTI was 10.48% (95% CI 8.28-12.69). For patients who had > 4 L removed, the mean delta LVOT VTI was 16.84% (95% CI 13.47-20.22) and the mean MV VTI was 14.77% (95% CI 13.03-16.51). Mitral valve VTI with PLR was found to have a sensitivity of 89.18% and a specificity of 94.11% in detecting volume responsiveness.
Conclusion: Mitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients.
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