Bedside assessment of central venous pressure by sonographic measurement of right ventricular outflow-tract fractional shortening

Ünlüer, Erol Erden; Yavaşı, Özcan; Akoğlu, Haldun; Kara, Hanife Pinar; Bayata, Serdar; Yurekli, Ismail; Yilik, Levent; Gürbüz, Ali

doi:10.1097/mej.0b013e32834f835a

Cited by 7 publications

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“…A previous study found that right ventricular outflow fractional shortening, which is used to assess right ventricular systolic function, can be used to predict the central venous pressure [ 18 ]. In a large cohort of healthy subjects, Ferrara F et al noted that the TAPSE was correlated with echo-Doppler indices reflecting preload [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Tricuspid annular plane systolic excursion and central venous pressure in mechanically ventilated critically ill patients

Zhang

Wang

Chen

et al. 2018

Cardiovasc Ultrasound

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BackgroundThe tricuspid annular plane systolic excursion (TAPSE) is commonly recommended for estimating the right ventricular systolic function. The central venous pressure (CVP), which is determined by venous return and right heart function, was found to be associated with right ventricular outflow fractional shortening. This study thus aimed to investigate the relationship between the TAPSE and CVP in mechanically ventilated critically ill patients.MethodsThis is a prospective observational study. From October 1 to December 31, 2017, patients admitted to the intensive care unit with CVP monitoring and controlled mechanical ventilation were screened for enrolment. Echocardiographic parameters, including the TAPSE, mitral annular plane systolic excursion (MAPSE), left ventricular ejection fraction (LVEF), and internal diameter of inferior vena cava (dIVC), and haemodynamic parameters, including the CVP, were collected.ResultsSeventy-four patients were included. Thirty-one were included in the low LVEF (< 55%) group, and 43 were included in the high LVEF (≥55%) group. In the high LVEF group, the TAPSE and CVP were not correlated (r = − 0.234, P = 0.151). In the low LVEF group, partial correlation analysis indicated that the TAPSE and CVP were correlated (r = − 0.516, P = 0.006), and multivariable linear regression analysis indicated that the TAPSE was independently associated with the CVP (standard coefficient: − 0.601, p < 0.001). Additionally, in the low LVEF group, a ROC analysis showed that the area under the curve of the TAPSE for the detection of CVP greater than 8 mmHg was 0.860 (95% confidence interval: 0.730–0.991; P = 0.001). The optimum cut-off value was 1.52 cm, which resulted in a sensitivity of 75.0%, a specificity of 86.7%, a positive predictive value of 84.6% and a negative predictive value of 77.8%.ConclusionsThe TAPSE is inversely correlated with the CVP in mechanically ventilated critically ill patients who have a LVEF less than 55%.

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Section: Introductionmentioning

confidence: 99%

Tricuspid annular plane systolic excursion and central venous pressure in mechanically ventilated critically ill patients

Zhang

Wang

Chen

et al. 2018

Cardiovasc Ultrasound

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Section: Introductionmentioning

confidence: 99%

“…To date, evaluation of goal-directed emergency department (ED) BECH has focused on the diagnosis of pericardial effusions, diastolic heart failure, and determination of central venous pressure. 5 – 7 A study by Moore et al 8 found 84% agreement between ED sonographers and cardiologists in determining LVEF in hypotensive patients. To date, most of the studies in the EDs are based on quantitative measurements of LVEF, such as single- or biplane Simpson ejection fraction, fractional shortening of left ventricular walls, or Mitral E point septal separation.…”

Section: Introductionmentioning

confidence: 99%

Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians

Ünlüer¹,

Karagöz²,

Akoğlu³

et al. 2014

WestJEM

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IntroductionThe objective of this study was to determine whether bedside visual estimates of left ventricular systolic function (LVSF) by emergency physicians (EP) would agree with quantitative measurement of LVSF by the modified Simpson’s method (MSM), as recommended by the American Society of Echocardiography.MethodsAfter limited focused training, 2 trained EPs performed bedside echocardiography (BECH) procedures s between January and June 2012 to prospectively evaluate patients presenting to the emergency department (ED) with dyspnea. EPs categorized their visually estimated ejection fractions (VEF) as either low or normal. Formal echocardiography were ordered and performed by an experienced cardiologist using the MSM and accepted as the criterion standard. We compared BECH results for each EP using chi-squared testing and performed correlation analysis by Pearson correlation coefficient.ResultsOf the 146 enrolled patients with dyspnea, 13 were excluded and 133 were included in the study. Comparison of EPs vs. cardiologist’s estimate of ejection fraction yielded a Pearson’s correlation coefficient of 0.77 (R, p<0.0001) and 0.78 (R, p<0.0001). Calculated biserial correlations using point-biserial correlation and z-scores were 1 (rb, p<0.0001) for both EPs. The agreement between EPs and the cardiologist was 0.861 and 0.876, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and the positive and negative likelihood ratios for each physician were 98.7–98.7%, 86.2–87.9%, 0.902–0.914, 0.980–0.981, 7.153–8.175, 0.015–0.015, respectively.ConclusionEPs with a focused training in limited BECH can assess LVSF accurately in the ED by visual estimation.

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“…Over the past two decades, there has been considerable enthusiasm for the development and use of FOCUS for assessing patients admitted to the ED with the complaint of dyspnea . Most of the studies designed within the ED have primarily focused on a visual estimation of LVEF rather than calculations involving the measurement of LV chamber dimensions throughout the cardiac cycle .…”

Section: Discussionmentioning

confidence: 99%

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

Ünlüer

Karagöz

Bayata

et al. 2013

Academic Emergency Medicine

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Objectives: Left ventricular ejection fraction (LVEF) is a crucial parameter in the management of patients with dyspnea in the emergency department (ED). The use of techniques other than echocardiography such as nuclear or magnetic resonance imaging to measure LVEF is unsuitable in the ED because of time constraints. This study aimed to compare echocardiographic aortic root (AR) excursion and LVEF measurement using the modified Simpson's method (biplane method of disks) as recommended by the American Society of Echocardiography. Methods: After 2 hours of theoretical video and hands-on training with 20 patients by an experienced echocardiographer, two emergency physicians prospectively evaluated patients with dyspnea. Two-dimensional echocardiograms of the parasternal long-axis view were obtained, and the displacement of the aortic root (DAR) was studied. M-mode DAR recordings were obtained, and distances were measured as the maximized anterior displacement of the AR from the horizontal axis at end-systole by using the leading-edge methodology. LVEF was measured by an experienced cardiologist using the modified Simpson's rule. The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-), and positive and negative predictive values (PPV, NPV) were analyzed. A new formula for the prediction of the ejection fraction (EF) with the aid of DAR was then created. Results: The mean (AESD) age with of the 70 study patients was 69.7 (AE11.91) years. In these patients, DAR was highly correlated with EF (point biserial correlation coefficient = 0.79, p < 0.001) and one-way analysis of variance (ANOVA) results were significant (F = 115.9; p < 0.001). The sensitivity was 94.4; specificity, 94.1; LR+, 16.6; LR-, 0.059; PPV, 94.4; and NPV, 94.1. Conclusions: The results indicate that DAR is a sensitive index of left ventricular systolic function (SF) and can be used to reliably predict EF values using the rough formula of EF = 20 + 44 (DAR). ACADEMIC EMERGENCY MEDICINE 2013; 20:367-373 O ptimizing cardiac performance is an important goal in the management of critical illnesses. Physical examination has proven unreliable for differentiating between cardiogenic and noncardiogenic causes of hypotension, 1,2 and rapid determination of left ventricular ejection fraction (LVEF) may have important implications for patient diagnosis and treatment. 3,4 Studies in intensive care units have shown that echocar-diography may supplement or replace invasive measures of volume status and have provided information about short-and long-term prognosis. 5-11 The use of focused cardiac ultrasound (FOCUS) within the emergency department (ED) has historically provided both prognostic information for patients with suspected cardiac ischemia and diagnostic clues about diastolic heart failure. 12-15 Studies have also demonstrated that experienced emergency physicians (EPs) with additional FOCUS training can accurately assess LVEF in ED patients with acute dyspnea. 16-18 Because of the limited time available for ED patient evaluation, t...

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Bedside assessment of central venous pressure by sonographic measurement of right ventricular outflow-tract fractional shortening

Abstract: In the hands of emergency physicians, a RVOT fractional shortening measurement is a good predictor of low CVP.

Cited by 7 publications

References 0 publications

Tricuspid annular plane systolic excursion and central venous pressure in mechanically ventilated critically ill patients

Tricuspid annular plane systolic excursion and central venous pressure in mechanically ventilated critically ill patients

Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians

An Alternative Approach to the Bedside Assessment of Left Ventricular Systolic Function in the Emergency Department: Displacement of the Aortic Root

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