Guidelines for the Use of Echocardiography as a Monitor for Therapeutic Intervention in Adults: A Report from the American Society of Echocardiography

Porter, Thomas R.; Shillcutt, Sasha K.; Adams, Mark; Desjardins, Georges; Glas, Kathryn E.; Olson, Joan; Troughton, Richard W.

doi:10.1016/j.echo.2014.09.009

Cited by 382 publications

(201 citation statements)

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“…Aunque inicialmente obtenida por técnicas invasivas, el desarrollo de técnicas no invasivas como el ecocardiograma transtorácico, permite la valoración de la hemodinámica del paciente de manera inocua, a bajo costo y en forma reiterativa. El desarrollo de múltiples índices para los diferentes parámetros hemodinámicos en el transcurso del tiempo ha llevado a la publicación de diversas guías para su uso en años recientes (2)(3)(4) . La ecocardiografía presenta bondades, pero también limitaciones, siendo las principales: la disponibilidad del ecocardiógrafo, la capacitación del personal involucrado en su uso, el tiempo requerido para realizar el examen y la elaboración de esquemas prácticos de ejecución a partir de la información científica disponible.…”

Section: Introductionunclassified

Características de los factores de riesgo cardiovascular en una población urbana y rural de la selva peruana, julio - 2014

Martínez-Espichán

Zambrano-Huailla

et al. 2017

HorizMed

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RESUMENObjetivo: Evaluar la factibilidad de realizar una estratificación hemodinámica en pacientes con infarto agudo de miocardio con segmento ST elevado, mediante el uso de ecocardiografía transtorácica. Materiales y métodos: Estudio descriptivo, prospectivo y transversal que incorporó a 30 pacientes en ritmo sinusal con diagnóstico de infarto agudo de miocardio con ST elevado, ingresados a la unidad coronaria del Hospital Edgardo Rebagliati Martins. Se estimó: gasto cardíaco, presión de llenado de ventrículo izquierdo, resistencia vascular sistémica y resistencia vascular pulmonar. Resultados: La edad promedio fue 67 ± 10.6 años, predominio masculino (86.7%). La estimación del gasto cardiaco y la presión de llenado del ventrículo izquierdo fue posible en el 100% de los individuos. La resistencia vascular sistémica y resistencia vascular pulmonar pudieron ser estimadas en 29 (96.6%) y 28 (93.3%) pacientes, respectivamente. La estratificación hemodinámica fue: estadio I (normal): 18 pacientes (60%), estadio II (congestivo): 6 pacientes (20%), estadio III (hipovolemia, compromiso de VD): 5 pacientes (16.7%) y estadio IV (Choque): 1 paciente (3.3%). Conclusiones: Se concluye que es factible realizar la estratificación hemodinámica ecocardiográfica transtorácica en la población estudiada.Palabras clave: Estratificación hemodinámica; ecocardiografía transtorácica; infarto de miocardio. Hemodynamic stratification using transthoracic echocardiography in patients with ST segment elevation acute myocardial infarction ABSTRACTObjective: To evaluate the feasibility of performing a hemodynamic stratification in patients with ST segment elevation acute myocardial infarction using transthoracic echocardiography. Materials and methods: A descriptive, prospective and cross-sectional study that included 30 patients in sinus rhythm with ST segment elevation acute myocardial infarction, admitted to the coronary care unit of Hospital Edgardo Rebagliati Martins. Cardiac output, left ventricle filling pressure, systemic vascular resistance and pulmonary vascular resistance were estimated. Results: The mean age was 67 ± 10.6 years old, with male predominance (86.7%). The estimation of cardiac output and left ventricle filling pressure was possible in 100% of the individuals. The systemic vascular resistance and pulmonary vascular resistance could be estimated in 29 (96.6%) and 28 (93.3%) patients, respectively. The hemodynamic stratification was as follows: stage I (normal): 18 patients (60%), stage II (congestive): 6 patients (20%), stage III (hypovolemia, RV infarction): 5 patients (16.7%) and stage IV (shock): 1 patient (3.3%). Conclusions: It is concluded that a transthoracic echocardiographic hemodynamic stratification may be performed in the studied population.

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Section: Introductionunclassified

Características de los factores de riesgo cardiovascular en una población urbana y rural de la selva peruana, julio - 2014

Martínez-Espichán

Zambrano-Huailla

et al. 2017

HorizMed

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“…Right ventricular (RV) systolic function was estimated using M-mode and measuring the tricuspidal annular plane systolic excursion (24). The transmitral LV outflow tract Doppler spectra (E, A, ET) was recorded from an apical four-chamber view, and the myocardial performance index (MPI) was calculated as the ratio of isovolumetric contraction time and isovolumetric relaxation time (IRT) divided by the ejection time (21). Tissue Doppler was used to measure the lateral E= spectra, and calculate the E-to-E= ratio (E/E=).…”

Section: Ethical Aspectsmentioning

confidence: 99%

A mouse model of heart failure with preserved ejection fraction due to chronic infusion of a low subpressor dose of angiotensin II

Regan

Mauro

Carbone

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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A, Toldo S. A mouse model of heart failure with preserved ejection fraction due to chronic infusion of a low subpressor dose of angiotensin II. Am J Physiol Heart Circ Physiol 309: H771-H778, 2015. First published July 17, 2015; doi:10.1152/ajpheart.00282.2015.-Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of HF symptoms associated with impaired diastolic function. Although it represents ϳ50% of patients with HF, the mechanisms of disease are poorly understood, and therapies are generally ineffective in reducing HF progression. Animal models of HFpEF not due to pressure or volume overload are lacking, therefore limiting in-depth understanding of the pathophysiological mechanisms and the development of novel therapies. We hypothesize that a continuous infusion of low-dose angiotensin II (AT II) is sufficient to induce left ventricular (LV) diastolic dysfunction and HFpEF, without increasing blood pressure or inducing LV hypertrophy or dilatation. Osmotic pumps were implanted subcutaneously in 8-wk-old male mice assigned to the AT II (0.2 mg·kg Ϫ1 ·day Ϫ1 ) or volume-matched vehicle (N ϭ 8/group) for 4 wk. We measured systolic and diastolic arterial blood pressures through a tail-cuff transducer, LV dimensions and ejection fraction through echocardiography, and LV relaxation through pulsed-wave Doppler and LV catheterization. Myocardial fibrosis and cardiomyocyte cross-sectional area were measured. AT II infusion had no effects on systemic arterial blood pressure. ATII induced significant impairment in LV diastolic function, as measured by an increase (worsening) in LV isovolumetric relaxation time, myocardial performance index, isovolumetric relaxation time constant, and LV end-diastolic pressure without altering LV dimensions, mass, or ejection fraction. Chronic infusion of low-dose AT II recapitulates the HFpEF phenotype in the mouse, without increasing systemic arterial blood pressure. This mouse model may provide insight into the mechanisms of HFpEF.heart failure with preserved ejection fraction; diastolic dysfunction; animal model; angiotensin II; end-diastolic pressure; isovolumetric relaxation time NEW & NOTEWORTHY Chronic infusion of low-dose angiotensin II in the mouse induces diastolic dysfunction and HFpEF in the absence of pressure overload, LV systolic dysfunction, LV dilatation or hypertrophy, and metabolic abnormalities. This model may be considered a novel tool for mechanistic preclinical studies in HFpEF with translational potential.HEART FAILURE (HF) WITH PRESERVED ejection fraction (HFpEF) is a clinical syndrome of symptoms of HF, such as breathlessness and exercise intolerance, associated with impaired left ventricular (LV) diastolic function in the presence of a normal LV ejection fraction (LVEF Ͼ 50%) (2). HFpEF carries significant morbidity and mortality burdens, and the prevalence of the disease has increased over the past 30 yr (2, 17). To date, the mechanisms underlying diastolic dysfunction and the progression of HFpEF are poorly understood. The path...

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“…Since echocardiography is increasingly used not only for diagnosing cardiac dysfunction, but also for monitoring and for titrating therapy in septic shock, the results of study III may have clinical implications (29,31). The observer-related differences in the assessment of diastolic function suggest the need for some caution in this regard.…”

Section: Reliability and Variabilitymentioning

confidence: 97%

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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Guidelines for the Use of Echocardiography as a Monitor for Therapeutic Intervention in Adults: A Report from the American Society of Echocardiography

Cited by 382 publications

References 92 publications

Características de los factores de riesgo cardiovascular en una población urbana y rural de la selva peruana, julio - 2014

Características de los factores de riesgo cardiovascular en una población urbana y rural de la selva peruana, julio - 2014

A mouse model of heart failure with preserved ejection fraction due to chronic infusion of a low subpressor dose of angiotensin II

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

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