Rapid echocardiographic assessment of left and right heart hemodynamics in critically ill obstetric patients.
OBJECTIVE
Our purpose was to compare noninvasive two-dimensional and Doppler echocardiography and right heart catheterization with a pulmonary artery catheter in the estimation of stroke volume, cardiac output, cardiac index, left ventricular filling pressure, pulmonary artery systolic pressure, and right atrial pressure in a heterogeneous group of critically ill obstetric patients.


METHODS
Eleven critically ill obstetric patients requiring invasive monitoring for clinical management were prospectively studied. Simultaneous Doppler and pulmonary artery catheter readings of stroke volume, cardiac output, cardiac index, left ventricular filling pressure, pulmonary artery systolic pressure, and right atrial pressure were acquired. Mean +/- SD or median and range, as appropriate, of each parameter were compared, and data for all parameters were subjected to regression analysis. A two-tailed p value < 0.05 was regarded as significant.


RESULTS
There was no significant difference between the two techniques in the estimation of cardiac index, intracardiac pressures, or pulmonary artery systolic pressure. There was a good correlation between the two methods for stroke volume (R2 = 0.98), cardiac output (R2 = 0.98), cardiac index (R2 = 0.96), left ventricular filling pressure (R2 = 0.79), pulmonary artery systolic pressure (R2 = 0.85), and right atrial pressure (R2 = 0.86).


CONCLUSIONS
Two-dimensional and Doppler echocardiography allow rapid, reliable, noninvasive assessment of hemodynamic parameters in critically ill obstetric patients and may give the clinician valuable information that may influence therapeutic and clinical management.
Belfort
M A
MA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030.
Rokey
R
R
Saade
G R
GR
Moise
K J
KJ
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002302:Cardiac Output; D016638:Critical Illness; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006325:Heart Atria / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011446:Prospective Studies; D011651:Pulmonary Artery; D011669:Pulmonary Wedge Pressure; D012044:Regression Analysis; D017725:Ventricular Pressure