[The semiquantitative evaluation of systemic vascular resistances in heart failure via an analysis of Doppler aortic flow].
In patients with advanced heart failure (HF) submitted to tailored therapy, monitoring of systemic vascular resistance (SVR) is essential to establish an adequate hemodynamic response, being one of the end-points to achieve SVR < 18 Wood U (WU).


OBJECTIVE
To correlate SVR value with parameters derived from the analysis of echo-Doppler aortic flow in patients with HF on tailored therapy, in order to allow a non-invasive semiquantitative evaluation of this hemodynamic end-point.


METHODS
In 13 patients with dilated cardiomyopathy (eight idiopathic, five ischemic) and advanced HF (mean age 60 +/- 10 years, 10 male, all in sinus rhythm, NYHA class IV), admitted in the ICU and submitted to tailored therapy, serial simultaneous hemodynamic and echocardiographic studies were performed (2 to 5 per patient, overall 43 evaluations). The following parameters derived from the analysis of continuous wave aortic Doppler flow were analysed: peak velocity, acceleration, deacceleration and ejection times, systolic time intervals ratio, mean acceleration, mean deacceleration, acceleration, deacceleration and overall systolic flow velocity time integrals.


RESULTS
SVR ranged from 10.4 to 41.9 WU (mean = 21.7, SD = 6.9). A significant correlation was found only with mean deacceleration (MnDc)-r = -0.60. MnDc ranged from 362 to 1162 cm/s2 (mean = 667, SD = 188) and proved to be independent from heart rate, systolic, diastolic and mean blood pressure, capillary wedge pressure, cardiac output, cardiac index and ejection volume. MnDc < 700 cm.s2 occurred in 25/28 evaluations with SVR > 18 WU and only in 3/15 evaluations with SVR < 18 WU-p = 0.00003. A MnDc value < 700 cm.s2 showed sensitivity = 89%, specificity = 80%, and predictive value = 89% for SVR > 18 WU (Kappa index = 0.693).


CONCLUSIONS
Mean deacceleration of aortic continuous wave flow is reliable for semiquantitative evaluation of systemic vascular resistance and can be particularly useful for patients with advanced heart failure submitted to tailored therapy.
Martins
S
S
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa.
Soares
R M
RM
do Rosário
L
L
Bico
P
P
Rasteiro
R
R
Abreu
J
J
Branco
L
L
Ramos
S
S
Salomão
S
S
Antunes
A M
AM
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology; D002407:Catheterization, Swan-Ganz; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012212:Rheology / Q000379:methods / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014655:Vascular Resistance