title: Contrast-enhanced Doppler hemodynamics for noninvasive assessment of patients with chronic heart failure and left ventricular systolic dysfunction.
abstract: We sought to evaluate whether contrast-enhanced Doppler echocardiography can improve the noninvasive estimation of hemodynamic variables in left ventricular (LV) dysfunction. Right-heart catheterization and Doppler echocardiography were simultaneously performed in 45 patients with LV dysfunction (ejection fraction: 29 +/- 7%) in sinus rhythm. Noninvasive variables were estimated as follows: cardiac output by pulsed Doppler of LV outflow tract; pulmonary capillary wedge pressure by a regression equation including mitral and pulmonary venous flow variables; pulmonary artery mean pressure from the calculated systolic and diastolic pulmonary artery pressures; and pulmonary vascular resistance from the previous measurements according to hemodynamic definition. Contrast enhancement increased the feasibility of pulmonary capillary wedge pressure estimation from 60% to 100%; of pulmonary artery mean pressure from 42% to 91%; and of pulmonary vascular resistance from 42% to 91%. Strong correlations between invasive and noninvasive hemodynamic variables were found: r = 0.90, standard error of the estimate (SEE) 0.45 L/min for cardiac output; r = 0.90, SEE 3.1 mm Hg for pulmonary capillary wedge pressure; r = 0.93, SEE 3.7 mm Hg for pulmonary artery mean pressure; and r = 0.85 SEE 1.0 Wood units for pulmonary vascular resistance. Weaker correlations for PAMP (r = 0.82, SEE 5.6 mm Hg) and PVR (r = 0.66, SEE 1.7 Wood units) were apparent prior to contrast enhancement. When patients were separated according to PVR threshold values, the contrast allowed the correct placement of 88% of patients, whereas only 57% were correctly assigned without it. The contrast increased accuracy and reduced interobserver variability in the evaluation of hemodynamic variables. The contrast-enhanced study is capable of increasing the value of noninvasive hemodynamic assessment in LV dysfunction.
authors.affiliation: Unità Operativa di Cardiologia, Villamarina Hospital, Pisa, Italy. frank.dini@tiscali.it
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Egidio
authors.initials: E
authors.lastname: Traversi
authors.forename: Mirella
authors.initials: M
authors.lastname: Franchini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Micheli
authors.forename: Franco
authors.initials: F
authors.lastname: Cobelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Pozzoli
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007089:Image Enhancement; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011134:Polysaccharides / Q000008:administration & dosage; D011669:Pulmonary Wedge Pressure; D013599:Systole; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508