Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit.
OBJECTIVE
To compare hemodynamic and echocardiographic indexes of left ventricular performance.


METHODS
Retrospective database analysis of four clinical trials.


METHODS
University hospital.


METHODS
Cardiac surgery patients.


METHODS
Left ventricular performance was evaluated using left ventricular stroke work index (LVSWI) calculated from the pulmonary artery catheter and both fractional area change and regional wall motion score index (RWMSI) measured from transesophageal echocardiography. Measures of left ventricular performance were obtained before and after bypass (group 1, n = 30), during acute increase and decrease in preload (group 2, n = 14), after administration of inhaled prostacyclin or placebo in patients with pulmonary hypertension (group 3, n = 20), and in hemodynamically unstable patients in the intensive care unit at admission and at 2 and 4 hrs (group 4, n = 20).


RESULTS
A total of 186 simultaneous LVSWI, fractional area change, and RWMSI were analyzed and compared. Patients with RWMSI <1.3 had a LVSWI of 23.4 +/- 10.3 g.m.m compared with 18.4 +/- 7.2 g.m.m in those with RWMSI >1.3 (p =.0349). Subdividing fractional area change into three different groups (> or =50%, 25% to 49%, and < or =24%), the corresponding values of LVSWI were 22.3 +/- 9.7 g.m.m, 22.2 +/- 10.8 g.m.m, and 17.7 +/- 5.5 g.m.m, respectively (p =.5114). Correlations between LVSWI and RWMSI changes ranged from -0.28 to 0.16 (p values from.31 to.94). Correlations between LVSWI and fractional area change changes ranged from -0.62 to 0.22 (p values from.07 to.95).


CONCLUSIONS
There is a significant discrepancy and limited relationship between the hemodynamic and echocardiographic evaluation of left ventricular performance.
Bouchard
Marie-Josée
MJ
Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada.
Denault
André
A
Couture
Pierre
P
Guertin
Marie-Claude
MC
Babin
Denis
D
Ouellet
Paul
P
Carrier
Michel
M
Tardif
Jean-Claude
JC
D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures; D002407:Catheterization, Swan-Ganz; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D016277:Ventricular Function, Left