Evaluation of left ventricular function in anesthetized patients using femoral artery dP/dt(max).
OBJECTIVE
The purpose of this study was to compare dP/dt(max) estimated from a femoral artery pressure tracing to left ventricular (LV) dP/dt(max) during various alterations in myocardial loading and contractile function.


METHODS
Seventy patients scheduled for elective coronary artery bypass surgery.


METHODS
All patients were instrumented with a high-fidelity LV catheter, a pulmonary artery catheter, and a femoral arterial catheter. In 40 patients, hemodynamic measurements were performed before and after passive leg raising and before and after calcium administration (5 mg/kg); and in 30 other patients, hemodynamic measurements were performed before and after dobutamine infusion (5 microg/kg/min over 10 minutes).


RESULTS
LV and femoral dP/dt(max) were significantly correlated (r = 0.82, p < 0.001), but femoral dP/dt(max) systematically underestimated LV dP/dt(max) (bias = -361 +/- 96 mmHg/s). Passive leg raising induced significant increases in central venous pressure and LV end-diastolic pressure, but femoral dP/dt(max), stroke volume, and LV dP/dt(max) remained unaltered. Calcium administration induced significant and marked increases in LV dP/dt(max) (23% +/- 9%) and femoral dP/dt(max) (37% +/- 14%) associated with a significant increase in stroke volume (9% +/- 2%). Dobutamine infusion also induced significant and marked increases in LV dP/dt(max) (25% +/- 8%) and femoral dP/dt(max) (35% +/- 12%) associated with a significant increase in stroke volume (14% +/- 3%). Overall, a very close linear relationship (r = 0.93) and a good agreement (bias = -5 +/- 17 mmHg/s) were found between changes in LV dP/dt(max) and changes in femoral dP/dt(max). A very close relationship was also observed between changes in LV dP/dt(max) and changes in femoral dP/dt(max) during each intervention (leg raising, calcium administration, and dobutamine infusion).


CONCLUSIONS
Femoral dP/dt(max) underestimated LV dP/dt(max), but changes in femoral dP/dt(max) accurately reflected changes in LV dP/dt(max) during various interventions.
De Hert
Stefan G
SG
Department of Anesthesiology, University Hospital Antwerp, Edegem, Belgium. stefan.dehert@ua.ac.be
Robert
Dominique
D
Cromheecke
Stefanie
S
Michard
Frédéric
F
Nijs
Jan
J
Rodrigus
Inez E
IE
D000758:Anesthesia; D001794:Blood Pressure; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures; D005260:Female; D005263:Femoral Artery / Q000502:physiology*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D016277:Ventricular Function, Left