title: Respiratory variations of R-wave amplitude in lead II are correlated with stroke volume variations evaluated by transesophageal Doppler echocardiography.
abstract: OBJECTIVE
  The authors hypothesized that variations in electrocardiographically derived R-wave amplitude might be correlated with mechanical ventilation-induced variations in stroke volume as determined by transesophageal echocardiography.
  
  
  METHODS
  Observational prospective study.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  Thirty-four patients undergoing coronary artery bypass surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  Respiratory R-wave variations in lead II (ΔRII) were correlated with aortic velocity time integral variations (r = 0.82, p < 0.0001). Respiratory R-wave variations in leads III and aVF and pulse pressure variation also were correlated with aortic velocity time integral variations (r = 0.49, p = 0.015; r = 0.61, p = 0.0016; and r = 0.72, p < 0.0001, respectively). R-wave respiratory variations in lead V(5) were not correlated with aortic velocity time integral variations. ΔRII was correlated with pulse pressure variation (r = 0.71, p < 0.0001). A ΔRII cutoff value of 15% accurately predicted stroke volume variations >15%, with a specificity of 92%, a sensitivity of 86%, a positive likelihood ratio of 11.1, a negative likelihood ratio of 0.15, a positive predictive value of 95%, and a negative predictive value of 80%.
  
  
  CONCLUSIONS
  ΔRII is correlated with stroke volume variations as determined by transesophageal echocardiography in mechanically ventilated patients and can identify the stroke volume variation cutoff of 15%, previously determined to be the cutoff for volume responsiveness.
authors.affiliation: Pôle Anesthésie-Réanimation, CHU d'Amiens, Amiens, France. lorne.emmanuel@chu-amiens.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
authors.forename: Yazine
authors.initials: Y
authors.lastname: Mahjoub
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.forename: Yannick
authors.initials: Y
authors.lastname: Fournier
authors.forename: Matthieu
authors.initials: M
authors.lastname: Detave
authors.forename: Cyrille
authors.initials: C
authors.lastname: Pila
authors.forename: Ammar
authors.initials: A
authors.lastname: Ben Ammar
authors.forename: Beatris
authors.initials: B
authors.lastname: Labont
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*