What does this research mean for the field?

Pulse contour analysis-derived femoral dP/dtmax is an unreliable estimate of left ventricular systolic function because it is highly sensitive to changes in left ventricular afterload and arterial waveform characteristics. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

January 1, 2019Annals of Intensive CareOpen Access

Influence of changes in ventricular systolic function and loading conditions on pulse contour analysis-derived femoral dP/dtmax

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute cardiovascular failure (n=19). Intervention: Haemodynamic interventions (dobutamine, norepinephrine, volume expansion, passive leg raising) vs. Baseline (pre-intervention). Primary outcome: Absolute deviation from baseline in femoral dP/dtmax following variations in dobutamine dose (21% deviation, p=0.013).

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Key result

Pulse contour analysis-derived femoral dP/dtmax deviated from baseline by 21% (p=0.013) following dobutamine variations and 15% (p<0.001) following norepinephrine changes, demonstrating it is an unreliable estimate of left ventricular systolic function due to its sensitivity to afterload.

Why the study?

Femoral dP/dtmax has been proposed as a surrogate of LV systolic function, but may be influenced by LV loading conditions.

Does pulse contour analysis-derived femoral dP/dtmax reliably estimate LV systolic function during changes in loading conditions in critically ill patients with cardiovascular failure?

Population

Critically ill patients with cardiovascular failure

Comparison

Variations in dobutamine and norepinephrine doses, volume expansion, and passive leg raising vs baseline

Design

Prospective observational study

Authors

SVSergi VaquerWyle (United States)DCD. S. ChemlaUniversité Paris-Sud JTJean‐Louis TeboulGeneral Cardiology

Discussion

Member takes

Implication

Femoral dP/dtmax should not guide LV systolic assessment amid afterload changes; leaves open validation of load-independent indices.

Study Design

Type

Observational (n=19)

Multicenter

Yes

Structured PICO

Does pulse contour analysis-derived femoral dP/dtmax reliably estimate LV systolic function during changes in loading conditions in critically ill patients with cardiovascular failure?

Population

Critically ill patients with cardiovascular failure

Intervention

Variations in dobutamine and norepinephrine doses, volume expansion (VE), and passive leg raising (PLR)

Comparator

Baseline measurements prior to hemodynamic interventions

Outcome

Changes in femoral dP/dtmaxsurrogate

Main Result

Effect estimate: 21% deviation

p-value: p=0.013

Femoral dP/dtmax calculated by pulse contour analysis is an unreliable estimate of LV systolic function during changes in LV afterload and arterial load, as it is prominently influenced by arterial waveform characteristics.

Limitations

Small number of cases and slow inclusion rate
Did not compare measurements of femoral dP/dtmax with LV dP/dtmax
Did not use any device to evaluate and compensate damping of the arterial pressure signal
Repetition of measurements on the same patient
Did not follow a crossover interventional study design
Respiratory cycle variations may alter LVEF
Potential mathematical coupling between the measurement of femoral dP/dtmax and systolic arterial pressure or pulse pressure

Cite This Study

Vaquer et al. (2019) conducted an observational in Acute cardiovascular failure (n=19). Haemodynamic interventions (dobutamine, norepinephrine, volume expansion, passive leg raising) vs. Baseline (pre-intervention) was evaluated on Absolute deviation from baseline in femoral dP/dtmax following variations in dobutamine dose (21% deviation, p=0.013). Pulse contour analysis-derived femoral dP/dtmax deviated from baseline by 21% (p=0.013) following dobutamine variations and 15% (p<0.001) following norepinephrine changes, demonstrating it is an unreliable estimate of left ventricular systolic function due to its sensitivity to afterload.

synapsesocial.com/papers/6a19c637196cd56b09eab28d https://doi.org/10.1186/s13613-019-0537-4

Topics

Echocardiography

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Influence of changes in ventricular systolic function and loading conditions on pulse contour analysis-derived femoral dP/dtmax

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Influence of changes in ventricular systolic function and loading conditions on pulse contour analysis-derived femoral dP/dtmax

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider