Echocardiography has been evolving to play a pivotal role in hemodynamic management, both intraoperatively and at the bedside. A full assessment of hemodynamics necessitates the use of all of the options available on modern echocardiographs. This introductory review provides insight into three important issues of hemodynamic monitoring by echocardiography: evaluation of preloading conditions, assessment of systolic function, and contractility and estimation of afterload. Mastering these three features will help in a minimally invasive approach of hemodynamic instability.
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References
1.
Garcia M, Thomas J, Klein A: New Doppler echocardiographic applications for the study of diastolic function. Review article. J Am Coll Cardiol32:865-875, 1998.
2.
Vasan RS, Sullivan LM, Roubenoff R, et al: Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: The Framingham Heart Study. Circulation107:1486-1491, 2003.
3.
Mebazaa A, Karpati P, Renaud E, et al: Acute right ventricular failure—from pathophysiology to new treatments. Intensive Care Med30:185-196, 2004.
4.
Appleton C, Galloway J, Gonzalez M, et al: Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol22:1972-1982, 1993.
5.
Ito T, Suwa M, Otake Y, et al: Left ventricular Doppler filling pattern in dilated cardiomyopathy: Relation to hemodynamics and left atrial function. J Am Soc Echocardiogr10:518-525, 1997.
6.
Jardin F, Fourme T, Page B, et al: Persistent preload defect in severe sepsis despite fluid loading: A longitudinal echocardiographic study in patients with septic shock. Chest116:1354-1359, 1999.
7.
Kuecherer HF, Muhiudeen IA, Kusumoto FM, et al: Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation82:1127-1139, 1990.
8.
Nagueh S, Middleton K, Kopelen H, et al: Doppler tissue imaging: A noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol30:1527-1533, 1997.
9.
Schiller N: Pulmonary artery pressure estimation by Doppler and two-dimensional echocardiography. Cardiol Clin8:277-287, 1990.
10.
Vieillard Baron A, Schmitt JM, Beauchet A, et al: Early preload adaptation in septic shock? A transesophageal echocardiographic study. Anesthesiology94:400-406, 2001.
11.
Leung JM, Levine EH: Left ventricular end-systolic cavity obliteration as an estimate of intraoperative hypovolemia. Anesthesiology81:1102-1109, 1994.
12.
Borow KM, Neumann A, Marcus RH, et al: Effects of simultaneous alterations in preload and afterload measurements of left ventricular contractility in patients with dilated cardiomyopathy: Comparisons of ejection phase, isovolumetric and end-systolic force-velocity indexes. J Am Coll Cardiol20:787-795, 1992.
13.
De Hert S, Vander Linden P, Ten Broecke P, et al: Assessment of length-dependent regulation of myocardial function in coronary surgery patients using transmitral flow velocity patterns. Anesthesiology93:374-381, 2000.
14.
Coriat P, Vrillon M, Perel A, et al: A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg78:46-53, 1994.
15.
Perel A, Pizov R, Cotev S: Systolic blood pressure variation is a sensitive indicator of hypovolaemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology67:498-502, 1987.
16.
Tavernier B, Makhotine O, Lebuffe G, et al: Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology89:1313-1321, 1998.
17.
Slama M, Ahn J, Varagic J, et al: Long-term left ventricular echocardiographic follow-up of SHR and WKY rats: Effects of hypertension and age. Am J Physiol Heart Circ Physiol286:H181-185, 2004.
18.
Vieillard-Baron A, Chergui K, Rabiller A, et al: Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med30:1734-1739, 2004.
19.
Hruda J, Rothuis EG, van Elburg RM, et al: Echocardiographic assessment of preload conditions does not help at the neonatal intensive care unit. Am J Perinatol20:297-303, 2003.
20.
Poelaert J, Heerman J, Schupfer G, et al: Estimation of myocardial performance in CABG patients. Acta Anaesthesiol Scand48:973-979, 2004.
21.
Amà R, Segers P, Roosens C, et al: Effects of load on systolic mitral annular velocity by tissue Doppler imaging. Anesthesia Analgesia99:332-338, 2004.
22.
Poelaert J, Schmidt C, Colardyn F: Transoesophageal echocardiography in the critically ill. Anaesthesia53:55-68, 1998.
23.
Poelaert JI, Schupfer G: Hemodynamic monitoring utilizing transesophageal echocardiography: The relationships among pressure, flow, and function. Chest127:379-390, 2005.
24.
Stefanadis C, Dernellis J, Tsiamis E, et al: Aortic stiffness as a risk factor for recurrent acute coronary events in patients with ischaemic heart disease. Eur Heart J21:390-396, 2000.
25.
Molino P, Cerutti C, Juline C, et al: Beat-to-beat estimation of windkessel model parameters in conscious rats. Am J Physiol Heart Circ Physiol274:H171-H177, 1998.
26.
Segers P, Verdonck P, Deryck Y, et al: Pulse pressure method and the area method for the estimation of total arterial compliance in dogs: Sensitivity to wave reflection intensity. Ann Biomed Engin27:480-485, 1999.
27.
Heerman JR, Segers P, Roosens CD, et al: Echocardiographic assessment of aortic elastic properties with automated border detection in an ICU: In vivo application of the arctangent Langewouters’ model. Am J Physiol Heart Circ Physiol288:H2504-H2511, 2005.
28.
Langewouters G, Wesseling K, Goedhard W: The static elastic properties of 45 human thoracic and 20 abdominal aortas in vitro and the parameter of a new model. J Biomechanics17:425-435, 1984.
29.
Langewouters G, Wesseling K, Goedhard W: The pressure dependent dynamic elasticity of 35 thoracic and 16 abdominal human aortas in vitro described by a five component model. J Biomechnics18:613-620, 1985.
