Non-invasive assessment of central venous pressure in heart failure: a systematic prospective comparison of echocardiography and Swan-Ganz catheter
Non-invasive assessment of central venous pressure in heart failure: a systematic prospective comparison of echocardiography and Swan-Ganz catheter
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DOI：
10.1007/s10554-020-01889-3
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发表时间：
2020-05-22
影响因子：
2.1
通讯作者：
Fox, Henrik
中科院分区：
文献类型：
--
作者：
Szymczyk, Tobias;Sauzet, Odile;Fox, Henrik
评价血流动力学，尤其是中心静脉压（CVP），是心力衰竭（HF）的重要指标。右心导管插入术（RHC）是金标准，但也需要非侵入性方法。然而，二维超声心动图（2DE）的作用仍然不确定，三维超声心动图（3DE）并不总是可用的。本研究比较了使用超声心动图（2DE和3DE）对下腔静脉（IVC）容量进行标准化和呼吸校正评估与使用RHC有创确定的CVP。纳入60例连续HF患者（82%为男性，年龄54 ± 11岁，纽约心脏协会分级2.23 ± 0.8，射血分数46 ± 18.4%，脑钠肽696.93 ± 773.53 pg/mL）。所有患者均接受Swan-Ganz RHC，随后进行2DE和3DE以及IVC容量评估。在2DE上，最大偏转和最短扩张时的平均IVC尺寸分别为18.3 +/- 5.5 mm和13.8 +/- 6 mm。RHC的平均CVP为9.3 ± 5.3 mmHg。2DE和3DE与有创测量的CVP均未显示可接受的相关性; IVC容积采集与RHC CVP显示最佳相关性（0.64; 95%置信区间0.46-0.77），当加入二尖瓣早期舒张末期E波和右室舒张末期内径时，相关性更好。以CVP临界值10 mmHg为标准，受试者工作特征曲线显示预测CVP的真阳性（特异性）为0.90，敏感性为62%。一项验证研究证实了这些发现，并验证了IVC容量评估的高预测价值。单独的2DE和3DE都不能可靠地反映CVP，但使用超声心动图进行IVC容积采集可以无创和充分近似CVP。当CVP> 10 mmHg时，与有创测量压力的相关性最强。
Assessing hemodynamics, especially central venous pressure (CVP), is essential in heart failure (HF). Right heart catheterization (RHC) is the gold-standard, but non-invasive methods are also needed. However, the role of 2-dimensional echocardiography (2DE) remains uncertain, and 3-dimensional echocardiography (3DE) is not always available. This study investigated standardized and breathing-corrected assessment of inferior vena cava (IVC) volume using echocardiography (2DE and 3DE) versus CVP determined invasively using RHC. Sixty consecutive HF patients were included (82% male, age 54 +/- 11 years, New York Heart Association class 2.23 +/- 0.8, ejection fraction 46 +/- 18.4%, brain natriuretic peptide 696.93 +/- 773.53 pg/mL). All patients underwent Swan-Ganz RHC followed by 2DE and 3DE, and IVC volume assessment. On 2DE, mean IVC size was 18.3 +/- 5.5 mm and 13.8 +/- 6 mm in the largest deflection and shortest distention, respectively. Mean CVP from RHC was 9.3 +/- 5.3 mmHg. Neither 2DE nor 3DE showed acceptable correlation with invasively measured CVP; IVC volume acquisition showed optimal correlation with RHC CVP (0.64; 95% confidence interval 0.46-0.77), with better correlation when mitral valve early diastole E wave and right ventricular end-diastolic diameter were added. Using a CVP cut-point of 10 mmHg, receiver operating characteristic curve showed true positivity (specificity) of 0.90 and sensitivity of 62% for predicting CVP. A validation study confirmed these findings and verified the high predictive value of IVC volume assessment. Neither 2DE nor 3DE alone can reliably mirror CVP, but IVC volume acquisition using echocardiography allows non-invasive and adequate approximation of CVP. Correlation with invasively measured pressure was strongest when CVP is > 10 mmHg.