Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study.
Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study.
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DOI：
10.1186/s13054-014-0482-4
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发表时间：
2014-08-12
期刊：
影响因子：
--
通讯作者：
Ishikawa T
中科院分区：
文献类型：
--
作者：
Mutoh T;Kazumata K;Terasaka S;Taki Y;Suzuki A;Ishikawa T
Takotsubo心肌病(中医)是蛛网膜下腔出血(SAH)后早期危及生命的全身性后果，但确切的血流动力学和相关结果尚未研究。本研究旨在探讨中医药经肺热稀释对SAH患者心功能的影响及其对临床结局的影响。我们回顾分析了连续46例SAH术后发展为中医的患者。将患者分为两组，超声心动图左心室射血分数(≥)<40%(中医伴左心功能不全组)和左心室射血分数<40%(中医无左心功能不全组)。心功能指数(CFI)和血管外肺水指数(ELWI)监测采用经肺热稀释法，同时测定超声心动图参数和血生化指标。肺内热稀释后CFI与左心室射血分数显著相关(r = 0.82，P <； 0.0001)。左心功能不全患者0~7天的CFI值(40%)明显低于左心室射血分数(≥)为40%的患者(P<0.05)。CFI较心输出量更能检出心功能不全(LVEF40%)(曲线下面积 = 0.85 ± 0.02；P ； 0.001)。CFI值4.2min−-1检测LVEF40%的敏感性为82%，特异性为84%。−-1与迟发性脑缺血相关(优势比(OR) = 2.14，95%可信区间(CI) = 1.33~2.86；P = 0.004)和3个月功能不良(OR = 1.87，95%CI = 1.06~3.29；P = 0.02)。血管外肺水指数(ELWI)和GT；1400ml/kg增加了3个月随访时功能不良的风险(OR = 2.10，95%CI = 1.11至3.97；P = 0.04)。持续心功能不全和肺水肿增加了中医药治疗SAH患者术后3个月发生DCI的风险和不良的功能预后。通过经肺热稀释连续测定CFI和ELWI，可以提供一种简便的床边方法，检测早期心肺功能的变化，指导SAH后的正确治疗。本文的在线版本(doi：10.1186/s13054-0140482-4)包含补充材料，授权用户可以使用。
Takotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcomes have not been studied. The purpose of this study was to investigate TCM-induced cardiac function by transpulmonary thermodilution and its impact on clinical outcome of SAH. We retrospectively analyzed 46 consecutive postoperative SAH patients who developed TCM. Patients were divided into two groups of echocardiographic left ventricular ejection fraction (LVEF) <40% (TCM with left ventricular (LV) dysfunction) and LVEF ≥40% (TCM without LV dysfunction). Cardiac function index (CFI) and extravascular lung water index (ELWI) were monitored by transpulmonary thermodilution in parallel with serial measurements of echocardiographic parameters and blood biochemical markers. Transpulmonary thermodilution-derived CFI was significantly correlated with LVEF (r = 0.82, P < 0.0001). The CFI between days 0 and 7 was significantly lower in patients with LV dysfunction (LVEF <40%) than in patients with LVEF ≥40% (P < 0.05). CFI had a better ability than cardiac output to detect cardiac dysfunction (LVEF <40%) (area under the curve = 0.85 ± 0.02; P < 0.001). A CFI value <4.2 min−1 had a sensitivity of 82% and specificity of 84% for detecting LVEF <40%. CFI <4.2 min−1 was associated with delayed cerebral ischemia (DCI) (odds ratio (OR) = 2.14, 95% confidence interval (CI) = 1.33 to 2.86; P = 0.004) and poor 3-month functional outcome on a modified Rankin Scale of 4 to 6 (OR = 1.87, 95% CI = 1.06 to 3.29; P = 0.02). An extravascular lung water index (ELWI) >14 ml/kg after day 4 increased the risk of poor functional outcome at 3-month follow-up (OR = 2.10, 95% CI = 1.11 to 3.97; P = 0.04). Prolonged cardiac dysfunction and pulmonary edema increased the risk of DCI and poor 3-month functional outcome in postoperative SAH patients with TCM. Serial measurements of CFI and ELWI by transpulmonary thermodilution may provide an easy bedside method of detecting early changes in cardiopulmonary function to direct proper post-SAH treatment. The online version of this article (doi:10.1186/s13054-014-0482-4) contains supplementary material, which is available to authorized users.
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DOI：
10.1186/cc7994
发表时间：
2009
期刊：
Critical care (London, England)
影响因子：
--
作者：
Ritter S;Rudiger A;Maggiorini M
通讯作者：
Maggiorini M
影响因子：
8.3
作者：
Mutoh, Tatsushi;Kazumata, Ken;Terasaka, Shunsuke
通讯作者：
Terasaka, Shunsuke
影响因子：
--
作者：
Mutoh T;Ishikawa T;Kobayashi S;Suzuki A;Yasui N
通讯作者：
Yasui N
影响因子：
8.3
作者：
Connolly, E. Sander, Jr.;Rabinstein, Alejandro A.;Vespa, Paul
通讯作者：
Vespa, Paul
影响因子：
8.3
作者：
Mutoh, Tatsushi;Kazumata, Ken;Ishikawa, Tatsuya
通讯作者：
Ishikawa, Tatsuya