Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects
Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects
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DOI：
10.1097/01.ccm.0000114996.68110.c9
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发表时间：
2004-03-01
影响因子：
8.8
通讯作者：
Parrillo, JE
中科院分区：
文献类型：
--
作者：
Kumar, A;Anel, R;Parrillo, JE
客观的。在需要侵入性血流动力学监测的专利中，肺动脉闭塞压和中心静脉压被认为是左心室和右心室前负荷的可靠测量方法。近年来的研究对心室充盈的这些估计值之间的相关性提出了质疑。特定患者组的压力和心室舒张末期容积/心脏功能变量，但临床医生继续认为这种关系在更广泛的背景下有效。本研究的目的是评估健康志愿者心室前负荷的压力估计值（肺动脉闭塞压、中心静脉压）与舒张末期心室容积/心脏性能之间的关系。设计：前瞻性、非随机、非盲介入研究。心导管检查和超声心动图实验室。科目。正常健康志愿者（n = 12 组 1，n = 32 组 2）。干预措施：在 3 小时内输注 3 L 生理盐水期间进行肺导管插入术和放射性核素血管造影（组 1）和容积超声心动图（组 2）。测量和主要结果。在组 1 中，初始肺动脉闭塞压和中心静脉压与初始舒张末期没有显着相关性心室容量指数或心脏性能（心脏指数和每搏输出量指数）。输注盐水后肺动脉闭塞压和中心静脉压的变化也与舒张末期心室容积指数或心脏性能的变化无关。相反，初始舒张末期心室容积指数和这些心室容积指数对 3 L 生理盐水负荷的反应分别与初始每搏输出量指数和每搏输出量指数变化密切相关。使用数学独立技术测量这些变量，在第 2 组受试者中证实了左心室舒张末期容积指数和每搏输出量指数之间的关系。此外，第1组受试者的初始中心静脉压、右心室舒张末期容积指数、肺动脉闭塞压和左心室舒张末期容积指数与盐水输注引起的心脏性能变化没有显着相关性。结论：正常健康志愿者表现出初始中心静脉压/肺动脉闭塞压与心室舒张末期容积指数和每搏输出量指数之间缺乏相关性。对于容量输注后这些变量的变化也发现了类似的结果。相比之下，初始舒张末期心室容积指数和舒张末期心室容积指数响应盐水负荷的变化与通过每搏输出量指数测量的心脏性能的初始和盐水负荷后变化密切相关。这些数据表明，其他研究中描述的特定患者群体中这些变量缺乏相关性代表了包括正常受试者在内的更普遍的现象。中心静脉压和肺动脉闭塞压似乎都不是心室前负荷对于优化心脏性能的有用预测因子。
Objective. Pulmonary artery occlusion pressure and central venous pressure have been considered to be reliable measures of left and fight ventricular preload in patents requiring invasive hemodynamic monitoring. Studies in recent years have questioned the correlation between these estimates of ventricular filling. pressures and ventricular end-diastolic volumes/cardiac performance variables in specific patient groups, but clinicians have continued to consider the relationship valid in the broader context. The objective of this study was to assess the relationship between pressure estimates of ventricular preload (pulmonary artery occlusion pressure, central venous pressure) and end-diastolic ventriculair volumes/cardiac performance in healthy volunteers.Design: Prospective, nonrandomized, nonblinded interventional study.Setting. Cardiac catheterization and echocardiography laboratories. Subjects. Normal healthy volunteers (n = 12 group 1, n = 32 group 2).Interventions: Pulmonary catheterization and radionuclide cineangiography (group 1) and volumetric echocardiography (group 2) during 3 L of normal saline infusion over 3 hrs.Measurements and Main Results., In group 1, the initial pulmonary artery occlusion pressure and central venous pressure did not correlate significantly with initial end-diastolic ventricular volume indexes or cardiac performance (cardiac index and stroke volume index). Changes in pulmonary artery occlusion pressure and central venous pressure following saline infusion also did not correlate with changes in end-diastolic ventricular volume indexes or cardiac performance. In contrast, initial end-diastolic ventricular volume indexes and changes in these ventricular volume indexes in response to 3 L of normal saline loading correlated well with initial stroke volume index and changes in stroke volume index, respectively. The relationship between left ventricular end-diastolic volume index and stroke volume index was confirmed in group 2 subjects using mathematically independent techniques to measure these variables. In addition, initial central venous pressure, right ventricular end-diastolic volume index, pulmonary artery occlusion pressure, and left ventricular end-diastolic volume index failed to correlate significantly with changes in cardiac performance in response to saline infusion in group 1 subjects.Conclusions: Normal healthy volunteers demonstrate a lack of correlation between initial central venous pressure/pulmonary artery occlusion pressure and both end-diastolic ventricular volume indexes and stroke volume index. Similar results are found with respect to changes in these variables following volume infusion. In contrast initial end-diastolic ventricular volume indexes and changes in end-diastolic ventricular volume indexes in response to saline loading correlate strongly with initial and postsaline loading changes in cardiac performance as measured by stroke volume index. These data suggest that the lack of correlation of these variables in specific patient groups described in other studies represents a more universal phenomenon that includes normal subjects. Neither central venous pressure nor pulmonary artery occlusion pressure appears to be a useful predictor of ventricular preload with respect to optimizing cardiac performance.