Clinical validation of bioreactance for the measurement of cardiac output in pregnancy.
- 作者列表："Ling HZ","Gallardo-Arozena M","Company-Calabuig AM","Nicolaides KH","Kametas NA
:Maternal cardiac dysfunction is associated with pre-eclampsia, fetal growth restriction and haemodynamic instability during obstetric anaesthesia. There is growing interest in the use of non-invasive cardiac output monitoring to guide antihypertensive and fluid therapies in obstetrics. The aim of this study was to validate thoracic bioreactance using the NICOM® instrument against transthoracic echocardiography in pregnant women, and to assess the effects of maternal characteristics on the absolute difference of stroke volume, cardiac output and heart rate. We performed a prospective study involving women with singleton pregnancies in each trimester. We recruited 56 women who were between 11 and 14 weeks gestation, 57 between 20 and 23 weeks, and 53 between 35 and 37 weeks. Cardiac output was assessed repeatedly and simultaneously over 5 min in the left lateral position with NICOM and echocardiography. The performance of NICOM was assessed by calculating bias, 95% limits of agreement and mean percentage difference relative to echocardiography. Multivariate regression analysis evaluated the effect of maternal characteristics on the absolute difference between echocardiography and NICOM. The mean percentage difference of cardiac output measurements between the two methods was ±17%, with mean bias of -0.13 l.min-1 and limits of agreement of -1.1 to 0.84; stroke volume measurements had a mean percentage difference of ±15%, with a mean bias of -0.8 ml (-10.9 to 12.6); and heart rate measurements had a mean percentage difference of ±6%, with a mean bias of -2.4 beats.min-1 (-6.9 to 2.0). Similar results were found when the analyses were confined to each individual trimester. The absolute difference between NICOM and echocardiography was not affected by maternal age, weight, height, race, systolic or diastolic blood pressure. In conclusion, NICOM demonstrated good agreement with echocardiography, and can be used in pregnancy for the measurement of cardiac function.
: 产妇心功能障碍与先兆子痫、胎儿生长受限和产科麻醉期间血液动力学不稳定有关。在产科中使用非侵入性心输出量监测来指导抗高血压和液体治疗的兴趣日益增加。本研究的目的是使用NICOM验证胸生物活性。®仪器对经胸超声心动图在孕妇中的应用，并评估母体特征对每搏输出量、心输出量和心率绝对差异的影响。我们进行了一项前瞻性研究，涉及每三个月单胎妊娠的女性。我们招募了56名孕11 ~ 14周，57名孕20 ~ 23周，53名孕35 ~ 37周的女性。在左侧卧位用NICOM和超声心动图在5分钟内重复并同时评估心输出量。通过计算偏倚、95% 的一致性界限和相对于超声心动图的平均百分比差异来评估NICOM的性能。多元回归分析评估了母亲特征对超声心动图和NICOM绝对差异的影响。两种方法测量心输出量的平均百分比差异为 ± 17%，平均偏倚为-0.13 l。min-1，协议范围为-1.1至0.84; 每搏输出量测量的平均百分比差异为 ± 15%，平均偏倚为-0.8毫升 (-10.9至12.6);心率测量的平均百分比差异为 ± 6%，平均偏差为-2.4次min-1 (-6.9至2.0)。当分析限于每个个体的三个月时，发现类似的结果。NICOM和超声心动图之间的绝对差异不受母亲年龄、体重、身高、种族、收缩压或舒张压的影响。总之，NICOM与超声心动图具有良好的一致性，可用于妊娠期心功能的测定。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.