Báo cáo y học: Myocardial Doppler velocities as a marker of prognosis in the ICU

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Myocardial Doppler velocities as a marker of prognosis in the ICU...
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Báo cáo y học: "Myocardial Doppler velocities as a marker of prognosis in the ICU" Available online http://ccforum.com/content/11/5/167CommentaryMyocardial Doppler velocities as a marker of prognosis in theICUJan Poelaert1 and Carl Roosens21Department of Anesthesiology, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium2Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, BelgiumCorresponding author: Jan Poelaert, jan.poelaert@uzbrussel.bePublished: 26 October 2007 Critical Care 2007, 11:167 (doi:10.1186/cc6129)This article is online at http://ccforum.com/content/11/5/167© 2007 BioMed Central LtdSee related research by Sturgess et al., http://ccforum.com/content/11/5/R97Abstract intramural sites. Doppler myocardial imaging allows estimation of both longitudinal systolic and diastolicRelatively simple measures of echocardiography and Doppler, as function of the ventricles.left ventricular end-systolic area and volume, should be taken inconsideration when performing a Doppler echocardiographicexamination, as they could have both clinical and prognostic value. The present study retrospectively analyzed a series of data in critically ill patients with respect to myocardial DopplerEchocardiography made an enormous technological evolu- imaging as part of a general echocardiographic examination.tion from M mode imaging in the sixties, to two-dimensional, Although the decision to perform the echo investigation wascolour, pulsed and continuous wave Doppler echocardio- taken on a clinical basis in the sickest patients, and thereforegraphy to come to some rather sophisticated items such as contains a considerable selection bias both in terms ofmyocardial Doppler imaging, colour Doppler analysis of flow patient selection and timing, some remarkable issues werevelocities and speckle tracking. The prognostic potential of put forward. The most prominent conclusion is the importantthese new techniques has not yet been elucidated, in prognostic value of left ventricular end-systolic volume,particular in critically ill patients. In this issue of Critical Care, related with outcome. From the literature, it is well-known thatSturgess et al. retrospectively analyzed a cohort of intensive presence of a dilated cardiomyopathy has a strong inversecare unit patients with respect to outcome [1]. relationship with outcome, not only in adults but also in children [4-8]. Also in mitral valve disease, echocardiographicDoppler myocardial imaging is a newer cardiac ultrasound findings of a left ventricular end-systolic diameter abovetechnique in which the Doppler signals are processed 4.5 cm strongly hampers two-years survival [9]. Therefore, thefollowing reflection of ultrasound beams originating within importance of the presence of a dilated left ventricle in athe myocardium. With this technique, pulsed Doppler critically ill patient should not be denied.signals are analyzed by performing spectral or poweranalysis allowing more extensive analysis of diastolic The second finding of this study was also not astonishing:function, when used in conjunction with transmitral and Sturgess et al. found only a weak relationship between thepulmonary venous Doppler flow pattern analysis. Although pulmonary artery occlusion pressure and the ratio of the earlyIsaaz et al. already described pulsed Doppler recordings of filling wave velocity at the level of the mitral valve (E) and themyocardial tissue motion using a simple sample volume analogue myocardial velocity assessed at the mitral annulustechnique in 1989 [2], little clinical value was awarded to with tissue Doppler imaging (E’). The authors found nothis technique. A single pulsed Doppler myocardial velocity correlation between E/E’ and some other static variables ofsample volume interrogation inherently permits the analysis preload: left ventricular end-diastolic volume, the inferior cavalof regional wall motions, related to electric ...