Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation
10.3760/cma.j.issn.1004-4477.2019.11.002
- VernacularTitle: 超声对急性暴发性心肌炎患者静脉－动脉体外膜肺氧合支持下血流动力学评估的初步研究
- Author:
Juan GUO
1
;
Renfeng YI
1
;
Hao WANG
1
;
Yuanting YANG
1
;
Min ZHANG
2
;
Bo HU
1
;
Sheng CAO
1
;
Qing DENG
1
;
Qing ZHOU
1
Author Information
1. Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
2. Department of Cardiovascular Surgery, RenMin Hospital, Wuhan University, Wuhan 430030, China
- Publication Type:Clinical Trail
- Keywords:
Echocardiography;
Acute fulminant myocarditis;
Venous-arterial extracorporeal membrane oxygenation;
Hemodynamics
- From:
Chinese Journal of Ultrasonography
2019;28(11):927-932
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).
Methods:A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.
Results:Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05).
Conclusions:Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.
