Introduction: There is no single haemodynamic parameters either static central venous pressure (CVP) or dynamic stroke volume variation, inferior vena cava distensibility index (SVV,IVCd) that can be used precisely to assess fluid responsiveness. It must be performed concurrently with clinical assessment. Therefore, this study was conducted to determine the correlation between these 3 parameters. Methods: This was a cross sectional non-interventional study conducted in intensive care unit. Each patient who fulfilled the criteria will have their CVP, SVV and IVCd measured instantaneously. Analysis of correlation was done using bivariate (Pearson) correlation, while agreement between SVV and IVCd was assessed using Cohen’s Kappa analysis. Results: A total of 37 patients were enrolled in this study. 70.3% were males and 29.7% were females. Mean age was 59.7 ± 13.3. Mean APACHE score was 24.1 ± 6.1. IVCd had significant positive correlation with SVV (r = 0.391, p = 0.017). Agreement between IVCd and SVV was 0.329 (0.95 CI = 0.0174 – 0.6412; p = 0.033). There was non-significant negative correlation between IVCd with CVP and SVV with CVP with r = -0.155 (p=0.359) and r = -0.068 (p= 0.691) respectively. Conclusion: There is only fair correlation between IVCd and SVV in determining fluid responsiveness. However, CVP does not correlate to both SVV and IVCd. Neither one of them is a good method in assessing fluid responsiveness during standard care in our centre. Therefore, the usage of above methods needs to combine with clinical parameters to yield better result.
Stroke volume variation

BACKGROUND: Although the modified Simpson's method is widely used for the assessment of left ventricular ejection fraction (LVEF), it has limitations including relatively high inter- and intra-observer variability and time consuming nature. We want to evaluate whether assessing mitral annular systolic velocity (S' velocity) by tissue Doppler imaging (TDI) can be used to evaluate LV systolic function with comparing LVEF by three dimensional echocardiography (3DE). METHODS: We examined 3DE and TDI studies of patients between January and August 2008. 3DE LVEF was measured by offline commercial computer software EchoPac PC(R) (GE, Andover, MA, USA). S' velocity was obtained from the medial side with apical four chamber view by pulsed-wave Doppler with TDI. RESULTS: We included 125 patients (78 males (62.4%), mean age: 57.5+/-13.0 years). The mean S' velocity was 7.7+/-1.9 cm/s and the mean LVEF was 57.2+/-10.4%. The S' velocity measured by TDI showed a linear correlation with LVEF measured by 3DE (r=0.688, p<0.001). Study patients were divided into two groups according to the presence of LV systolic dysfunction: Group I (normal LVEF), n=102 and Group II (LVEF <50%), n=23. For prediction of significant LV systolic dysfunction by the receiver operating characteristic curve according to S' velocity, the optimal cutoff value was 6.8 cm/s. At this cutoff value, the sensitivity and specificity were 94.1% and 87%, respectively. CONCLUSION: In this study, S' velocity measured by TDI showed a significant correlation with three dimensional LVEF and can be used to detect patients with LV systolic dysfunction.
Echocardiography, Three-Dimensional ; Humans ; Male ; Observer Variation ; ROC Curve ; Sensitivity and Specificity ; Software ; Stroke Volume ; Ventricular Function, Left

PURPOSE: Accurate determination of left ventricular ejection fraction (LVEF) is important in the emergency management of patients with cardiovascular disease. In 10% to 20% of patients, LVEF cannot be accurately determined by 2D echocardiography because of suboptimal endocardial definition on fundamental imaging. Measurement of mitral annular velocity is advantageous because it is not dependent on endocardial definition. METHODS: One hundred fifty-four consecutive patients with acute dyspnea who visited our emergency medical center from September 2005 to March 2007 were prospectively recruited. Patients with atrial fibrillation, valvular disease and regional wall motion abnormality were excluded. Mitral annular peak systolic velocity was obtained from the medial site with apical 4-chamber view by pulsed wave tissue Doppler imaging. LVEF was calculated by modified Simpson's method for apical 4- and 2-chamber views. RESULTS: The mean mitral annular peak systolic velocity was 7.2+/-1.8 cm/s (range 2.9 to 12.1), and the mean ejection fraction was 57.9+/-14.6% (range 17.9 to 83.9). The mitral annular peak systolic velocity correlated linearly with the ejection fraction (r=0.72, p<0.001): LVEF = 15+6 x mitral annular peak systolic velocity(%). The optimal cutoff value of mitral annular peak systolic velocity for identifyng LV systolic dysfunction (LVEF <55%) was 6.7 cm/s. At this cutoff value, the sensitivity, specificity, and accuracy were 84%, 85% and 85%, respectively. The area under the receiver operating characteristic curve was 0.91 (95% CI: 0.85-0.96). The intra-observer variability was +/-0.4 cm/s (3%) and the inter-observer variability was +/-0.6 cm/s (5%). CONCLUSION: Simple measurement of mitral annular systolic velocity by pulsed wave tissue Doppler imaging can be easily applied to patient care and can be used to quantify LVEF accurately and with a high level of reproducibility.
Atrial Fibrillation ; Cardiovascular Diseases ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Emergencies ; Humans ; Observer Variation ; Patient Care ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume ; Ventricular Function

To determine normal values for Doppler parameters of left ventricular function, ascending aortic blood flow velocity was measured by pulsed wave Doppler echocardiography in 63 healthy children with body surface area (BSA) <1 m(2) (age <10 yr). Peak velocity was independent of sex, but increased with body size. Mean acceleration was related to peak velocity (r=0.75, p<0.0001). Both stroke distance and ejection time had strong negative correlations with heart rate and positive correlations with BSA, suggesting that these parameters should be evaluated in relation to heart rate and body size. Mean intra- and interobserver variability for peak velocity, ejection time, stroke and minute distance ranged from 3 to 7%, whereas variability for acceleration time was 9 to 13%. These data may be used as reference values for the assessment of hemodynamic states in young children with cardiac disease.
Age Factors ; Aorta/*physiology ; Blood Flow Velocity ; Body Constitution ; Child ; Child, Preschool ; Echocardiography, Doppler/*standards/statistics & numerical data ; Female ; Heart Rate ; Human ; Infant ; Infant, Newborn ; Male ; Observer Variation ; Reference Values ; Stroke Volume