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The silent force of the heart: right ventricular energetics : validity and feasibility of cardiac ultrasound for the determination of right ventricular – pulmonary vasculature coupling in Intensive Care Unit patients

Boonstra, M.J. (2018) The silent force of the heart: right ventricular energetics : validity and feasibility of cardiac ultrasound for the determination of right ventricular – pulmonary vasculature coupling in Intensive Care Unit patients.

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Abstract:Right heart failure is increasingly being recognized as an independent predictor of adverse outcome in the critically ill. Right ventricular (RV) - pulmonary artery (PA) coupling quantifies right heart efficiency and performance. Mechanical ventilation, pulmonary pathology, and cardiovascular support affect RV-PA coupling. Therefore, assessment of RV-PA coupling in ICU patients may yield important guidance for diagnosis and treatment. Theoretically, bedside determination of RV-PA coupling is possible using ultrasound, circumventing the need of MRI and/or right heart catheterization. RV systolic pressure, RV stroke volume and RV end systolic volume were estimated from ultrasound measurements. Thereof RV-PA coupling was determined using a multiple beat method and a single beat method. Obtained estimates were compared against invasive pressure measurement and cardiac MRI. Besides, feasibility of the method was assessed in the intensive care unit. \Using ultrasound, a systolic RV pressure profile as well as a systolic RV volumic profile could be obtained. However, ultrasound derived RV systolic pressure, RV stroke volume and RV end systolic volume showed poor correlation with gold standard invasive pressure measurements respectively MRI. Poor correlation existed between ultrasound derived single beat RV-PA coupling and gold standard single beat RV-PA coupling. In the ICU, ultrasound derived RV-PA coupling estimation was challenging. Tricuspid regurgitation was not always present and ultrasound views of the pulmonic valve could often not be obtained. It is feasible to derive RV-PA coupling value from ultrasound measurements. Despite discrepancy between gold standard and ultrasound measurements, a single beat ultrasound method may provide patient specific guidance during ICU treatment and may therefore be of additional value. Future research should be aimed at the reduction of estimation errors and the ability of ultrasound derived RV-PA coupling to describe treatment effects.
Item Type:Essay (Master)
Clients:
Amsterdam UMC, Amsterdam, The Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/75715
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