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首页> 外文期刊>Critical care : >The subxiphoid view cannot replace the apical view for transthoracic echocardiographic assessment of hemodynamic status
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The subxiphoid view cannot replace the apical view for transthoracic echocardiographic assessment of hemodynamic status

机译：剑突下视图不能代替经胸超声心动图评估血流动力学状态的顶视图

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IntroductionThis prospective study aimed to assess whether use of the subxiphoid acoustic window in transthoracic echocardiography (TTE) can be an accurate alternative in the absence of an apical view to assess hemodynamic parameters.MethodsThis prospective study took place in a teaching hospital medical ICU. Over a 4-month period, TTE was performed in patients admitted for more than 24 hours. Two operators rated the quality of parasternal, apical, and subxiphoid acoustic windows as Excellent, Good, Acceptable, Poor, or No image. In the subpopulation presenting adequate (rated as acceptable or higher) apical and subxiphoid views, we compared the left ventricular ejection fraction (LVEF), the ratio between right and left ventricular end-diastolic areas (RVEDA/LVEDA), the ratio between early and late mitral inflow on pulsed Doppler (E/A ratio), the aortic velocity time integral (Ao VTI), and the ratio between early mitral inflow and displacement of the mitral annulus on tissue Doppler imaging (E/Ea ratio).ResultsAn adequate apical view was obtained in 80%, and an adequate subxiphoid view was obtained in 63% of the 107 patients included. Only 5% of patients presented an adequate subxiphoid view without an adequate apical view. In the subpopulation of patients with adequate apical and subxiphoid windows (n = 65), LVEF, E/A, and RVEDA/LVEDA were comparable on both views, and were strongly correlated (r > 0.80) with acceptable biases and precision. However, the Ao VTI and the E/Ea ratio were lower on the subxiphoid view than on the apical view (18 ± 5 versus 16 ± 5 cm and 9.6 ± 4.6 versus 7.6 ± 4 cm, respectively, P = 0.001 for both).ConclusionsAn adequate TTE subxiphoid window was obtained in fewer than two thirds of ICU patients. In addition to the classic indication for the subxiphoid window to study the vena cava and pericardium, this view can be used to study right and left ventricular morphology and function, but does not provide accurate hemodynamic Doppler information. ICU echocardiographers should therefore record both apical and subxiphoid views to assess comprehensively the cardiac function and hemodynamic status.
机译：前言这项前瞻性研究旨在评估在无心尖评估血流动力学参数的情况下，经胸超声心动图（TTE）中剑突下声窗的使用是否可以作为一种准确的选择。方法该前瞻性研究在教学医院的ICU中进行。在4个月的时间内，对入院超过24小时的患者进行了TTE。两名操作员将胸骨旁，根尖和剑突下声窗的质量评为“好”，“好”，“可接受”，“差”或“无图像”。在呈现出足够（定为可接受或更高）的心尖和剑突下视野的亚人群中，我们比较了左心室射血分数（LVEF），右心室和左心室舒张末期面积之间的比率（RVEDA / LVEDA），早搏和早搏之间的比率。脉冲多普勒晚期二尖瓣入流（E / A比），主动脉速度时间积分（Ao VTI）以及组织多普勒成像中早期二尖瓣入流与二尖瓣环移位之间的比率（E / Ea比）。 80％的患者获得了最佳视野，所纳入的107例患者中有63％获得了剑突下视野。仅5％的患者表现出足够的剑突下视野，而没有足够的根尖视野。在具有足够的心尖和剑突下窗口（n = 65）的患者亚人群中，两种观点的LVEF，E / A和RVEDA / LVEDA相当，并且与可接受的偏倚和精确度密切相关（r> 0.80）。但是，剑突下的Ao VTI和E / Ea比低于顶尖的（分别为18±5对16±5 cm和9.6±4.6对7.6±4 cm，两者均P = 0.001）。结论不到三分之二的ICU患者获得了足够的TTE剑突下窗口。除了用于研究腔静脉和心包的剑突下窗口的经典指征外，该视图还可以用于研究左右心室的形态和功能，但不能提供准确的血液动力学多普勒信息。因此，ICU超声心动图检查者应记录心尖和剑突下视图，以全面评估心功能和血流动力学状态。

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