Respiratory Variations of R-Wave Amplitude in Lead II Are Correlated With Stroke Volume Variations Evaluated by Transesophageal Doppler Echocardiography

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• 作者：Emmanuel Lorne ; MD ; PhD^鈦?/sup> ; ^&dagger ; ; ^{lorne.emmanuel@chu-amiens.fr} ; Yazine Mahjoub ; MD^鈦?/sup> ; ^&dagger ; ; Pierre-Gré ; goire Guinot ; MD^鈦?/sup> ; Yannick Fournier ; MD^鈦?/sup> ; Matthieu Detave ; MD^鈦?/sup> ; Cyrille Pila ; MD^鈦?/sup> ; Ammar Ben Ammar ; MD^鈦?/sup> ; Beatris Labont ; MD^鈦?/sup> ; Elie Zogheib ; MD^鈦?/sup> ; Hervé ; Dupont ; MD ; PhD^鈦?/sup> ; ^&dagger ;
• 关键词：stroke volume ; R-wave in lead II ; pulse pressure variations ; electrocardiogram ; transesophageal echocardiography
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2012
• 期刊代码：163_10530770
• 类别：med
• 出版时间：June, 2012
• 卷：26
• 期：3
• 页码：381-386
• 文件大小：651 K

摘要

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Objective

The authors hypothesized that variations in electrocardiographically derived R-wave amplitude might be correlated with mechanical ventilation-induced variations in stroke volume as determined by transesophageal echocardiography.

Design

Observational prospective study.

Setting

Single university hospital.

Participants

Thirty-four patients undergoing coronary artery bypass surgery.

Interventions

None.

Measurements and Main Results

Respiratory R-wave variations in lead II (螖RII) were correlated with aortic velocity time integral variations (r = 0.82, p < 0.0001). Respiratory R-wave variations in leads III and aVF and pulse pressure variation also were correlated with aortic velocity time integral variations (r = 0.49, p = 0.015; r = 0.61, p = 0.0016; and r = 0.72, p < 0.0001, respectively). R-wave respiratory variations in lead V₅ were not correlated with aortic velocity time integral variations. 螖RII was correlated with pulse pressure variation (r = 0.71, p < 0.0001). A 螖RII cutoff value of 15%accurately predicted stroke volume variations >15%, with a specificity of 92%, a sensitivity of 86%, a positive likelihood ratio of 11.1, a negative likelihood ratio of 0.15, a positive predictive value of 95%, and a negative predictive value of 80%.

Conclusions

螖RII is correlated with stroke volume variations as determined by transesophageal echocardiography in mechanically ventilated patients and can identify the stroke volume variation cutoff of 15%, previously determined to be the cutoff for volume responsiveness.