Cardiac Afterload Indices Measured in Ascending and Descending Aorta: Rational for the Use of Velocity-Pressure Loop in the Operating Room
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 55
- 主要终点
- Aortic velocity in the descending aorta in cm/s (VAdes.)
研究概览
简要总结
In surgical patients considered with "high cardiovascular risk", by their field or by the nature of their intervention, it is recommended to use hemodynamic monitoring including a continuous measurement device of arterial pressure and cardiac output (CO). However, targeting mean arterial pressure (MAP) with boluses of selective peripheral vasopressors (without positive inotropic or chronotropic effects) could have deleterious effects on CO. Thus, it seems important to use a combined analysis of MAP and CO to estimate the afterload-related cardiac performance (ACP) The investigators recently proposed a cardiac afterload monitoring, in the descending thoracic aorta, based on a combined analysis of flow velocity signal recorded by trans-oesophageal Doppler and aortic pressure, the Velocity-Pressure Loop (VP Loop). VP Loop, and its derived indicators, especially Global AfterLoad Angle (GALA), could be useful during hemodynamic management for continuous cardiac afterload monitoring. However, in cardiology unit, cardiac afterload is usually measured at the ascending aorta behind the aortic valves.
The main objective of this study is to compare VP Loop parameters build in the ascending and descending thoracic aorta according to patient cardiovascular risk factors.
详细描述
Main objective In order to personalize patient approach and better care during surgery, the investigators recently proposed a cardiac afterload monitoring, in the descending thoracic aorta, based on a combined analysis of flow velocity signal recorded by trans-oesophageal Doppler and aortic pressure, the Velocity-Pressure Loop (VP Loop). Cardiac afterload is usually measured at the ascending aorta behind the aortic valves. The main objective of this study is then to compare VP Loop parameters build in the ascending and descending thoracic aorta according to patient cardiovascular risk factors.
Cardiac afterload is measured under general anesthesia in the ascending and descending aorta, using recognized arterial indices describing it and parameters derived from the VP loop.
Cardiac afterload can be schematically defined by the combination of three components: peripheral vascular resistance (PVR), total arterial compliance (Ctot) and aortic wave reflections (WR). WR could be assessed by pulse wave pressure analysis with the augmentation index (Aix) or after pulse wave pressure separation into a forward and backward wave with the wave reflection index (WRi) or the wave reflection area (WRa).
Aortic pressure measurements As required by the standard of care of the interventional neuroradiology procedure, the neuroradiologist also cannulated the femoral artery. At the end of the procedure, during catheter withdrawal, pressure waveforms are recorded at two predefined aortic locations: in the ascending aorta and in the descending thoracic aorta just in front of the esophageal Doppler probe.
Aortic velocity recording VP Loop in ascending aorta and aortic velocity are measured in the flushing chamber of the left ventricle from the apical five-chamber view by trans-thoracic echocardiography (TTE) (Philips, EPIQ 7). Descending aortic velocity is measured with a transesophageal Doppler CardioQ-ODM+ (Deltex Medical, Chichester, UK) in order to construct the VP Loop in descending thoracic aorta.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •• Patients > 18 years scheduled an elective interventional neuroradiology procedure under general anesthesia requiring a continuous monitoring of mean arterial pressure and cardiac output.
- •oral agreement obtained from each patient before anesthesia
排除标准
- •• age <18 years
- •an emergency procedure
结局指标
主要结局
Aortic velocity in the descending aorta in cm/s (VAdes.)
时间窗: Duration of the surgical intervention or interventional neuroradiology procedure (maximum 1 day)]
For all patients, aortic descending velocity will be collected at the end of the procedure during catheter withdrawal
Measure of aortic pressure in the ascending aorta and in the descending thoracic aorta in mmHg (PAo)
时间窗: Duration of the surgical intervention or interventional neuroradiology procedure (maximum 1 day)]
For all patients, aortic pressure will be collected at the end of the procedure during catheter withdrawal
Aortic velocity in the ascending aorta in cm/s (VAasc.)
时间窗: Duration of the surgical intervention or interventional neuroradiology procedure (maximum 1 day)
For all patients, aortic ascending velocity will be collected at the end of the procedure during catheter withdrawal
次要结局
未报告次要终点
研究者
Joaquim MATEO
MD
Hopital Lariboisière