Clinical Research
Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation
Guo Juan, Yi Renfeng, Wang Hao, Yang Yuanting, Zhang Min, Hu Bo, Cao Sheng, Deng Qing, Zhou Qing
Published 2019-11-25
Cite as Chin J Ultrasonogr, 2019,28(11): 927-932. DOI: 10.3760/cma.j.issn.1004-4477.2019.11.002
Abstract
ObjectiveTo investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO).
MethodsA total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups.
ResultsAge, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05).
ConclusionsEchocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO.
Key words:
Echocardiography; Acute fulminant myocarditis; Venous-arterial extracorporeal membrane oxygenation; Hemodynamics
Contributor Information
Guo Juan
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Yi Renfeng
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Wang Hao
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Yang Yuanting
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Zhang Min
Department of Cardiovascular Surgery, RenMin Hospital, Wuhan University, Wuhan 430030, China
Hu Bo
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Cao Sheng
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Deng Qing
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China
Zhou Qing
Department of Ultrasound, RenMin Hospital, Wuhan University, Wuhan 430030, China