Cardiac Function Index And Global Ejection Fraction For Assessment Of Left Ventricular Systolic Function In Critical Ill Patients

Background: Because of various causes of critically ill patients admitted to the ICU,either primary or secondary heart disease cardiac dysfunction,heart function is very common,so the evaluation of heart function is particularly important,and the degree of involvement of the heart function were related with prognosis.There are many ways to evaluate cardiac function,such as invasive Swan-Ganz catheter(PAC),noninvasive echocardiography,and so on.But because of the serious complications of PAC,the interpretation of data error and the patient did not reach the expected benefit;echocardiography as a result of equipment,technical requirements,not at any time and continuous monitoring of the defects,the operator's experience and technology between different personal differences lead to differences in measurement results,affect the treatment decision and prognosis of patients.A single indicator for clinical application in recent years the transpulmonary thermodilution pulse indicator continuous cardiac output monitoring,cardiac function monitoring equipment is a minimally invasive,repeatable use,continuous monitoring of heart function,widely used in the assessment of cardiac output,cardiac preload,reaction capacity,extravascular lung water and etc.to evaluate the two parameters of cardiac function index(CFI)and Global ejection fraction(GEF).Correlation studies showed that CFI,GEF and cardiac function were continuous,but the subjects were mainly patients with septic shock,and there was no report on left ventricular dysfunction.Objective: To investigate the clinical significance of cardiac function index and global ejection fraction,derived from single-indicator transpulmonary thermodilution technique,for assessment of cardiac function in critically ill patients.Methods:1.Study design:Prospective clinical observational study.2.The object of observation: from January 2012 to December 2013 in the First Affiliated Hospital of Guangzhou Medical University intensive care unit(ICU),Pi CCO monitoring was inserted patients who are seriously ill.According to the heart function group,39 patients were enrolled,left ventricular systolic dysfunction in normal heart function group 18 cases,21 cases in the control group,each patient underwent indwelling jugular vein or subclavian vein catheter and PICCO connection device.3 data collection: the average PICCO per patient collected every three times the value of the data by thermodilution,cardiac ultrasound measurement of left heart ejection fraction,cardiac output(SV)data,and through the examination to exclude the cardiomyopathy,pulmonary heart disease,pulmonary hypertension,severe valvular heart disease.The data of CFI,GEF and LVEF measured by echocardiography were compared between the two groups.The diagnostic value of CFI,GEF and LVEF in the diagnosis of left ventricular dysfunction(ROC)curve.Find out the fault threshold and the sensitivity and specificity of the area under the ROC curve and the area of the 95% confidence interval.There were significant differences in P<0.05 judgment.Results:LVEF was significantly correlated with CFI and GEF(r=0.553,P<0.005;r=0.468,P<0.005).The area under ROC curve of CFI,GEF and LVEF for diagnosing cardiac insufficiency was 0.885,0.862 and 0.903,respectively(P>0.05 for comparison).The cut-off value of CFI for predicting cardiac insufficiency was 4.25,with the sensitivity of 0.778 and specificity of 0.889.The cut-off value of GEF for predicting cardiac dysfunction was 19.5,with the sensitivity of 0.889 and specificity of 0.667.Conclusion:CFI and GEF measured by transpulmonary thermodilution correlate with LVEF which was assessed by transthoracic echocardiography.These two measures can be used for assessment of left ventricular systolic function.