Pulse pressure variation is not a valid predictor of fluid responsiveness in patients with elevated left ventricular filling pressure

Jae Kwang Shim, Jong Wook Song, Young Song, Ji Ho Kim, Hye Min Kang, Young Lan Kwak

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Abstract

Purpose: The purpose of this study was to test the hypothesis that the predictive ability of pulse pressure variation (PPV) for fluid responsiveness would be altered in patients with elevated left ventricular (LV) filling pressure. Materials and methods: According to the preoperative echocardiographic assessment of the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/E'), patients undergoing surgical coronary revascularization were classified into normal (n = 34, E/E' <. 8) and high (n = 34, E/E' > 15) LV filling pressure group. After anesthetic induction, PPV and hemodynamic data were measured before and after 6 mL/kg of colloid administration. Fluid responsiveness was defined as 12% or more increase in stroke volume index assessed by pulmonary artery catheter and tested by the area under the receiver operating characteristic curve (AUROC). Results: The AUROCs of PPV in the normal and high filling pressure group were 0.829 (95% confidence interval [CI], 0.661-0.963; P < .001) and 0.583 (95% CI, 0.402-0.749; P = .110), respectively. The AUROCs of cardiac filling pressures and right ventricular end-diastolic volume index did not show statistical significance in both groups. Conclusions: None of the assessed preload indices including PPV were able to predict fluid responsiveness in patients with elevated LV filling pressure.

Original languageEnglish
Pages (from-to)987-991
Number of pages5
JournalJournal of Critical Care
Volume29
Issue number6
DOIs
Publication statusPublished - 2014 Dec 1

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All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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