The Application Of Non-invasive Hemodynamic Monitoring In Patients With Heart Failure

[Background and Objective]Being at the vital stage of various structural or functional cardiac discorder,heart failure(HF) is a serious and complex clinical syndrome.And a series of abnormal activation of neuroendocrine is one of the most important influencing factors in the process of hemodynamics disordering and myocardial remodeling. At present,HF is growing to be the world’s public health problem. The epidemiological datum show that there are22.5million patients with heart failure,and still increasing at the rate of2million one year.Although the aggressive treatments can extend the HF patients’ lives, the mortality rate of HF is remained dominating the cardioascular death at present.The5-year survival rate of HF patients is similar with malignant tumors.Hemodynamics is the study of the blood’s flow mechanics in cardiovascular system,we general use two kinds of methods, invasive or non-invasive,to measure the parameters. HF patients exist the phenomenon of the hemodynamic disorder, monitoring the patients’ hemodynamic changes can be more objective and accurate to evaluating the cardic function of HF patients, and it has very important clinical significance in discoverying the abnormal of cardiac function timely.Currently, the invasive method of monitoring the patients’ hemodynamic variables,like Swan-Ganz catheter, needing higher technical requirements and having more complications,can’t be popular application in the clinic. Non-invasive hemodynamic monitoring USCOM used Continuous Wave Doppler (CW) principle to monitor CO, can avoid the complications of the invasive monitoring.There has been a large number of domestic and foreign research proving that there is good correlation with USCOM and the Swan-Ganz catheter in measuring CO.This study was to using USCOM instead of invasive methods to check HF patients’CO,observing whether there are correlations between the indexes of CO (L/min), BNP and LVEF, and guide its clinical values in decompensated heart failure (HF).[Methods]Fifty-seven patients with HF in Shandong Provincial Qianfoshan Hospital were divided into3groups by New York Heart Association(NYHA) classification,the cardiac function was class Ⅱ in18patients, class Ⅲ in20cases, and class Ⅳ in19cases. Fifty-two healthy persons were studied as control.Certain amount of venous blood was kept for rapid measuring of BNP concentration when the patients have the symptom of dyspnea. Hemodynamic variables were measured by using non-invasive ultrasonic cardiac output monitor (USCOM) between the57HF patients and52normal persons near the bed.The left ventricular ejection fraction(LVEF) were measured by use of PHILIPS iE33color Doppler ultrasonic instrument.The p value <0.05was considered statistically significant. Statistical analysis were performed by using SPSS17.0version.[Results]1. The values of BNP, LVEF, CO, CI in57cases of patients are signally different to the controls. With increased cardiac function classification, the values of BNP are gradually increasing (P<0.05), the values of LVEF, CO, CI are reducing (P<0.05).2. According to the concentration of BNP>100pg/ml,55cases are diagnosed with HF in57HF patients,and if according to the values of CO<4L/min there are53patients with HF(χ2=0.176, p=0.75), there is no difference between the two methods.3. In HF patients, the plasma BNP levels had observably negative correlations with LVEF and CO(r=-0.727,-0.496, P<0.01).There are positive correlations between LVEF and CO (r=0.546, P<0.01). [Conclusion]This study showed that patients with HF exist the phenomene of hemodynamic disorder. We can monitor the hemodynamic changes by using USCOM accurately,timely,and this method is noninvasive,simple,we can adjust the treatment to reducing mortality according to values.At the same time,monitoring the changes of hemodynamic monitoring combined with BNP levels can make up the limitation of the BNP, and to improve the diagnostic HF specificity.Applying non-invasive ultrasonic cardiac output monitor to detect CO for identifying HF is clinically valuable.