Here's an interesting study on echocardiographic surrogates for PCWP during cardiac surgery. Unsurprisingly classic doppler measures perform poorly, the more interesting finding is the value finding is the atrial septal shape, which many (including myself) rely based on physiology but has little data. #critcareecho https://pubs.asahq.org/anesthesiology/article/121/4/719/12174/Interatrial-Septum-Motion-but-Not-Doppler

6th paper of my #adventarticles: E/E’ has fair correlation to LAP under certain conditions across populations, but how does it track within individual change in LAP? Poorly it seems in this study, and several others have shown E/E’ increasing in healthy hearts with preload reduction. https://www.ahajournals.org/doi/full/10.1161/CIRCIMAGING.110.960575 #echocardiography #critcareecho #physiology

4th papers of my #adventarticles: This time not an original article, but the authors response to criticism. It’s the most succinct and convincing explanation of why single beat estimation of ventricular elastance is likely impossible, particularly in the critically ill/perioperative setting. https://www.bjanaesthesia.org/article/S0007-0912(17)31876-7/fulltext #cardiology #physiology #critcareecho

4th papers of my #adventarticles: This time not an original article, but the authors response to criticism. It’s the most succinct and convincing explanation of why single beat estimation of ventricular elastance is likely impossible, particularly in the critically ill/perioperative setting. https://www.bjanaesthesia.org.uk/article/S0007-0912(17)31876-7/pdf #cardiology #physiology #critcareecho

3rd paper of my #adventarticles: Still on the theme of V-A coupling, this paper attempting to validate multiple noninvasive measures of contractility, including Chen’s single beat method for estimating Emax, lead me down a rabbit hole and finding the lack of validity of single-beat measures for ventricular elastance. In this study, single-beat estimated Emax reflects afterload, not contractility. https://www.ahajournals.org/doi/full/10.1161/CIRCIMAGING.113.000722 #physiology #cardiology #critcareecho