Objectives To compare hemodynamic and echocardiographic indexes of left ventricular performance. Design Retrospective database analysis of four clinical trials. Setting University hospital. Patients Cardiac surgery patients. Intervention Left ventricular performance was evaluated using left ventricular stroke work index (LVSWI) calculated from the pulmonary artery catheter and both fractional area change and regional wall motion score index (RWMSI) measured from transesophageal echocardiography. Measures of left ventricular performance were obtained before and after bypass (group 1, n = 30), during acute increase and decrease in preload (group 2, n = 14), after administration of inhaled prostacyclin or placebo in patients with pulmonary hypertension (group 3, n = 20), and in hemodynamically unstable patients in the intensive care unit at admission and at 2 and 4 hrs (group 4, n = 20). Main Results A total of 186 simultaneous LVSWI, fractional area change, and RWMSI were analyzed and compared. Patients with RWMSI <1.3 had a LVSWI of 23.4 ± 10.3 g·m−1·m−2 compared with 18.4 ± 7.2 g·m−1·m−2 in those with RWMSI >1.3 (p = .0349). Subdividing fractional area change into three different groups (≥50%, 25% to 49%, and ≤24%), the corresponding values of LVSWI were 22.3 ± 9.7 g·m−1·m−2, 22.2 ± 10.8 g·m−1·m−2, and 17.7 ± 5.5 g·m−1·m−2, respectively (p = .5114). Correlations between LVSWI and RWMSI changes ranged from −0.28 to 0.16 (p values from .31 to .94). Correlations between LVSWI and fractional area change changes ranged from −0.62 to 0.22 (p values from .07 to .95). Conclusion There is a significant discrepancy and limited relationship between the hemodynamic and echocardiographic evaluation of left ventricular performance.
SUMMARY A 4% pilocarpine gel applied topically to eyes was evaluated in glaucomatous Beagles and normotensive Miniature Schnauzers to determine its efficacy in reducing intraocular pressure ( IOP ) and to assess any side effects. Pilocarpine gel significantly ( P < 0.05) reduced IOP for 24 hours after treatment, compared with baseline (predrug) values, untreated fellow eyes, and placebo-treated eyes. The IOP remained significantly lower ( P < 0.05) during 3 treatment days, as well as the first 2 days after treatment. The pupil sizes were significantly smaller ( P < 0.01) in all treated dogs after the first administration of pilocarpine, compared with baseline values, untreated eyes, and placebo-treated eyes. The subsequent pilocarpine gel administrations induced significant miosis ( P < 0.01), compared with baseline values, but the extent of miosis and duration were significantly less ( P < 0.01) as the number of treatments increased. Conjunctival irritation and blepharospasm were observed mainly in the first 2 days of treatment and were minimal after subsequent applications. There was no contralateral effect on IOP or pupil size, compared with baseline values and placebo-treated eyes.
