Efficiency CPO – Cardiac Power Output Cardiac power output represents cardiac pumping ability to generate blood flow. It expresses the cardiac power reserves that can be recruited to increase the heart’s pumping ability. The higher the CPO, the higher the recruitable reserves to increase pumping ability. CPO is directly correlated to CO and MAP: CPO = MAP · CO/ k with k=451 as a conversion factor. Physiological range at rest: from 0.80 to 1.20 Watt. CPO has been demonstrated to be a good predictor for mortality in heart failure patients. Available also: CPI = MAP · CI/ k cardiac power index from 0.50 to 0.70 W/m2 1. Cotter G, Williams SG,Vered Z, Tan LB. Role of cardiac power in heart failure. Curr Opin Cardiol. 2003 May;18(3):215-22 2. F incke R, Hochman JS, Lowe AM et al (2004) Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll Cardiol 44:340–348. 3. Mendoza DD, Cooper HA, Panza JA. Cardiac power output predicts mortality across a broad spectrum of patients with acute cardiac disease. Am Heart J. 2007 Mar;153(3):366-70. 4. G iglioli C, Landi D, Cecchi E, Chiostri M, Gensini GF,Valente S, Ciaccheri M, Castelli G, Romano SM. Effects of ULTRAfiltration vs DIureticS on clinical neurohormonal and hemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail 2011;13(3): 337-46. 5. Hothi SS, Tan LB, Cotter G. Resting cardiac power index and prediction of prognosis in heart failure. Eur J Heart Fail. 2015 Jul;17(7):642-4. 6. M orelli A, Singer M, Ranieri VM, D’Egidio A, Mascia L, Orecchioni A, Piscioneri F, Guarracino F, Greco E, Peruzzi M, Biondi-Zoccai G, Frati G, Romano SM. Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study. Intensive Care Med 2016. 7. N athania M, Hollingsworth KG, Bates M, Eggett C, Trenell MI,Velicki L, Seferovic PM, MacGowan GA, Turnbull DM, Jakovljevic DG. Impact of age on the association between cardiac high-energy phosphate metabolism and cardiac power in women. Heart. 2018 Jan;104(2):111-118.
CCE – Cardia Cycle Efficiency Cardiac Cycle Efficiency describes hemodynamic performance in term of energy expenditure. Indeed, CCE depends on the energy required to generate a given SV, which depends on the interaction between pump function and arterial system (i.e. A-V coupling). Many factors may influence CCE, for example changes in left ventricular function, heart rate, preload, afterload, including arterial elastance and reflected pressure waves. The value of CCE can range from +1 (ideal condition with no energy expenditure) to negative values: the greater the energy expenditure to generate a given SV, the lower the CCE value. CCE is computed beat by beat as the ratio of the sum of systolic powers [W(t)sys] to the sum of all powers of entire cycle [W(t)beat]. Physiological range: -0.2 – 0.3 units.
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CCE can change according to different clinical settings (e.g. bradycardia, tachycardia, poor myocardial contractility, increased or reduced venous return, changes of systemic vascular resistance) and may be useful for assessing the hemodynamic response to cardioactive and vasoactive drugs. Additionally, monitoring the trend of CCE can be of value in preventing unexpected hemodynamic impairments and may help in clinical decision-making. 1. G iglioli C, Landi D, Cecchi E, Chiostri M, Gensini GF,Valente S, Ciaccheri M, Castelli G, Romano SM. Effects of ULTRAfiltration vs DIureticS on clinical neurohormonal and hemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail 2011;13(3): 337-46. 7. P avoni V, Romagnoli S, Batignani G, Gianesello L, Horton A, Romano SM. Unsuspected Heart Failure: Usefulness of a Minimally Invasive Hemodynamic Monitoring System. J Anesth Clin Res 2012; 3(8). 8. Romano SM. Cardiac cycle efficiency: a new parameter able to fully evaluate the dynamic interplay of the cardiovascular system. Int J Cardiol 2012; 155:326-7 9. O norati F, Santini F, Amoncelli E, Campanella F, Chiominto B, Faggian G, Mazzucco A. How should I wean my next intra-aortic balloon pump? Differences between progressive volume weaning and rate weaning. J Thorac Cardiovasc Surg 2012;145: 1214-21. 10. Scolletta S et al. Assessment of left ventricular function by pulse wave analysis in critically ill patients. Intensive Care Med 2013;39: 1025-33. 11. M orelli A, Singer M, Ranieri VM, D’Egidio A, Mascia L, Orecchioni A, Piscioneri F, Guarracino F, Greco E, Peruzzi M, Biondi-Zoccai G, Frati G, Romano SM. Heart rate reduction with esmolol is associated with improved arterial elastance in patients with septic shock: a prospective observational study. Intensive Care Med 2016. 12. M essina A, Romano SM, Bonicolini E, Colombo D, Cammarota G, Chiostri M, Della Corte F, Navalesi P, Payen D, Romagnoli S. Cardiac cycle efficiency and dicrotic pressure variations: new parameters for fluid therapy: A pilot observational study. Eur J Anaesthesiol 2017; 34:1–9. 13. R istalli F, Romano SM, Stolcova M, Meucci F, Squillantini G,Valente S, Di Mario C. Hemodynamic monitoring by pulse contour analysis during trans-catheter aortic valve replacement: A fast and easy method to optimize procedure results. Cardiovasc Revasc Med 2018 Jul 19. 14. H an D, Liu YG, Pan SD, Luo Y, Li J, Ou-Yang C. Comparison of sufentanil-midazolam and sevoflurane for anesthesia induction in children undergoing cardiac surgery by real-time hemodynamic and cardiac efficiency monitoring: A prospective randomized study. Heart Surg Forum 2019 Feb 18;22(1):E038-E044. 15. N euschwander A, Barthélémy R, Ditchi D, Dramé F, Redouté M, Stern J, Cholley B, Mebazaa A, Chousterman BG, Pirracchio R. Accuracy of a multiparametric score based on pulse wave analysis for prediction of fluid responsiveness: ancillary analysis of an observational study. Can J Anaesth 2020 Sep;67(9):1162-1169. 16. G iglioli C, Cecchi E, Stefàno PL, Spini V, Fortini G, Chiostri M, Marchionni N, Romano SM. Six-month prognostic impact of hemodynamic profiling by short minimally invasive monitoring after cardiac surgery. J Cardiovasc Thorac Res 2020;12(4):313-320.
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