Ultrasound-guided haemodynamic state assessment

The haemodynamic state refers to the integration of myocardial and vascular systems, and involves both left and right hearts, and systolic and diastolic phases. The assessment of the haemodynamic state can be performed with echocardiography, and provides a higher level of diagnosis than conventional pressure- and flow-based monitoring. Whilst hypotension alerts the practitioner about the existence of haemodynamic abnormality, it does not provide sufficient information to identify the cause or the underlying haemodynamic state. The premise of haemodynamic state monitoring is that better diagnosis will lead to more rational therapy, which in turn may improve the outcome.

The haemodynamic state can be classified into seven broad categories: normal, empty, vasodilation, systolic failure, primary diastolic failure, systolic and diastolic failure and right ventricular failure. These are identified as patterns based upon ventricular size, ventricular function and left atrial (LA) filling pressure. Patients may have an abnormal haemodynamic state (such a systolic failure), but may not need active treatment if they are haemodynamically stable. However, if treatment is required, it can be directed according to the underlying haemodynamic state. For example, a patient with systolic failure may benefit from inotrope support, whereas an empty state acquires volume infusion and vasodilation requires vasopressor support.

Keywords: echocardiography, haemodynamic, myocardial, vascular, hypotension