Abstract
Introduction: Shock, which, if not treated adequately, will increase the risk of mortality in children. Non-invasive hemodynamic monitoring is one of the keys to reducing child mortality due to shock. The Smith-Madigan inotropy index (SMII) has been tested as a tool for rapid and non-invasive estimation of myocardial contractility measures. This study evaluated the correlations between arterial dP/dt measured by supra-systolic oscillometric central blood pressure (cBP) and SMII to identify the clinical utility of this non-invasive method as an alternative.
Methods: This cross-sectional study was conducted among a healthy child population from four elementary schools in two provinces in Indonesia, aged 8-14 years. Individuals who met the inclusion criteria were performed on a physical examination (weight and height) as well as cBP and arterial dP/dt max measurements using BP+ USCOM and SMII measurements using USCOM 1A simultaneously. Measurements using BP+ USCOM and USCOM 1A were performed simultaneously. Based on the previous study, left ventricle (LV) dP/dt = 1.25 (arterial dP/dt), so in this study, after obtaining arterial dP/dt data, the calculation of LV dP/dt was continued, and then evaluated the correlations between 1.25 arterial dP/dt (LV dP/dt) and SMII.
Results: Between August 2023 and January 2024, 283 children were enrolled as research subjects, with a median age of 11 years (ranging from 7 to 14 years). The cohort comprised 146 boys (51.6%) and 137 girls (48.4%). The median body weight recorded was 34.9 kg. The predominant nutritional status observed was classified as good nutrition (55.8%), while the prevalent height status among the subjects was categorized as normal height. In this study, a significant correlation was found between 1.25 arterial dP/dt (LV dP/dt) and SMII contractility parameters of kinetic energy (KE) with r=0.34, 95% confidence interval (CI) 0.22-0.44, p<0.0001.
Conclusion: This study obtained results indicating a significant relationship between arterial dP/dt max and SMII contractility parameters. The LV dP/dt max value, calculated from the measurement of arterial dP/dt max using a non-invasive method, can be used as an alternative to assess LV contractility.
Kurniawan Taufiq Kadafi, Takhta Khalasha, Sharfina Fulki Adilla Hidayat, Sarah Rafika Nursyirwan, Nielda Kezia Sumbung, Ardhanis Ramadhanti, Daendy Nova Setya, Dyahris Koentartiwi, Saptadi Yuliarto, Antonius H. Pudjiadi
