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Hitzeman TC, Xie Y, Zadikany RH, Nikolova AP, Baum R, Caldaruse AM, Agvanian S, Melmed GY, McGovern DPB, Geft DR, Chang DH, Moriguchi JD, Hage A, Azarbal B, Czer LS, Kittleson MM, Patel JK, Wu AHB, Kobashigawa JA, Hamilton M, Hong T, Shaw RM. cBIN1 Score (CS) Identifies Ambulatory HFrEF Patients and Predicts Cardiovascular Events. Front Physiol 2020; 11:503. [PMID: 32670075 PMCID: PMC7326053 DOI: 10.3389/fphys.2020.00503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiac Bridging Integrator 1 (cBIN1) is a membrane deformation protein that generates calcium microdomains at cardiomyocyte t-tubules, whose transcription is reduced in heart failure, and is released into blood. cBIN1 score (CS), an inverse index of plasma cBIN1, measures cellular myocardial remodeling. In patients with heart failure with preserved ejection fraction (HFpEF), CS diagnoses ambulatory heart failure and prognosticates hospitalization. The performance of CS has not been tested in patients with heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS CS was determined from plasma of patients recruited in a prospective study. Two comparative cohorts consisted of 158 ambulatory HFrEF patients (left ventricular ejection fraction (LVEF) ≤ 40%, 57 ± 10 years, 80% men) and 115 age and sex matched volunteers with no known history of HF. N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were also analyzed for comparison. CS follows a normal distribution with a median of 0 in the controls, which increases to a median of 1.9 (p < 0.0001) in HFrEF patients. CS correlates with clinically assessed New York Heart Association Class (p = 0.007). During 1-year follow-up, a high CS (≥ 1.9) in patients predicts increased cardiovascular events (43% vs. 26%, p = 0.01, hazard ratio 1.9). Compared to a model with demographics, clinical risk factors, and NT-proBNP, adding CS to the model improved the overall continuous net reclassification improvement (NRI 0.64; 95% CI 0.18-1.10; p = 0.006). Although performance for diagnosis and prognosis was similar to CS, NT-proBNP did not prognosticate between patients whose NT-proBNP values were > 400 pg/ml. CONCLUSION CS, which is mechanistically distinct from NT-proBNP, successfully differentiates myocardial health between patients with HFrEF and matched controls. A high CS reflects advanced NYHA stage, pathologic cardiac muscle remodeling, and predicts 1-year risk of cardiovascular events in ambulatory HFrEF patients. CS is a marker of myocardial remodeling in HFrEF patients, independent of volume status.
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Affiliation(s)
- Tara C. Hitzeman
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, United States
| | - Yu Xie
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Ronit H. Zadikany
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Andriana P. Nikolova
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Rachel Baum
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, United States
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Ana-Maria Caldaruse
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Sosse Agvanian
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Gil Y. Melmed
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Dermot P. B. McGovern
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Dael R. Geft
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - David H. Chang
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Jaime D. Moriguchi
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Antoine Hage
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Babak Azarbal
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Lawrence S. Czer
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Michelle M. Kittleson
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Jignesh K. Patel
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Alan H. B. Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jon A. Kobashigawa
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Michele Hamilton
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - TingTing Hong
- Department of Medicine, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States
| | - Robin M. Shaw
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, United States
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Respiratory Variability of Pulmonary Velocity-Time Integral As a New Gauge of Fluid Responsiveness For Mechanically Ventilated Patients in the ICU*. Crit Care Med 2019; 47:e310-e316. [DOI: 10.1097/ccm.0000000000003642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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3
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Miller FA. The Integration of Doppler Ultrasound With Two-Dimensional Echocardiography and the Noninvasive Cardiac Hemodynamic Revolution of the 1980s. J Am Soc Echocardiogr 2018; 31:1353-1365. [PMID: 30340892 DOI: 10.1016/j.echo.2018.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 10/28/2022]
Abstract
In the 1970s, as cardiac imaging matured from M-mode to two-dimensional echocardiography, investigators in Norway showed that continuous-wave Doppler ultrasonography could be used to accurately measure the mean gradient and pressure half-time for stenotic mitral valves. In the 1980s, continuous-wave Doppler was validated for measurement of the pressure gradient across stenotic aortic valves, and pulsed-wave Doppler combined with two-dimensional echocardiographic imaging was validated for noninvasive measurement of stroke volume and cardiac output. The combination of stroke volume measurement and measurement of the time-velocity integral of flow through the aortic valve was then validated as a means to accurately calculate valve area for patients with stenotic aortic valves or aortic prostheses. This integration of cardiac Doppler ultrasonography with two-dimensional echocardiographic cardiac imaging led to a revolution in noninvasive hemodynamic evaluations, which have replaced invasive hemodynamic evaluations in surgical decision making for most patients with native or prosthetic valvular stenosis.
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Affiliation(s)
- Fletcher A Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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4
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Godfrey ME, Friedman KG, Drogosz M, Rudolph AM, Tworetzky W. Cardiac output and blood flow redistribution in fetuses with D-loop transposition of the great arteries and intact ventricular septum: insights into pathophysiology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:612-617. [PMID: 27873373 DOI: 10.1002/uog.17370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Although the postnatal physiology of D-loop transposition of the great arteries with intact ventricular septum (D-TGA/IVS) is well established, little is known about fetal D-TGA/IVS. In the normal fetus, the pulmonary valve (PV) is larger than the aortic valve (AoV), there is exclusive right-to-left flow at the foramen ovale (FO) and ductus arteriosus (DA), and the left ventricle (LV) ejects 40% of combined ventricular output (CVO) through the aorta, primarily to the brain. In D-TGA/IVS, the LV ejects oxygen-rich blood to the pulmonary artery, theoretically leading to pulmonary vasodilation, increased branch pulmonary artery flow and reduced DA flow. In this study, we tested the hypothesis that D-TGA/IVS anatomy results in altered cardiac valve sizes, ventricular contribution to CVO, and FO and DA flow direction. METHODS Seventy-four fetuses with D-TGA/IVS that underwent fetal echocardiography at our institution between 2004 and 2015 were included in the study. AoV, PV, mitral valve and tricuspid valve sizes were measured and Z-scores indexed to gestational age were generated. Ventricular output was calculated using Doppler-derived velocity-time integral, and direction of flow at the FO and DA shunts was recorded in each fetus using both color Doppler and flap direction. Measurements in the D-TGA/IVS fetuses were compared with data of 222 controls, matched for gestational-age range, from our institutional normal fetal database. RESULTS The LV component of CVO was higher in D-TGA/IVS fetuses than in controls (50.7% vs 40.2%; P < 0.0001), with no difference in the total CVO. Flow was bidirectional at the FO in 56 (75.7%) and at the DA in 24 (32.4%) D-TGA/IVS fetuses. Only 21.6% fetuses had normal right-to-left flow at both shunts. Bidirectional shunting was more common in third-trimester fetuses than in second-trimester ones (P < 0.03). AoV and PV diameters were nearly identical in D-TGA/IVS in contrast to control fetuses, hence AoV Z-score was higher than PV Z-score (1.13 vs -0.65, P < 0.0001) in D-TGA/IVS. CONCLUSIONS In fetuses with D-TGA/IVS there is loss of the normal right-sided dominance, as each ventricle provides half of the CVO, with a relatively large AoV diameter and a small PV diameter, and high incidence of bidirectional FO and DA flow. This may support the theory that high pulmonary artery oxygen content reduces pulmonary vascular resistance, thereby increasing branch pulmonary artery flow and venous return, which results in increased LV preload and output. Pulmonary sensitivity to oxygen is thought to increase later in gestation, which may explain the higher incidence of bidirectional shunting. Consequences of these flow alterations include increased aortic and, most likely, brain flow, perhaps in an attempt to compensate for the substrate deficiency observed in D-TGA/IVS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M E Godfrey
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - K G Friedman
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Drogosz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - A M Rudolph
- Department of Pediatrics & Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - W Tworetzky
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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5
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Mercado P, Maizel J, Beyls C, Titeca-Beauport D, Joris M, Kontar L, Riviere A, Bonef O, Soupison T, Tribouilloy C, de Cagny B, Slama M. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:136. [PMID: 28595621 PMCID: PMC5465531 DOI: 10.1186/s13054-017-1737-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/23/2017] [Indexed: 01/28/2023]
Abstract
Background Cardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients. Methods Thirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral. Results Sixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were –1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of ΔCO measurements were compared. There was a significant correlation between ΔCO-PAC and ΔCO-TTE (r = 0.92; p < 0.0001). The median bias was –0.1 L/min and the LOAs were –1.3 and +1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0° and a percentage error LOAs of –26.8 to 28.8°. The concordance rate was 100% between 30 and –30°. When using CO-TTE to detect an increase in ΔCO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62–0.94) (p < 0.001). A ΔCO-TTE of more than 8% yielded a sensitivity of 88% and specificity of 66% for detecting a ΔCO-PAC of more than 10%. Conclusion In critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.
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Affiliation(s)
- Pablo Mercado
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France.,Medical-Surgical ICU, La Florida Dr. Eloisa Diaz Insunza Hospital, Santiago, Chile
| | - Julien Maizel
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | - Christophe Beyls
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | | | - Magalie Joris
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | - Loay Kontar
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | - Antoine Riviere
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France.,Medical-Surgical Intensive Care Unit, Abbeville General Hospital, Abbeville, France
| | - Olivier Bonef
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France.,Emergency Department, Saint Quentin General Hospital, Saint Quentin, France
| | - Thierry Soupison
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | | | - Bertrand de Cagny
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France
| | - Michel Slama
- Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France. .,Medical Intensive Care Unit, CHU Sud, F-80054, Amiens cedex 1, France.
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Maes F, Pierard S, de Meester C, Boulif J, Amzulescu M, Vancraeynest D, Pouleur AC, Pasquet A, Gerber B, Vanoverschelde JL. Impact of left ventricular outflow tract ellipticity on the grading of aortic stenosis in patients with normal ejection fraction. J Cardiovasc Magn Reson 2017; 19:37. [PMID: 28292302 PMCID: PMC5351048 DOI: 10.1186/s12968-017-0344-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/16/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The pathophysiology of paradoxical low-gradient (LG) severe aortic stenosis (SAS) remains controversial. As low transvalvular flow has been implicated, we sought to investigate the impact of left ventricular outflow tract (LVOT) ellipticity on the estimation of the LV stroke volume, the calculation of the aortic valve area (AVA) by use of the continuity equation and on AS severity grading. METHODS We studied 190 consecutive patients (mean age: 72 ± 13 years; male: 57%) with SAS (indexed AVA < 0.6 cm2/m2) and preserved LV ejection fraction, including 120 patients with severe high gradient (HG) AS and 70 with severe paradoxical LG-AS. AS severity, LV volumes and LVOT ellipticity were assessed by 2D-Doppler echocardiography and cardiac magnetic resonance (CMR). RESULTS The LVOT exhibited an elliptical shape on CMR images, with a shorter anterior-posterior than median-lateral diameter (2.2 ± 0.2 vs 2.8 ± 0.3 cm, p < 0.01). Accordingly, the LVOT area measured by planimetry was larger than by 2D-echocardiography, assuming a circular orifice (4.9 ± 0.9 cm2 vs 3.7 ± 0.8 cm2, p < 0.01). Inputting the elliptical LVOT area into the continuity equation resulted in a 29% increase in the indexed AVA (from 0.41 ± 0.09 cm2 to 0.54 ± 0.10 cm2). Accordingly, 30 (43%) patients with severe paradoxical LG-SAS were reclassified as having moderate AS. Similar results were obtained when considering 3D-echo for direct planimetry of the LVOT in a subset of 75 patients. CONCLUSIONS Our results confirm that the LVOT is elliptical in shape and that taking this parameter into account in the calculation of the AVA results in reclassification of 43% of patients with severe paradoxical LG-AS into moderate AS.
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Affiliation(s)
- Frédéric Maes
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sophie Pierard
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christophe de Meester
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jamila Boulif
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mihaela Amzulescu
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anne-Catherine Pouleur
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernhard Gerber
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Snyder EM, Van Iterson EH, Olson TP. Clinical Classification of Heart Failure Patients Using Cardiac Function during Exercise. Exerc Sport Sci Rev 2016. [PMID: 26196869 DOI: 10.1249/jes.0000000000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An effective approach for determining the clinical classification of heart failure (HF) patients is to estimate cardiac hemodynamics during exercise. This approach is strengthened further when measurements including cardiac power are used to describe cardiac hemodynamics. We hypothesize that cardiac power quantifies the hemodynamic and pressure-generating capability of the heart, relating with exercise tolerance better than traditional measurements in HF.
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Affiliation(s)
- Eric M Snyder
- 1School of Kinesiology, University of Minnesota, Minneapolis, MN; 2Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA; and 3Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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The effect of positive end-expiratory pressure and tripled tidal volume on pleth variability index during hypovolaemia in conscious subjects. Eur J Anaesthesiol 2013; 30:671-7. [DOI: 10.1097/eja.0b013e32836394c0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pees C, Glagau E, Hauser J, Michel-Behnke I. Reference values of aortic flow velocity integral in 1193 healthy infants, children, and adolescents to quickly estimate cardiac stroke volume. Pediatr Cardiol 2013; 34:1194-200. [PMID: 23344893 DOI: 10.1007/s00246-012-0628-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 12/27/2012] [Indexed: 11/27/2022]
Abstract
The aortic velocity time integral (VTI) is an echocardiographic tool used to estimate cardiac output (CO) by multiplying it with the aortic valve (AV) area and heart rate (HR). Inaccurate measurement of AV diameter will lead to squared miscalculation of CO. The aortic VTI itself can serve as a left-ventricular (LV) output parameter. The normal range of aortic VTI in adulthood is relatively stable, compared with childhood, but reference data are lacking. The aim of this study was to establish reference values of VTI in infants, children, and adolescents. A retrospective analysis of 1223 echocardiographic examinations of healthy children (age 0-20 years, body surface area [BSA] 0.11-2.23 m(2)) was performed. Data were correlated with age, BSA, and HR, and age subgroups with normal distribution were determined. Interobserver and intraobserver variability was calculated. Aortic VTI ranged from mean 13.8 cm (10.0-18.4 cm 5-95th percentile) in neonates to 25.1 cm (19.6-32.8 cm 5-95th percentile) in children >17 years of age and had a positive correlation with age (r = 0.685, p < 0.001), BSA (r = 0.645, p < 0.001) and a negative correlation with HR (r = -0.710, p < 0.001). Interobserver and intraobserver variability were excellent (3.9 ± 3.1 and 4.6 ± 3.7 %, respectively). Calculated mean values and percentile charts for the different age groups can serve as reference data to easily judge LV output in patients with or without congenital heart disease without enlargement or dysfunction of the AV.
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Affiliation(s)
- Christiane Pees
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, University Children's Hospital Vienna, Medical University Vienna, 1090 Vienna/Wien, Austria.
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Schoenhagen P, Drude L, Klein HH, Garcia MJ. Quantitative Doppler-Echocardiographic Determination of Regurgitant Volume in Patients with Aortic Insufficiency. Open Cardiovasc Med J 2008; 2:12-9. [PMID: 19590613 PMCID: PMC2707760 DOI: 10.2174/1874192400802010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 02/17/2008] [Accepted: 02/19/2008] [Indexed: 11/22/2022] Open
Abstract
Background: The severity of aortic regurgitation (AR) can be determined by invasive or echocardiographic methods. We systematically compared quantitative invasive and echocardiographic data with semiquantitative invasive grades in a prospective series of patients. Methods: Using Doppler-echocardiography we determined the cardiac output over the aortic, pulmonary and mitral valve in 27 patients (20 with, 7 without AR). Aortic regurgitant volume was calculated as the difference between the cardiac output over aortic and pulmonary valve/ mitral valve. During angiography the severity of AR was assessed semiquantitatively by aortography and the regurgitant volume was calculated invasively as the difference between the left- and right ventricular cardiac output. Results: The echocardiographically and invasively determined regurgitant blood volume correlated closely (R≈0.8). The regurgitant volume increased with higher angiographic grade but there was significant overlap between adjoining qualitative grades. Conclusion: In patients with AR, quantitative echocardiographic and angiographic measurements of the regurgitant volume correlate closely.
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12
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Melenovsky V, Borlaug BA, Rosen B, Hay I, Ferruci L, Morell CH, Lakatta EG, Najjar SS, Kass DA. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol 2006; 49:198-207. [PMID: 17222731 DOI: 10.1016/j.jacc.2006.08.050] [Citation(s) in RCA: 352] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 08/08/2006] [Accepted: 08/14/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to identify cardiovascular features of patients with heart failure with preserved ejection fraction (HFpEF) that differ from those in individuals with hypertensive left ventricular hypertrophy (HLVH) of similar age, gender, and racial background but without failure. BACKGROUND Heart failure with preserved ejection fraction often develops in HLVH patients and involves multiple abnormalities. Clarification of changes most specific to HFpEF may help elucidate underlying pathophysiology. METHODS A cross-sectional study comparing HFpEF patients (n = 37), HLVH subjects without HF (n = 40), and normotensive control subjects without LVH (n = 56). All subjects had an EF of >50%, sinus rhythm, and insignificant valvular or active ischemic disease, and groups were matched for age, gender, and ethnicity. Comprehensive echo-Doppler and pressure analysis was performed. RESULTS The HFpEF patients were predominantly African-American women with hypertension, LVH, and obesity. They had vascular and systolic-ventricular stiffening and abnormal diastolic function compared with the control subjects. However, most of these parameters either individually or combined were similarly abnormal in the HLVH group and poorly distinguished between these groups. The HFpEF group had quantitatively greater concentric LVH and estimated mean pulmonary artery wedge pressure (20 mm Hg vs. 16 mm Hg) and shorter isovolumic relaxation time than the HLVH group. They also had left atrial dilation/dysfunction unlike in HLVH and greater total epicardial volume. The product of LV mass index and maximal left atrial (LA) volume best identified HFpEF patients (84% sensitivity, 82% specificity). CONCLUSIONS In an urban, principally African American, cohort, HFpEF patients share many abnormalities of systolic, diastolic, and vascular function with nonfailing HLVH subjects but display accentuated LVH and LA dilation/failure. These latter factors may help clarify pathophysiology and define an important HFpEF population for clinical trials.
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Affiliation(s)
- Vojtech Melenovsky
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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13
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Koliopanos A, Zografos G, Skiathitis S, Stithos D, Voukena V, Karampinis A, Papastratis G. Esophageal Doppler (ODM II) improves intraoperative hemodynamic monitoring during laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2006; 15:332-8. [PMID: 16340564 DOI: 10.1097/01.sle.0000191631.66505.4a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Minimally invasive laparoscopic surgery has been expanded to the elderly and high-risk surgical patients with underlying cardiac and pulmonary disease. However, possible cardiovascular changes during CO2 pneumoperitoneum necessitate close intraoperative monitoring. In this prospective study, 55 patients (mean age 62.52 years, range 26-82) undergoing laparoscopic surgery were included. Patients were categorized into 3 groups of low (group A: 12 patients, mean age 55.5 years), moderate (group B: 22 patients, mean age 59.5 years), and high (group C: 21 patients, mean age 69.71 years) surgical risk according to ASA physical status classification. Similar anesthetic agents and anesthetic techniques were used in the above cases. An esophageal Doppler (ODM II, Abbott Laboratories) was used to measure aortic blood flow velocity and thereby estimating stroke volume (SVe) and cardiac output (COe) throughout anesthesia, in addition to traditional monitoring. After abdominal insufflation (peak intra-abdominal pressure: 13-15 mm Hg) COe values decreased from the initial value after induction of anesthesia by 22%, 20%, and 18% for groups A, B, and C, respectively (P < 0.05). The above values further deteriorated (25%, 28%, and 30% for groups A, B, and C, respectively) in the anti-Trendelenburg positioning of the patient. The peak aortic blood flow velocity (PV) followed the changes, thus indicating that heart muscle contractility is affected during the procedure. Stabilization of the above values was achieved after 20 minutes of CO(2) pneumoperitoneum and improvement was noted only after deflation of the abdomen. Heart rate and blood pressure essentially remained unchanged throughout the procedure, although the final values were increased compared with initial. Insufflation of the abdomen with CO(2) produces measurable effects on the cardiovascular system that require reappraisal of hemodynamic monitoring during anesthesia. ODM II offers a reliable, relatively noninvasive, cost-effective tool for intraoperative monitoring of the hemodynamic changes with a potential for future application for improvement of intraoperative hemodynamic status of patients.
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14
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Cohen M, Fasseas P, Singh VP, McBride R, Orford JL, Kussmaul WG. Impact of intra-aortic balloon counterpulsation with different balloon volumes on cardiac performance in humans. Catheter Cardiovasc Interv 2002; 57:199-204. [PMID: 12357520 DOI: 10.1002/ccd.10304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intra-aortic balloon (IAB) counterpulsation can augment the cardiac output. However, the effect of different IAB volumes on cardiac performance has not been adequately evaluated in humans. Eighty-two patients (52 males [63%]; mean age, 65 +/- 12 years; mean body surface area [BSA], 1.8 +/- 0.2 m(2)) had IAB counterpulsation for cardiogenic shock, refractory angina, and preoperatively for high-risk cardiac surgery. Cardiac hemodynamics were prospectively studied during IAB with inflation volumes of 32 vs. 40 cc. Hemodynamic data collected included aortic pressure, pulmonary artery pressure, systemic and mixed venous oxygen saturations, and cardiac output (by Fick). Transthoracic echocardiography (TTE) was used to obtain both velocity time integrals (VTIs) and the area of the left ventricular outflow tract (LVOT). Left ventricular stroke volume was then calculated as LVOT area x VTI. Cardiac output (CO) determined by the Fick method and VTI did not differ significantly (P = NS) between the two inflation volumes (y = 0.002 + 0.97x). In a subgroup of 33 patients with BSA <or= 1.8 m(2), the CO (by VTI) was slightly lower with IAB inflation volume of 32 vs. 40 cc (P = 0.05). Overall, smaller IAB inflation volumes do not affect the hemodynamic improvement seen during IAB counterpulsation. However, in patients with smaller BSA, larger inflation volumes may further augment CO.
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Affiliation(s)
- Marc Cohen
- Division of Cardiology, MCP Hahnemann University School of Medicine, Philadelphia, Pennsylvania, USA.
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15
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Goldman JH, Schiller NB, Lim DC, Redberg RF, Foster E. Usefulness of stroke distance by echocardiography as a surrogate marker of cardiac output that is independent of gender and size in a normal population. Am J Cardiol 2001; 87:499-502, A8. [PMID: 11179548 DOI: 10.1016/s0002-9149(00)01417-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Left ventricular outflow tract stroke distance (SD) can be measured using pulsed-wave Doppler echocardiography, and is independent of body size. Moreover, persons with structurally normal hearts (heart rate < 55 beats/min) had SD > 0.18 m, and those with a heart rate > 95 beats/min had SD < 0.22 m; outside of these parameters, low- and high-output states are likely to exist, and suspicion of these can be confirmed by calculation of minute distance (normal range 9.7 to 20.5 m/min).
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Affiliation(s)
- J H Goldman
- Department of Echocardiography, University of Califonia, San Francisco 94143-0214, USA
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16
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Dennig K, Nesser HJ, Hall D, Haase HU, Schömig A. Determination of prestenotic flow volume using an automated method based on colour Doppler imaging for evaluating orifice area by the continuity equation: validation in a pulsatile flow model. Heart 1998; 79:324-30. [PMID: 9616336 PMCID: PMC1728670 DOI: 10.1136/hrt.79.4.324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate, in a pulsatile flow model simulating flow conditions in valvar stenoses, whether accurate determination of orifice area can be achieved by the continuity equation using automated determination of flow volumes based on spatiotemporal integration of digital colour Doppler flow velocities. METHODS A method for automated determination of flow volumes which takes into account the velocity distribution across a region of interest was examined using flow through a tube and various restrictive outlet orifices with areas ranging between 0.2 and 3.1 cm2. The sampling rectangle of the Doppler method was positioned proximal to the obstructions within the flow convergence zone for evaluating prestenotic flow volume. Stenotic jet velocities were recorded by continuous wave Doppler to obtain the integral under the velocity curve. Prestenotic flow volume was then divided by the velocity integral to calculate functional orifice area according to the continuity equation. RESULTS The presence of parabolically shaped velocity profiles across the prestenotic region was demonstrated by the Doppler method. Excellent agreement was found between prestenotic flow volumes measured by the Doppler technique and actual values (r = 0.99, SEE = 1.35 ml, y = 0.99x-0.24). Use of the continuity equation led to a close correlation, with a systematic underestimation of geometric orifice sizes. Correction of Doppler data for flow contraction yielded an excellent agreement with actual orifice areas. CONCLUSIONS The study validated the accuracy of a Doppler method for automated determination of flow volumes for quantifying orifice area by the continuity equation. Prestenotic flow volume and functional orifice area could be evaluated reliably in the presence of non-flat velocity profiles. Thus the method contributes to the non-invasive assessment of valvar stenoses.
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Affiliation(s)
- K Dennig
- Deutsches Herzzentrum, Technische Universität, Munich, Germany
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17
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Kearney MT, Stubbs TA, Cowley AJ, Macdonald IA. A carbohydrate meal attenuates the forearm vasoconstrictor response to lower body subatmospheric pressure in healthy young adults. Clin Auton Res 1997; 7:285-91. [PMID: 9430799 DOI: 10.1007/bf02267719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The cardiovascular (CV) responses to meal ingestion and orthostasis are well established. The effect of meal ingestion and meal composition on the CV responses to orthostasis are unknown. The effect of high carbohydrate (HC) and high fat (HF) meal ingestion on the CV responses to simulated orthostatic stress (using graded lower body subatmospheric pressure (LBSP)) was assessed in nine healthy young volunteers. Cardiac output (CO), forearm blood flow (FABF) heart rate (HR) and blood pressure (BP) were measured before and during LBSP while fasted and after eating HC and HF meals. Ingestion of both meals led to an increase in CO and HR. Both meals resulted in a fall in total peripheral resistance but only HC led to a significant fall in BP (p < 0.05). HF had no effect on the CV responses to LBSP, whereas HC resulted in attenuated FABF and forearm vascular resistance responses (p < 0.05). Thus, ingestion of an HC meal significantly attenuates the forearm vascular response to orthostatic stress and the hypotensive effect of orthostasis is additive to that occurring after an HC meal.
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Affiliation(s)
- M T Kearney
- Department of Physiology and Pharmacology, Queens' Medical Centre, Nottingham, UK
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18
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Abstract
Significant physiological adaptations during pregnancy contribute to its successful outcome. These occur early in the pregnancy and continue throughout gestation, with complete reversal after delivery. Many changes that are normal during pregnancy are pathological should they occur in the nonpregnant woman. Adequate understanding of these normal changes is essential in the assessment of all pregnancies and in the management of those with complications. This article reviews the cardiovascular and pulmonary changes that occur during a normal gestation.
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Affiliation(s)
- M P O'Day
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston 77555-0587, USA
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19
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Sun JP, Pu M, Fouad FM, Christian R, Stewart WJ, Thomas JD. Automated cardiac output measurement by spatiotemporal integration of color Doppler data. In vitro and clinical validation. Circulation 1997; 95:932-9. [PMID: 9054753 DOI: 10.1161/01.cir.95.4.932] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A new Doppler echocardiographic technique has been developed for automated cardiac output measurement (ACOM) that assumes neither a flat flow profile nor collinearity with the scan line, but clinical validation of this method is lacking. METHODS AND RESULTS In 165 subjects (50 intensive care patients, 10 dobutamine echocardiography patients, and 105 normal volunteers; age, 49.4 +/- 19.3 years; 92 men), ACOM was performed in the left ventricular outflow tract (LVOT), with the color baseline shifted to avoid aliasing. ACOM was also tested in a pulsatile in vitro model. Stroke volume was calculated by double integration of Doppler signals in space (across the LVOT) and in time (through the systolic period), assuming hemiaxial symmetry: integral of integral of pi r v(r,t) dr dt, where v(r,t) is the velocity at a distance r from the center of the LVOT at time t during systole. Stroke volume from ACOM was compared with thermodilution (TD), aortic valve pulsed-wave Doppler (PWAO), and left ventricular echocardiographic (two-dimensional [2D]) methods. There was good correlation between ACOM and PWAO (r = .93). TD (r = .86), and 2D (r = .74), with close agreement seen. ACOM had higher correlation and agreement with TD than did either PWAO (P < .02) or 2D (P < .01). ACOM was also able to track accurately the changes in cardiac output with dobutamine infusion in comparison with PWAO (r = .94). In vitro assessment demonstrated excellent correlation (r = .98, y = 1.0x + 1.94) with little impact of pulse repetition frequency or misalignment up to 30 degrees. Gain dependency was noted but could be optimized by visual inspection of the color image. CONCLUSIONS Automatic integration of numerical data within color Doppler flow fields is a feasible new method for quantifying flow. It is simpler and faster, requires fewer assumptions, and uses only one apical view. ACOM is a promising new approach to echocardiographic quantification that deserves further study and refinement.
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Affiliation(s)
- J P Sun
- Department of Cardiology, Cleveland (Ohio) Clinic Foundation 44195, USA
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20
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Willenbrock R, Ozcelik C, Osterziel KJ, Dietz R. Angiotensin-converting enzyme inhibition, autonomic activity, and hemodynamics in patients with heart failure who perform isometric exercise. Am Heart J 1996; 131:999-1006. [PMID: 8615323 DOI: 10.1016/s0002-8703(96)90186-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Effects of angiotensin-converting enzyme inhibition (ACEI) on autonomic responses and hemodynamics in patients with congestive heart failure (CHF) subjected to isometric exercise have not been studied. We tested whether acute ACEI might influence the effects of isometric exercise in patients with CHF. In the first part of the study we showed that isometric exercise increased blood pressure in the control group and in the CHF group, whereas cardiac output increased only in the control group. Stroke volume remained unchanged in the control group, whereas it decreased significantly in CHF group. We next analyzed the effect of acute ACEI (5 mg ramipril) on the decrease in cardiac output during isometric stress in patients with CHF. During isometric exercise mean blood pressure and heart rate increased similarly in both groups. However, cardiac output decreased during placebo by -0.48 +/- 0.12 L/min (p < 0.01) but not during ACEI. Spectral analysis of blood pressure showed an increase (p < 0.01) in the high-frequency parasympathetic component from 7.3% +/- 3.6% to 18.1% +/- 9.5% after ACEI. norepinephrine plasma levels increased after isometric stress in the placebo group, whereas other hormones did not change. ACEI prevented the norepinephrine increase after isometric stress. Thus the decrease in cardiac output during isometric exercise in patients with CHF was prevented by acute ACEI. The effect of ACE inhibition may be related to reduced sympathetic activity.
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Affiliation(s)
- R Willenbrock
- Franz Volhard Clinic, Rudolf Virchow University Hospitals, Berlin, Germany
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21
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Tanaka H, Sjöberg BJ, Thulesius O. Cardiac output and blood pressure during active and passive standing. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1996; 16:157-70. [PMID: 8964133 DOI: 10.1111/j.1475-097x.1996.tb00565.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study compared the haemodynamic pattern of active and passive standing. We used non-invasive techniques with beat-to-beat evaluation of blood pressure, heart rate and stroke volume. Seven healthy subjects, aged 24-41 (mean 30) years were examined. Finger blood pressure was continuously recorded by volume clamp technique (Finapres), and simultaneous beat-to-beat beat stroke volume was obtained, using an ultrasound Doppler technique, from the product of the valvular area and the aortic flow velocity time integral in the ascending aorta from the suprasternal notch. Measurements were performed at rest, during active standing and following passive tilt (60 degrees). Active standing caused a transient but greater reduction of blood pressure and a higher increase of heart rate than passive tilt during the first 30s (delta mean blood pressure: -39 +/- 10 vs. -16 +/- 7 mmHg, delta heart rate: 35 +/- 8 vs. 12 +/- 7 beats m-1 (active standing vs. passive tilt; P < 0.01). There was a significantly larger increase in cardiac output during active standing (37 +/- 24 vs. 0 +/- 15%, P < 0.01) and a more marked decrease in total peripheral resistance (-58 +/- 11 vs. -16 +/- 17%, P < 0.01). A precipitous rise in intra-abdominal pressure (43 +/- 22 mmHg) could be observed upon rising only in active standing. This was interpreted as an indication of translocation of blood to the thorax. There was no significant difference in haemodynamic changes during the later stage of standing (1-7 min) between both manoeuvres. These results suggest that active standing causes a marked blood pressure reduction in the initial phase which seems to reflect systemic vasodilatation caused by activation of cardiopulmonary baroreflexes, probably due to a rapid shift of blood from the splanchnic vessels in addition to the shift from muscular vessels associated with abdominal and calf muscle contraction. Moreover, the ultrasound Doppler technique was found to be a more adequate method for rapid beat-to-beat evaluation of cardiac output during orthostatic manoeuvres.
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Affiliation(s)
- H Tanaka
- Department of Pediatrics, Osaka Medical College, Japan
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22
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Evangelista A, Garcia-Dorado D, Garcia del Castillo H, Gonzalez-Alujas T, Soler-Soler J. Cardiac index quantification by Doppler ultrasound in patients without left ventricular outflow tract abnormalities. J Am Coll Cardiol 1995; 25:710-6. [PMID: 7860918 DOI: 10.1016/0735-1097(94)00456-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We attempted to ascertain whether cardiac index can be directly estimated from Doppler mean velocity. BACKGROUND Although diverse Doppler echocardiographic methods have been described for cardiac output quantification, they are not widely used in clinical practice. Cross-sectional area measurement has been identified as the main source of error in flow volume quantification. METHODS A three-phase study by Doppler echocardiography was conducted in 306 patients. In phase I, the normal mean velocity ratio of the left and right ventricular outflow tracts was established in 170 normal subjects. In phase II, cardiac index, calculated as the product of aortic annular area index by mean velocity (conventional method), and mean velocity determined in the left ventricular outflow tract and ascending aorta by pulsed and continuous wave Doppler, respectively, were correlated with thermodilution cardiac index in 66 patients. In phase III, the accuracy of the regression equations obtained was prospectively assessed in an additional 70 patients. RESULTS The normal left/right ventricular outflow tract mean velocity ratio by pulsed wave Doppler was 1.1 +/- 0.1. Cardiac index (CI) calculated by the conventional method and thermodilution (TD) showed acceptable correlation (r = 0.90, CITD = 1.20 CIPWD + 357; r = 0.86, CITD = 0.90 CICWD + 262) for pulsed (PWD) and continuous wave (CWD) Doppler, respectively, but with systematic underestimation (-28 +/- 13%, p < 0.01) by pulsed wave Doppler. Mean velocity (MV) showed excellent correlation with the thermodilution cardiac index (r = 0.97, CITD = 172 MVPWD - 172; r = 0.93, CITD = 129 MVCWD - 255). When these regression equations were prospectively applied, better agreement with the thermodilution cardiac index was obtained by pulsed wave Doppler directly from mean velocity (SD 240 ml/min per m2) than when aortic annular area was considered in the calculation (SD 428 ml/min per m2). Similar results were obtained by continuous wave Doppler (SD 433 vs. 599 ml/min per m2) but with less accuracy. CONCLUSIONS Left ventricular outflow tract mean velocity determined by pulsed wave Doppler permits easy, accurate cardiac index quantification in the absence of left ventricular outflow abnormalities. The simplicity of this method enhances its clinical applicability in noninvasive monitoring of cardiac index.
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Affiliation(s)
- A Evangelista
- Servei de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
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23
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Seear M, Webber S, Leblanc J. Descending aortic blood flow velocity as a noninvasive measure of cardiac output in children. Pediatr Cardiol 1994; 15:178-83. [PMID: 7991435 DOI: 10.1007/bf00800672] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In previous work, we postulated that mean aortic flow velocity (MAFV) might be a direct measure of cardiac index. To investigate the assumptions inherent in this relation, we measured body surface area, aortic cross-sectional area (two-dimensional ultrasonography) and MAFV (Doppler ultrasonography) in 70 normal children. For a direct check of the relation, we simultaneously measured cardiac index (Fick technique) and MAFV (Doppler ultrasonography) in 25 children after cardiac surgery. In the normal group, we found that body surface area was directly proportional to aortic cross-sectional area (R 0.94), and MAFV at rest was the same in the ascending and descending aorta (t test, p < 0.05). In the intensive care patients, MAFV in the descending aorta was directly proportional to cardiac index over a wide clinical range [MAFV (cm/s) = CI (L/min/m2).7.7-1.2]. The assumptions made when deriving the relation between MAFV and cardiac index appear to be valid whether measured in the ascending or descending aorta. However, the scatter of results limits its clinical value. Mean aortic flow velocity is probably of greater use as a trend indicator and has the potential for continuous display using an esophageal Doppler probe when measured in the descending aorta.
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Affiliation(s)
- M Seear
- Department of Intensive Care, Children's Hospital, Vancouver, Canada
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24
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Tham TC, Herity N, Guy S, Silke B. Haemodynamic comparison of amlodipine and atenolol in essential hypertension using the quantascope. Br J Clin Pharmacol 1993; 36:555-60. [PMID: 12959272 PMCID: PMC1364660 DOI: 10.1111/j.1365-2125.1993.tb00414.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
1 We have utilised a non-imaging echo-Doppler cardiac output device, using the principle of attenuated compensation volume flow (ACVF), to assess the cardiovascular effects of amlodipine and atenolol over 3 months in 24 patients with essential hypertension. 2 Both amlodipine and atenolol, at 4 and 12 weeks, similarly reduced mean arterial pressure (12 weeks amlodipine -12.6 mmHg, atenolol -14.9 mmHg; P < 0.01 for each vs baseline). 3 The heart rate fell on atenolol, both at 4 weeks (amlodipine -3 vs atenolol -12 beats min(-1); P < 0.05) and 12 weeks (-1 vs -11 beats min(-1); P < 0.05), without change on amlodipine. 4 Stroke volume initially rose on atenolol without change on amlodipine (4 weeks amlodipine -1.3 ml vs atenolol +10.1 ml; P = 0.05) but between drug effects were not different at 12 weeks. 5 The systemic vascular resistance was reduced on amlodipine (12 weeks: amlodipine -176 dyn s cm(-5): P < 0.05) without change on atenolol (atenolol -48 dyn s cm(-5): NS). 6 The cardiac stroke work was lowered on amlodipine both at 4 weeks (P < 0.01) and 12 weeks (P < 0.05) and statistically different from the unaltered atenolol values at both time points. 7 Skin nutrient flow or fingertip temperature was not altered by either treatment. 8 These results are consistent with contrasting mechanisms of action--vasodilator for amlodipine and decreased cardiac pumping for atenolol. The greater reduction in cardiac stroke work on amlodipine compared with atenolol warrants further investigation during longer-term studies.
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Affiliation(s)
- T C Tham
- Department of Therapeutics and Pharmacology, Queen's University of Belfast, Belfast, Northern Ireland
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25
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Stoddard MF, Prince CR, Ammash N, Goad JL, Vogel RL. Pulsed Doppler transesophageal echocardiographic determination of cardiac output in human beings: comparison with thermodilution technique. Am Heart J 1993; 126:956-62. [PMID: 8213455 DOI: 10.1016/0002-8703(93)90712-i] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Measurement of cardiac output is a clinically valuable and widely used index of cardiac function. Although transesophageal echocardiography has been used to assess left ventricular function, little data exist on the accuracy of this technique in the measurement of cardiac output. Therefore cardiac output derived by pulsed Doppler transesophageal echocardiography and thermodilution methods were compared in adult patients being mechanically ventilated. The left ventricular outflow tract diameter was determined from a transgastric long-axis view of the left ventricle by using the transverse plane and longitudinal plane of the transesophageal scope. The cross-sectional area of the left ventricular outflow tract was calculated from the diameter assuming a circular shape. Pulsed Doppler recordings were obtained at the left ventricular outflow tract. Doppler time-velocity integrals were measured from the leading edge of the velocity curve. Cardiac output derived by transesophageal echocardiography was calculated as time-velocity integral multiplied by left ventricular outflow tract area and heart rate. Cardiac output derived by transesophageal echocardiography from the transverse plane (n = 26) and longitudinal plane (n = 22) were correlated with simultaneous thermodilution measurements. Thermodilution-derived cardiac output demonstrated excellent correlation with cardiac output measured by using transesophageal echocardiography from the transverse plane (r = 0.97, SEE = 0.84 L/min; p < 0.0001) and longitudinal plane (r = 0.95, SEE = 0.97 L/min; p < 0.0001). Transesophageal echocardiography is a promising technique in the measurement of cardiac output and expands the clinical use of this modality in the assessment of cardiac function.
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Affiliation(s)
- M F Stoddard
- Department of Internal Medicine, Cardiology Division, Louisville, KY 40202
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26
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Abstract
A new method to measure cardiac output using transgastric continuous-wave Doppler was evaluated in 31 consecutive patients undergoing cardiac surgery with simultaneous measurement of cardiac output by the thermodilution technique. A 5 MHz single-plane imaging/5 MHz continuous-wave Doppler transesophageal transducer was used to image the left ventricular outflow tract, aortic valve and ascending aorta from a modified transgastric short-axis plane. The continuous-wave Doppler cursor was aligned parallel with blood flow across the aortic valve to obtain the maximal Doppler velocity spectra. Stroke volume was obtained by multiplying the mean Doppler flow velocity integral by the aortic annulus area, which was calculated from its diameter measured from the esophageal 5-chamber view. The stroke volume was multiplied by heart rate to yield cardiac output. A total of 57 simultaneous thermodilution and Doppler studies were attempted. Doppler data were technically limited for 2 patients both before and after cardiopulmonary bypass and for 3 patients before cardiopulmonary bypass with a result of 50 adequate studies of 57 (88%) attempted. The Doppler-derived cardiac outputs were correlated with the simultaneous measurements of cardiac output by the thermodilution technique. Linear regression analysis revealed a close correlation with R = 0.91, SEE = 0.8 liter/min, and y = 1.01x + 0.2 (p < 0.001). In conclusion, transgastric continuous-wave Doppler across the aortic valve is a promising new technique that may be used in selected patients for accurate measurement of cardiac output.
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Affiliation(s)
- W E Katz
- Department of Medicine, University of Pittsburgh Medical Center, Pennsylvania 15213
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27
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Hell K, Nellessen U, Dohrmann AM, Simon R. Doppler ultrasound of the subclavian artery as an aid to quantification of aortic insufficiency. J Am Soc Echocardiogr 1993; 6:134-41. [PMID: 8481242 DOI: 10.1016/s0894-7317(14)80483-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Aortic insufficiency (AI) induces backflow of blood in the arterial system that is most pronounced in the major arteries close to the heart. Assuming that the intensity of the arterial backflow of blood may reflect the severity of AI, the systolic and diastolic flow profiles of the subclavian artery were studied in 40 patients with and 10 patients without AI that was angiographically proved by use of continuous wave Doppler ultrasound (8 MHz transducer, supraclavicular approach). Patients with angiographically determined severe AI (n = 17) had significantly higher diastolic regurgitant flow velocities (V-max) than patients with only mild (n = 9) or moderate (n = 14) degrees of AI (Severe AI = 35.0 +/- 12.0 cm/sec, moderate AI = 16.8 +/- 3.9 cm/sec, mild AI = 7.4 +/- 2.6 cm/sec; p < 0.01) and also showed significantly higher values with regard to the time velocity integral of the regurgitant jet (severe AI = 13.8 +/- 5.6 cm; moderate AI = 5.7 +/- 2.4 cm, mild AI = 1.4 +/- 0.9 cm; p < 0.01). After classification by jacknife discrimination analysis, the Doppler ultrasound grading was compared with a corresponding three-point scale (mild, moderate, severe) from aortic root angiography. A correct estimation of the severity of AI was possible in 44 of 50 patients (88%; overestimation in one, underestimation in five) and in 41 of 50 patients (83%; overestimation in one, underestimation in eight) with regard to V-max and the time velocity integral of the regurgitant jet, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Hell
- Division of Cardiology, Christian Albrechts University Hospital, Germany
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28
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Lu C, Nicolosi GL, Burelli C, Cassin M, Zardo F, Brieda M, Cervesato E, Zanuttini D. Limitations in the assessment of changes of cardiac output by Doppler echocardiography under various hemodynamic conditions. Am J Cardiol 1992; 70:1370-4. [PMID: 1442595 DOI: 10.1016/0002-9149(92)90779-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Lu
- Cardiologia-Emodinamica, ARC, Ospedale Civile, Pordenone, Italy
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Gorcsan J, Diana P, Ball BA, Hattler BG. Intraoperative determination of cardiac output by transesophageal continuous wave Doppler. Am Heart J 1992; 123:171-6. [PMID: 1729822 DOI: 10.1016/0002-8703(92)90762-k] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A new prototype transesophageal transducer with continuous-wave Doppler and pulsed Doppler capabilities was evaluated to calculate intraoperative cardiac output from the main pulmonary artery. Fifteen consecutive patients undergoing elective coronary artery bypass surgery were studied. The main pulmonary artery diameter above the pulmonic valve was measured with the single horizontal plane transesophageal transducer. The pulmonary artery cross-sectional area was calculated from its diameter using the formula: Area = 1/4 pi (diameter)2. Continuous-wave Doppler and pulsed Doppler spectra were recorded from the main pulmonary artery and their flow velocity integrals were then multiplied by pulmonary artery area and heart rate to yield cardiac output. The main pulmonary artery diameter could not be confidently measured in 2 of 15 patients (13%). In the remaining 13 patients, Doppler cardiac output measurements were correlated with simultaneous thermodilution measurements. The closest correlation with thermodilution cardiac output was with the continuous-wave Doppler cardiac output method: R = 0.91, SEE = 0.2 L/min, and y = 1.1x . 0.2 (p less than 0.001). The correlation of thermodilution with pulsed Doppler cardiac output was R = 0.83, SEE = 0.5 L/min, and and y = 0.86 + 1.0 (p less than 0.001). Transesophageal continuous-wave Doppler is a new technique that may be used in selected patients for accurate determination of intraoperative cardiac output.
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Affiliation(s)
- J Gorcsan
- Division of Cardiology, University of Pittsburgh, Montefiore University Hospital, PA 15213
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30
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Seear MD, D'Orsogna L, Sandor GG, de Souza E, Popov R. Doppler-derived mean aortic flow velocity in children: an alternative to cardiac index. Pediatr Cardiol 1991; 12:197-200. [PMID: 1946006 DOI: 10.1007/bf02310565] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study tested the hypothesis that mean aortic velocity is relatively constant in children. Eighty-eight normal children (aged 1 month to 15 years) were studied prospectively. Ascending aortic flow velocities were obtained by pulse Doppler and mean aortic velocities calculated. Mean aortic flow velocity was relatively constant for all ages at 28.4 +/- 4.8 cm/s. As Doppler is easy to perform, mean aortic flow velocity may be an alternative approach to the assessment of cardiac output.
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Affiliation(s)
- M D Seear
- Department of Paediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada
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31
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Cerny JC, Ketslakh M, Poulos CL, Dechert RE, Bartlett RH. Evaluation of the Velcom-100 pulse Doppler cardiac output computer. Chest 1991; 100:143-6. [PMID: 2060334 DOI: 10.1378/chest.100.1.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The use of Doppler ultrasound as a means of obtaining cardiac output (CO) measurements quickly, easily, and noninvasively has been made possible by recent technologic developments. We evaluated a new pulse Doppler ultrasonic unit (Velcom-100, Waters Instruments, Inc) in the Surgical Intensive Care Unit at the University of Michigan Medical Center. Accuracy of this device was determined by comparison of CO results obtained from the Velcom-100 (COV) against those of conventional thermal dilution cardiac output (COT) measurements. Twenty-six postoperative patients were used for this study, ranging in age from 20 to 82 years old. Initial studies prior to in vivo standardization demonstrated a significantly lower result (p = 0.039) for the Velcom-100 with a mean difference of 0.86 L/min (COT-COV). This comparison was significantly improved in subsequent studies following in vivo standardization (COT-COV = 0.02 L/min, p = 0.646). Linear regression analysis showed a significant, positive correlation between the two results (r = 0.82, p less than 0.05) indicating an excellent trending capability for the Velcom-100. Our evaluation found the Velcom-100 to be user friendly, allowing rapid training of ICU technicians and applicability for postoperative monitoring.
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Affiliation(s)
- J C Cerny
- Department of Surgery, University of Michigan Medical Center, Ann Arbor
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32
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Sjöberg BJ, Wranne B. Cardiac output determined by ultrasound-Doppler: clinical applications. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1990; 10:463-73. [PMID: 2245596 DOI: 10.1111/j.1475-097x.1990.tb00826.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A non-invasive method for cardiac output determination (COD) based on ultrasound-Doppler technique was evaluated in patients with cardiac disease at rest and during exercise, including patients with heart transplants. The aortic blood flow velocity was measured with pulsed Doppler technique from the jugulum, placing the sample volume just above the aortic valve, and the area from a parasternal 2-D echocardiographic measurement of the aortic annulus diameter assuming a circular area. Cardiac output was calculated as the product of the systolic velocity integral, the aortic annulus area and the heart rate. A high correlation was found between this method and a simultaneously performed invasive cardiac output (COF) and stroke volume (SVF) determination by the direct Fick method (COD = 0.3 + 0.9 x COF, r = 0.96, SDres = 0.5 l min-1 and SVD = 3.9 + 0.92 x SVF, r = 0.94, SDres = 6.9 ml). However, looking just at the systolic velocity integral compared to stroke index determined with the Fick method we found a low correlation, especially in patients with heart transplants. We conclude that cardiac output can reliably be measured non-invasively with this method--also in patients with heart transplants. The systolic velocity integral alone can be used for assessing changes in stroke volume but for absolute values of stroke volume and stroke index flow area should also be determined.
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Affiliation(s)
- B J Sjöberg
- Department of Clinical Physiology, Faculty of Health Sciences, University of Linköping, Sweden
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33
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Dubin J, Wallerson DC, Cody RJ, Devereux RB. Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J 1990; 120:116-23. [PMID: 2360495 DOI: 10.1016/0002-8703(90)90168-w] [Citation(s) in RCA: 207] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Numerous Doppler echocardiographic methods to measure stroke volume have been proposed in experimental or clinical studies, but their relative accuracy in patients compared with an invasive reference standard remains uncertain. Accordingly, we compared Doppler with thermodilution stroke volume measurement in 18 hospitalized patients, 16 with an acute manifestation of coronary artery disease and two with chronic cardiomyopathies. Doppler time-velocity integrals were measured by darkest line (modal velocity) and the leading edge (maximal velocity) techniques at the aortic annular plane, the mitral orifice, and the mitral annular plane. Two-dimensional echocardiography was used to measure cross-sectional areas (M-mode-corrected at the mitral orifice). The combination of aortic annular cross-sectional area and the leading edge technique of measuring the time-velocity integral of blood flow at this site provided the most accurate measure of stroke volume (r = 0.87, p less than 0.0001, standard error of estimate = 11 cm3; mean difference from thermodilution = 2.8 ml +/- 8.9 ml, p = NS). It also resulted in the most accurate measurement of cardiac output (r = 0.88, p less than 0.0003; mean difference from thermodilution = 0.11 L/min +/- 0.69 L/min, p = NS). Other methods yielded values that correlated less closely and deviated systematically from thermodilution measurements. We therefore conclude that of the six common methods evaluated, the aortic annular leading edge method measures stroke volume with the best accuracy and is most suitable for clinical application.
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Affiliation(s)
- J Dubin
- Division of Cardiology, New York Hospital-Cornell Medical Center, NY 10021
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34
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Shu VW, Gardin JM, Knoll ML, Weber MA. Assessment of left ventricular systolic and diastolic function with Doppler echocardiography in hypertensive patients receiving intravenous medroxalol. Am Heart J 1990; 120:87-95. [PMID: 1972862 DOI: 10.1016/0002-8703(90)90164-s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intravenous medroxalol, an alpha- and beta-adrenergic blocking agent, causes an immediate hypotensive effect. In 14 subjects with mild-to-moderate hypertension, cardiac output (CO) and cardiac index (CI) were significantly decreased without significant changes in stroke volume, reflecting the fact that a reduced CO and CI were related to decreases in heart rate. The vasodilator effect of intravenous medroxalol was not apparent with the dosages used in this study. Transient changes noted in two Doppler diastolic velocity indexes--mitral early diastolic peak flow velocity (PFVE) and the ratio of mitral late-to-early diastolic peak flow velocity (PFVA/E)--are suggestive of an improvement in left ventricular (LV) diastolic filling during medroxalol infusion, possibly related to changes in loading conditions. Systolic and diastolic blood pressure did not correlate with any of the Doppler diastolic and systolic indexes in our patient population. Reduced aortic peak flow velocity, rate of aortic flow acceleration, and the rate of mitral early diastolic deceleration were noted with increasing LV mass index, independent of age or blood pressure. Doppler echocardiography may be a useful tool in the assessment and follow-up of LV systolic and diastolic function in patients undergoing pharmacologic interventions.
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Affiliation(s)
- V W Shu
- Division of Cardiology, Veterans Administration Medical Center, Long Beach, CA
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35
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Silke B, Verma SP, Taylor SH. Pharmacodynamic monitoring during acute intervention in ischaemic heart disease using a new echo-Doppler device. Br J Clin Pharmacol 1990; 29:741-7. [PMID: 2116160 PMCID: PMC1380177 DOI: 10.1111/j.1365-2125.1990.tb03696.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
1. We have utilised a new non-imaging echo-Doppler cardiac output device, using the principle of attenuated compensated volume flow (ACVF), to assess the cardiovascular effects of atenolol and buccal nitroglycerin (NTG) in a placebo-controlled study of 30 patients with coronary disease. 2. Atenolol (4 mg i.v.) reduced heart rate, cardiac output and time-averaged mean aortic velocity (P less than 0.01) and increased systemic vascular resistance (P less than 0.01). 3. Buccal NTG (5 mg) reduced systemic mean arterial pressure (P less than 0.01), cardiac stroke volume (P less than 0.05) and stroke length (P less than 0.01). 4. Thus although both drugs reduced time-averaged aortic velocity (an index of cardiac performance), the concomitant reduction in cardiac stroke length and tachycardia suggested sub-optimal cardiac filling for buccal NTG, whereas for atenolol (with the associated increased systemic vascular resistance but unchanged stroke length) attenuation of sympathetic stimulation at cardiac beta-adrenoceptors. 5. The ACVF method of cardiovascular monitoring should prove useful in human pharmacodynamic studies.
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Affiliation(s)
- B Silke
- University Department of Cardiovascular Studies, General Infirmary, Leeds
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36
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Spahn DR, Schmid ER, Tornic M, Jenni R, von Segesser L, Turina M, Baetscher A. Noninvasive versus invasive assessment of cardiac output after cardiac surgery: clinical validation. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1990; 4:46-59. [PMID: 2131856 DOI: 10.1016/0888-6296(90)90447-n] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The accuracy of noninvasive cardiac output (CO) measurement techniques, such as electrical bioimpedance (BIO), suprasternal continuous-wave Doppler (CWD), pulsed-wave Doppler (PWD), and transesophageal continuous-wave Doppler (TED) ultrasound has been variably judged in recent years. In addition, clinical comparisons are hampered by the fact that there is no generally accepted gold standard in CO measurement. After coronary artery bypass surgery in 25 patients, CO was simultaneously determined by invasive standard techniques (thermodilution [TD] and Fick methods) plus BIO, CWD, PWD, and TED. There was an excellent agreement found between TD and the Fick method (COF = 0.13 + 1.01.COTD; r = 0.96; n = 99). Thermodilution was thus chosen to be the reference method. Bioimpedance underestimated COTD (COBIO = 0.47 + 0.60.COTD; r = 0.78; n = 111). Allowing physiological ejection times only led to an improved agreement between BIO and TD (COBIO = 0.05 + 0.69.COTD; r = 0.82; n = 79), but BIO still significantly underestimated COTD (P less than 0.0005). Using physiologic ejection times during COCWD determination reduced the scatter of data as compared with TD; however, CWD still considerably overestimated COTD, when COCWD computation was based on the echocardiographic aortic diameter (ECHO) (COCWD ECHO = 0.79 + 1.40.COTD; r = 0.84; n = 52). With the surgical aortic diameter (SURG), the agreement improved (COCWD SURG = 0.75 + 1.16.COTD; r = 0.89; n = 44), but overestimation of COTD remained significant (P less than 0.05). Irrespective of the aortic diameter, COPWD values showed a considerable scatter of data compared with COTD (COPWD ECHO = 1.26 + 0.60.COTD; r = 0.62; n = 64 and COPWD SURG = 1.42 + 0.41.COTD; r = 0.47; n = 61). Correlation of absolute COTED values to thermodilution depended on the method used for calibration. All investigated noninvasive CO measurement techniques unreliably measured relative CO changes. Despite its invasiveness, TD remains the method of choice for accurate CO determination in adult patients following cardiac surgery.
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Affiliation(s)
- D R Spahn
- Division of Cardiovascular Anesthesia, University Hospital, Zurich, Switzerland
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37
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Veille JC, Tavill M, Sivakoff M, Cohen I, Ben-Ami M, Yang YC, Jovkovsky V. Evaluation of pulsed Doppler echocardiography for measurement of aortic blood flow in the fetal lamb. Am J Obstet Gynecol 1989; 161:1610-4. [PMID: 2603918 DOI: 10.1016/0002-9378(89)90935-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to assess the accuracy of a quantitative, range-gated, two-dimensional Doppler echocardiography method for measurement of blood flow in the fetal lamb descending aorta. Comparison was made between this method and measurements determined by an electromagnetic flowmeter placed directly on the aorta in the chest of the fetus. Stroke volume was manipulated acutely either by the removal of blood, the addition of fluid by injection, or by pharmacologic means. During each procedure, descending aortic blood flow was estimated by the Doppler ultrasonography method and compared to the flowmeter recording. The size of the lumen of the aorta determined by echocardiography was correlated with direct measurement during surgery and at autopsy. A total of 359 flow measurements were obtained in 15 fetuses. Doppler ultrasonographic flow studies and electromagnetic flowmeter measurements were found to be highly correlated (r = 0.93). The study demonstrates the accuracy and reliability of the two-dimensional pulsed Doppler echocardiography method for measurement of blood flow in the descending aorta in the fetal lamb.
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Affiliation(s)
- J C Veille
- Department of Reproductive Biology, MacDonald Hospital for Women, Cleveland, Ohio
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38
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Silke B, Zezulka AV, Verma SP, Taylor SH. Hemodynamic assessment of nicardipine alone and with atenolol in coronary artery disease using a modified echo-Doppler device. Am J Cardiol 1989; 64:28H-34H. [PMID: 2801572 DOI: 10.1016/0002-9149(89)90978-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We have used a modified noninvasive echo-Doppler cardiac output device, based on the principle of attenuated compensation volume flow, to assess the cardiovascular effects of the slow-calcium antagonist nicardipine in coronary disease. The dose-response effects of 2.5, 5.0 and 10.0 mg intravenous nicardipine were determined in 8 patients with angina. Dose-related decreases were seen in systemic mean arterial pressure (p less than 0.01) after administration of nicardipine. Cardiac pumping indexes were improved, as evident from linear increases in cardiac stroke volume (p less than 0.001), stroke length (p less than 0.01) and time-averaged mean velocity (p less than 0.01). The echo-Doppler device was also used to assess beta-blocking/nicardipine combination therapy in patients with angina. When nicardipine was given after the cardioselective beta blocker atenolol the reduction in heart rate and cardiac output after atenolol was reversed compared with a group that received atenolol followed by placebo. Cardiac performance improved and the 35% reduction in systemic vascular resistance was associated with markedly increased cardiac index (p less than 0.01), augmentation of time-averaged mean velocity (p less than 0.01) and cardiac stroke length (p less than 0.05). These data are consistent with previous invasive studies of nicardipine, either alone or when combined with beta blockade in coronary disease. The data also suggest that nicardipine/beta-blocking combination is safe in patients with coronary heart disease and that the echo-Doppler method of cardiovascular monitoring will prove useful in human pharmacodynamic studies.
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Affiliation(s)
- B Silke
- University Department of Cardiovascular Studies, General Infirmary, Leeds, England
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39
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Notterman DA, Castello FV, Steinberg C, Greenwald BM, O'Loughlin JE, Gold JP. A comparison of thermodilution and pulsed Doppler cardiac output measurement in critically ill children. J Pediatr 1989; 115:554-60. [PMID: 2795345 DOI: 10.1016/s0022-3476(89)80280-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To evaluate the pulsed Doppler cardiac output method as a noninvasive means for determining cardiac output in critically ill children, we performed paired pulsed Doppler and thermodilution cardiac output determinations in 17 critically ill children. Commercially available equipment, specifically designed for this purpose, was employed. Forty paired thermodilution and pulsed Doppler determinations were made. There was a significant correlation between the two measurements (pulsed Doppler = 0.84 thermodilution + 0.39; r = 0.79, p less than 0.01). The ranges of thermodilution measurements (1.02 to 6.26 L/min; median 2.77 L/min) and pulsed Doppler measurements (1.13 to 6.35 L/min; median 2.57 L/min) were not different (p = 0.25). However, differences between individual paired thermodilution and pulsed Doppler measurements were large (-3.13 to 2.03 L/min; median 0.12 L/min), and the percentage difference between individual paired thermodilution and pulsed Doppler measurements ranged from 0.41% to 102.5% (median 12.7%). A discrepancy of 15% or more between thermodilution and pulsed Doppler was encountered in 18 (45%) of 40 of paired measurements (95% confidence interval: 29% to 61%), and one fourth of the paired measurements differed by more than 25%. We conclude that, as employed in this study, pulsed Doppler cardiac output determination is not sufficiently representative of the thermodilution output to be employed for hemodynamic monitoring in critically ill children.
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Affiliation(s)
- D A Notterman
- Department of Pediatrics, Cornell University Medical College, New York, NY 10021
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40
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Pearson AC, Janosik DL, Redd RM, Buckingham TA, Labovitz AJ. Hemodynamic benefit of atrioventricular synchrony: prediction from baseline Doppler-echocardiographic variables. J Am Coll Cardiol 1989; 13:1613-21. [PMID: 2723274 DOI: 10.1016/0735-1097(89)90356-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The purpose of this study was to determine if baseline Doppler-echocardiographic variables of systolic or diastolic function could predict the hemodynamic benefit of atrioventricular (AV) synchronous pacing. Twenty-four patients with a dual chamber pacemaker were studied. Baseline M-mode and two-dimensional echocardiograms were obtained and Doppler-echocardiographic measurements of mitral inflow and left ventricular outflow were made in VVI mode (single rate demand) and in VDD (atrial synchronous, ventricular inhibited) and DVI (AV sequentially paced) modes at AV intervals ranging from 50 to 300 ms. Forward stroke volume and cardiac output were determined in each mode at each AV interval from the left ventricular outflow tract flow velocities, and the percent increase in cardiac output over VVI mode was determined. M-mode measurements, including left ventricular end-diastolic dimension, shortening fraction and left atrial size and Doppler measurement of diastolic filling, including peak early velocity and percent atrial contribution, did not correlate with the percent increase in cardiac output during physiologic pacing. The stroke volume in VVI mode correlated significantly with the percent increase in cardiac output during physiologic pacing (r = -0.61, p less than 0.005 for VDD mode and r = -0.55, p less than 0.05 for DVI mode). Five of the 15 patients with VVI stroke volume less than 50 ml but none of the 9 patients with stroke volume greater than 50 ml had ventriculoatrial (VA) conduction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A C Pearson
- Department of Internal Medicine, St. Louis University Medical Center, Missouri
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41
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La Sala GB, Gaddi O, Bruno G, Brandi L, Cantarelli M, Salvatore V, Torelli MG, Dall'Asta D. Noninvasive evaluation of cardiovascular hemodynamics during multiple follicular stimulation, late luteal phase and early pregnancy. Fertil Steril 1989; 51:796-802. [PMID: 2707454 DOI: 10.1016/s0015-0282(16)60669-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A noninvasive hemodynamic study in three moments of the gamete intrafallopian transfer (GIFT) cycle was carried out on 25 patients: before beginning multiple follicular stimulation (MFS) (study I); after rapid increase of serum estradiol (E2) (study II); and 12 days after GIFT (study III). In the 25 patients, the rapid increase in E2 proved to be combined with a significant increase in the left ventricular end diastolic dimension (LVEDD), the left ventricular end systolic dimension, the heart rate (HR), the systolic index, the cardiac index, and a significant reduction in the mean arterial pressure, in the systolic arterial pressure and in the systemic vascular resistence index. In the 14 pregnant patients in study III, all of the hemodynamic parameters studied proved to be significantly modified with respect to study I. In the 11 nonpregnant patients between Studies I and III were no significant cardiovascular modifications except for a significant increase in LVEDD in Study III. It is concluded that, during MFS, the rapid increase in E2 is combined with hemodynamic modifications and that, in pregnancy, the cardiovascular adaptation modifications occur in the very early stages.
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Affiliation(s)
- G B La Sala
- Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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Ascah KJ, Stewart WJ, Gillam LD, Triulzi MO, Newell JB, Weyman AE. Calculation of transmitral flow by Doppler echocardiography: a comparison of methods in a canine model. Am Heart J 1989; 117:402-11. [PMID: 2916413 DOI: 10.1016/0002-8703(89)90787-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although several Doppler echocardiographic methods for measuring transmitral flow have been described, the optimal method for calculation of flow remains unclear. Seven time/shape combinations were tested in an experimental preparation in which mitral flow could be precisely controlled and measured. Annular shape was considered to be either circular or elliptical, and the mitral orifice area was calculated from the anteroposterior and/or the mediolateral dimension(s) recorded at early and middiastole. In addition the orifice area was calculated from the maximal mitral leaflet area corrected for diastolic variation. Transmitral flow ranged between 0.4 and 4.6 L/min. Good correlations with measured transmitral flow (r = 0.83 to 0.92) were observed for all methods of calculating the mitral orifice area. Methods that assumed a circular geometry and used the mediolateral annular diameter overestimated flow. Conversely, flows calculated by means of the anteroposterior diameter with the assumption of a circular anulus underestimated flow. The best approximations of transmitral flow were obtained with the assumption of an elliptical configuration that used measurements made in early diastole (Y = 1.04x + 0.2) and with the Fisher method (y = 0.94x + 0.08). Thus in the canine model approximation of the mitral orifice as an ellipse provides the most accurate measurement of transmitral flow.
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Affiliation(s)
- K J Ascah
- University of Ottawa Heart Institute, Ontario, Canada
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43
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Looyenga DS, Liebson PR, Bone RC, Balk RA, Messer JV. Determination of cardiac output in critically ill patients by dual beam Doppler echocardiography. J Am Coll Cardiol 1989; 13:340-7. [PMID: 2913112 DOI: 10.1016/0735-1097(89)90509-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recent technology in Doppler echocardiography has produced a dual beam Doppler instrument that is capable of insonating the total cross-sectional area of the ascending aorta. The purpose of this study was to evaluate the accuracy of this instrument in measuring cardiac output in critically ill patients by comparing results with those of the thermodilution-derived cardiac output. A technically adequate Doppler cardiac output measurement was attained in 71 (91%) of 78 patients. The range of thermodilution-derived cardiac output measurements was from 1.58 to 11.70 liters/min. To maximize thermodilution cardiac output reliability, several measurements were made for each patient. Those patients in whom the difference between the highest and lowest measurement varied by less than 10% from the averaged results were accepted into the 50 patient study. There was significant correlation between dual beam Doppler- and thermodilution-derived cardiac output (r = 0.96, SEE = 0.55 liters/min, p less than 0.0001). This study demonstrates that dual beam Doppler ultrasound is a promising noninvasive method of measuring cardiac output in the critically ill patient.
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Affiliation(s)
- D S Looyenga
- Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612-3864
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44
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Fast JH, van den Merkhof L, Blans W, van Leeuwen K, Uijen G. Determination of cardiac output by single gated pulsed Doppler echocardiography. Int J Cardiol 1988; 21:33-42. [PMID: 3220601 DOI: 10.1016/0167-5273(88)90006-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim of the study was to evaluate the use of single gated pulsed Doppler cross-sectional echocardiography for measurement of the cardiac output. Pulsed Doppler echocardiography was used to assess both area and blood velocity at the aortic orifice. Stroke volume estimates were determined by multiplying area by systolic time velocity integral as measured from the parasternal and apical approach, respectively. We investigated a group of 17 healthy individuals and a group of 20 patients with coronary artery disease. In the first group no change was found in aortic area during systole (P less than 0.01). During a follow-up of two weeks no change in aortic area was observed either (P less than 0.01). Intraobserver, interobserver and day-to-day variability of the aortic area, expressed as the coefficient of variation was 3.6 +- 5.2%, 4.6 +- 5.7% and 7.8 +- 3.8% (mean +- 1 SD), respectively. The interobserver variability of the time velocity integrals was 6.0 +- 6.2%. In the second group the cardiac output as measured with the thermodilution method ranged from 3.8 to 8.0 l/min. Comparison of the Doppler and thermodilution technique for measurement of cardiac output showed a correlation coefficient of r = 0.76 (P less than 0.001) and the following regression equation: CO (Doppler) = 1.0 x CO (thermodilution)-700 ml. The Doppler method underestimated cardiac output relative to the thermodilution method.
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Affiliation(s)
- J H Fast
- Department of Cardiology, Sint Radboud Hospital, University of Nijmegen, The Netherlands
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Nicolosi GL, Pungercic E, Cervesato E, Pavan D, Modena L, Moro E, Dall'Aglio V, Zanuttini D. Feasibility and variability of six methods for the echocardiographic and Doppler determination of cardiac output. Heart 1988; 59:299-303. [PMID: 3355721 PMCID: PMC1216463 DOI: 10.1136/hrt.59.3.299] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The feasibility and the intrinsic variability of six different methods of echocardiographic and Doppler flow determination of cardiac output were analysed in 34 healthy volunteers. Four were excluded because of poor quality echocardiograms. The mean (range) age of the remaining 30 (12 women, 18 men) was 21 years (13-36 years). Cardiac output was calculated by six methods as a product of echocardiographically determined cross sectional area of the aorta (apical and suprasternal views), pulmonary trunk, tricuspid annulus, and mitral annulus (circular and corrected for diastolic variations), and the flow velocity integral measured by Doppler. Cardiac output ranged from 2.79 to 6.56 1/min (4.45 (1.29) 1/min) (mean (SD)). The feasibility of the methods ranged from 87% (26 patients) for the aorta from the suprasternal notch to 100% (30 patients) for the mitral orifice corrected for diastolic variations and for the tricuspid valve. The corresponding results for all 34 individuals were 76% and 88% respectively. Three way analysis of variance was performed in the 23 healthy volunteers in whom all six methods were feasible. Interobserver and intraobserver interpretative variabilities were 6.8% and 5.9% respectively. The intrinsic variability of each single measurement of cardiac output, independently of the observer and the method used, was 25%. Provided the image was suitable for analysis echocardiographic and Doppler flow determination of cardiac output was feasible in most healthy volunteers. But there was significant intrinsic variability for each of different methods. A single value of cardiac output in an individual should be interpreted with caution.
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Affiliation(s)
- G L Nicolosi
- Servizio di Emodinamica, Ospedale Civile, Pordenone, Italy
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46
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Sholler GF, Celermajer JM, Whight CM, Bauman AE. Echo Doppler assessment of cardiac output and its relation to growth in normal infants. Am J Cardiol 1987; 60:1112-6. [PMID: 3454657 DOI: 10.1016/0002-9149(87)90363-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In a study of 38 normal infants, serial measurements of systemic (n = 169) and pulmonary (n = 143) blood flow were undertaken from the ages of 2 weeks to 12 months by 2-dimensional, M-mode and pulsed Doppler echocardiography. Cardiac output changed linearly (cardiac output = 0.3 X height -0.99 liter/min), and cardiac index was validated as a means for standardizing cardiac output in infants younger than 10 to 13 months of age. Infants younger than 2 months had lower cardiac indexes and stroke volume indexes (2.6 +/- 0.7 liters/min/m2 and 19 +/- 5 ml/m2, respectively) compared with those aged 12 months (3.2 +/- 0.7 liter/min/m2 and 25 +/- 5 ml/m2, respectively). Changes in cardiac output in individual infants over time suggest nonmorphometric modulating factors for cardiovascular function.
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Affiliation(s)
- G F Sholler
- Adolph Basser Institute of Cardiology, Children's Hospital, Camperdown, Sydney, Australia
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47
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Robson SC, Dunlop W, Moore M, Hunter S. Combined Doppler and echocardiographic measurement of cardiac output: theory and application in pregnancy. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1987; 94:1014-27. [PMID: 3322366 DOI: 10.1111/j.1471-0528.1987.tb02285.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A non-invasive technique for the measurement of cardiac output in pregnancy by combined cross-sectional and Doppler echocardiography at three intracardiac sites is described. The validity of the technique for use during pregnancy is reviewed. Comparison with cardiac output determined simultaneously by the direct Fick technique in 15 non-pregnant subjects showed close agreement for all three measurement sites. Acceptable measurements were obtained from the aortic and pulmonary valves in all pregnant subjects and from the mitral valve in 84% of pregnant subjects. The within-patient intra-observer and hour-to-hour variabilities of cardiac output in pregnant and non-pregnant subjects were less than 5% of the mean for all three valves studied. Flow measurements at each of the three intracardiac sites correlated closely. The advantages and limitations of the technique for use during pregnancy are discussed.
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Affiliation(s)
- S C Robson
- University of Newcastle-upon-Tyne, Department of Obstetrics and Gynaecology, Princess Mary Maternity Hospital
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48
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Roewer N, Bednarz F, Schulte am Esch J. Continuous measurement of intracardiac and pulmonary blood flow velocities with transesophageal pulsed Doppler echocardiography: technique and initial clinical experience. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1987; 1:418-28. [PMID: 2979111 DOI: 10.1016/s0888-6296(87)96906-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pulsed Doppler techniques have become well established adjuncts to conventional echocardiography in the noninvasive diagnosis of various cardiac malfunctions. Disadvantages of the transthoracic approach, such as inaccessibility and instability of the probe position, limit the continuous application of pulsed Doppler echocardiography during surgery. This study presents a new technique using the transesophageal approach that combines pulsed Doppler measurements with two-dimensional echocardiographic imaging (TDE). The first intraoperative experience with this new enhancement to two-dimensional transesophageal echocardiography (TEE) showed that this relatively noninvasive technique is a safe method allowing constant monitoring of cardiac and pulmonary blood flow velocities. The simultaneous high-resolution two-dimensional imaging facilitates spatial orientation and placement of the sample volume, as well as continued control of the sampling location. The typical flow velocity patterns in standard TEE views are described. The mitral valve and pulmonary artery offer particularly favorable conditions for continuous high-quality TDE measurements. It is concluded that the new technique may further increase the value of TEE to clinicians in the perioperative period.
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Affiliation(s)
- N Roewer
- Department of Anesthesiology, University Hospital Eppendorf, Hamburg, West Germany
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49
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Dittmann H, Voelker W, Karsch KR, Seipel L. Influence of sampling site and flow area on cardiac output measurements by Doppler echocardiography. J Am Coll Cardiol 1987; 10:818-23. [PMID: 3655148 DOI: 10.1016/s0735-1097(87)80275-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 40 patients cardiac output was simultaneously determined by pulsed Doppler echocardiography and thermodilution (range 4.0 to 10.2 liters/min). The sample volume was located in the center of the mitral anulus, at the tips of the mitral leaflets and in the center of the aortic anulus. Circular cross-sectional areas of the mitral anulus, aortic anulus and aortic bulbus were calculated from M-mode and two-dimensional echocardiographic diameters. The varying short axis of the elliptical mitral opening area was obtained from the diastolic leaflet separation in the M-mode, and the long axis was derived from the maximal mitral orifice area or mitral anulus diameter. Cardiac output was calculated by multiplying time-velocity integrals with the different areas and heart rate. Doppler flow measurements correlated significantly with the thermodilution method (r = 0.79 to 0.93). Flow measurements at the aortic anulus were most accurate (r = 0.93, SEE = 0.589 liter/min) if the annular area was derived from the M-mode tracing. Measurement of the anulus in the apical five chamber view yielded a significant underestimation and the area of the aortic bulbus provided an overestimation of cardiac output. Left ventricular inflow was underestimated at the mitral leaflet tips and overestimated at the mitral anulus. The accuracy of pulsed Doppler cardiac output measurements strongly depends on the assumed flow area and sampling site. Both should be determined at the same level in the inflow or outflow tract of the left ventricle. Measurement of cardiac output in the center of the aortic anulus provided the highest accuracy.
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Affiliation(s)
- H Dittmann
- Medical Department III, University of Tuebingen, West Germany
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50
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WILLIAMS GEORGEA, LABOVITZ ARTHURJ. Doppler Estimation of Cardiac Output: Principles and Pitfalls. Echocardiography 1987. [DOI: 10.1111/j.1540-8175.1987.tb01345.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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