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Mangos JG, Crocker S, Flood M, Martyn J, Roberts L, Henry A, Pettit F. Use of the USCOM® noninvasive cardiac output measurement system to predict the development of pre-eclampsia in hypertensive pregnancies. Hypertens Pregnancy 2024; 43:2310607. [PMID: 38353244 DOI: 10.1080/10641955.2024.2310607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To assess the ability of the USCOM® (USCOM), using measurements of cardiac output (CO) and systemic vascular resistance (SVR), to predict the development of pre-eclampsia (PE) and severe PE in hypertensive pregnancies. STUDY DESIGN Prospective cohort study of women in the second or third trimester recruited at a tertiary center in Sydney, Australia. Demographic data and hemodynamic measurements using the USCOM were taken for all study participants at recruitment. Pregnancy outcome, including development of PE and severe PE, was tracked. Data were analyzed using ANOVA testing, pair-wise comparison testing, and Student's t-testing. RESULTS Recruitment included 65 normotensive controls, 34 women with chronic hypertension (CH), 51 with gestational hypertension (GH), and 21 with PE. Significantly higher weight, body surface area, and blood pressure measurements were found in the hypertensive, compared with the normotensive control and pregnancies. There were no observed differences in USCOM-measured CO, cardiac index, SVR, or systemic vascular resistance index between hypertensive women who did versus did not develop PE or severe PE in later pregnancy. Analysis of the CH and GH subgroups, as well as only unmedicated hypertensive women (n = 24), also showed no significant difference in hemodynamic parameters between those who did or did not develop PE or severe PE. CONCLUSIONS Our group was unable to successfully predict the onset of PE or severe PE based on hemodynamic parameters measured with the USCOM. It is possible this relates to the high proportion of women on antihypertensive medication at recruitment.
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Affiliation(s)
- Jack George Mangos
- Department of Anaesthesia, St. Vincent's Hospital, Darlinghurst, Australia
- Department of Anaesthesia, St. Vincent's Clinical School, UNSW Medicine, Darlinghurst, Australia
| | - Shyamalee Crocker
- Department of Renal Medicine, Calvary Public Hospital, Mary Potter Circuit, Bruce, Australia
| | - Macayla Flood
- Department of Renal Medicine, St. George Hospital, Kogarah, Australia
- St. George and Sutherland Clinical School, UNSW Medicine, Kogarah, Australia
| | - Jade Martyn
- Department of Renal Medicine, St. George Hospital, Kogarah, Australia
- St. George and Sutherland Clinical School, UNSW Medicine, Kogarah, Australia
| | - Lynne Roberts
- St. George and Sutherland Clinical School, UNSW Medicine, Kogarah, Australia
- Department of Women's Health, St. George Hospital, Kogarah, Australia
| | - Amanda Henry
- St. George and Sutherland Clinical School, UNSW Medicine, Kogarah, Australia
- Department of Women's Health, St. George Hospital, Kogarah, Australia
| | - Franziska Pettit
- St. George and Sutherland Clinical School, UNSW Medicine, Kogarah, Australia
- Department of Women's Health, St. George Hospital, Kogarah, Australia
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Doni D, Faraguna MC, Zannin E, Rinaldi A, Cafolla C, Iozzi L, Cavalleri V, Rigotti C, Sinelli M, Fedeli T, Ventura ML. Hemodynamic evaluation in preterm infants using ultrasonic cardiac output monitor ( USCOM). Eur J Pediatr 2024; 183:2183-2192. [PMID: 38376594 DOI: 10.1007/s00431-024-05465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
We aimed to establish reference ranges for USCOM parameters in preterm infants, determine factors that affect cardiac output, and evaluate the measurement repeatability. This retro-prospective study was performed at Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. We included infants below 32 weeks of gestational age (GA) and/or 1500 g of birth weight (BW). We excluded infants with congenital heart diseases or hemodynamic instability. Measurements were performed at 3 ± 1, 7 ± 2, and 14 ± 2 postnatal days. We analyzed 204 measurements from 92 patients (median GA = 30.57 weeks, BW = 1360 g). The mean (SD) cardiac output (CO) was 278 (55) ml/min/kg, cardiac index (CI) was 3.1 (0.5) L/min/m2, and systemic vascular resistance (SVRI) was 1292 (294) d*s*cm-5/m2. CO presented a negative correlation with postmenstrual age (PMA), while SVRI presented a positive correlation with PMA. The repeatability coefficient was 31 ml/kg/min (12%). Conclusion: This is the first study describing reference values for USCOM parameters in hemodynamically stable preterm infants and factors affecting their variability. Further studies to investigate the usefulness of USCOM for the longitudinal assessment of patients at risk for cardiovascular instability or monitoring the response to therapies are warranted. What is Known: • The ultrasonic cardiac output monitoring (USCOM) has been widely used on adult and pediatric patients and reference ranges for cardiac output (CO) by USCOM have been established in term infants. What is New: • We established reference values for USCOM parameters in very preterm and very-low-birth-weight infants; the reference ranges for CO by USCOM in the study population were 198-405 ml/kg/min. • CO normalized by body weight presented a significant negative correlation with postmenstrual age (PMA); systemic vascular resistance index presented a significant positive correlation with PMA.
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Affiliation(s)
- Daniela Doni
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | | | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Alessandro Rinaldi
- Residency in Pediatrics, Università degli Studi Milano Bicocca, Milan, Italy
| | - Claudia Cafolla
- Residency in Pediatrics, Università degli Studi di Ferrara, Ferrara, Italy
| | - Lucia Iozzi
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Valeria Cavalleri
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Mariateresa Sinelli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, MB, Italy
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Kellnar A, Naumann D, Scherer C, Lüsebrink E, Joskowiak D, Peterß S, Hagl C, Massberg S, Orban M, Stremmel C. Aortic arch blood flow measurements as a predictor of successful ECMO weaning in cardiogenic shock. Heliyon 2024; 10:e26773. [PMID: 38444470 PMCID: PMC10912227 DOI: 10.1016/j.heliyon.2024.e26773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Objective Acute cardiogenic shock is a life-threatening condition with mortality rates of up to 50%. If conventional therapy fails, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy has emerged to a promising alternative for temporary cardiac and respiratory support in specialized centers. However, it is only a bridge to recovery, final decision, heart transplantation or the permanent implantation of a left ventricular assist device. Therefore, the identification of the optimum weaning time point is challenging, and standardized weaning protocols are rare. Methods In this explorative pilot study, we evaluated the potential benefit of blood flow measurements in the aortic arch using an ultrasonic cardiac output monitor (USCOM) for the primary endpoint of successful VA-ECMO weaning. 12 patients under VA-ECMO therapy for acute cardiogenic shock and a hemodynamic condition which qualified for a stepwise weaning process were included in this study. Main exclusion criterion was the presence of additional venting therapy for left ventricular unloading, e.g. Impella. Statistical comparisons were performed using the Mann-Whitney test and corrected for multiple testing by the Holm-Sidak method. Results Peak velocity of flow in the aortic arch showed a positive correlation with weaning success independent of ECMO flow (weaning success vs. failure: 0.75 vs. 0.35 m/s (low ECMO support), p = 0.049), whereas we identified only a trend for mean pressure gradient, minute distance and stroke volume index. Conclusion We hypothesize, that USCOM might provide an additive benefit to conventional strategies in its ability to predict successful VA-ECMO weaning and prevent pulmonary congestion. Larger upcoming trials are required to address this relevant topic and provide standardized treatment protocols for optimized weaning in the future.
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Affiliation(s)
- Antonia Kellnar
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Dominik Naumann
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Dominik Joskowiak
- Herzchirurgische Klinik und Poliklinik, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Peterß
- Herzchirurgische Klinik und Poliklinik, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher Stremmel
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
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Lubrano C, Parisi F, Coco C, Marelli E, Burello E, Cetin I. Associations between Maternal Nutritional Status, Hemodynamic Parameters, and Delivery Outcomes in Low-Risk Pregnancies: A Prospective Observational Study. Nutrients 2024; 16:183. [PMID: 38257076 PMCID: PMC10819587 DOI: 10.3390/nu16020183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Maternal nutritional status represents a pivotal predictor of pregnancy outcome. This prospective observational study investigates the associations between maternal characteristics and nutritional habits at term, hemodynamic parameters, and pregnancy outcomes. Healthy women with singleton uncomplicated pregnancies were enrolled at 36-41 gestational weeks. At enrollment, a nutritional score (0-10) was calculated in order to quantify maternal adherence to a healthy diet and lifestyle. Maternal hemodynamic parameters were assessed by using the Ultrasonic Cardiac Output Monitor (USCOM), including cardiac output (CO), systemic vascular resistance (SVR) and Smith-Madigan inotropy index (SMII). Pregnancy outcomes were recorded at delivery. Associations between maternal characteristics and nutritional score, hemodynamic parameters, and pregnancy outcomes were investigated by using multi-adjusted generalized linear models. In total, 143 pregnancies were enrolled. Pregestational body mass index (BMI) was positively associated with SVR, and negatively associated with CO and SMII. Additionally, a positive association was detected between the nutritional score and SMII. Finally, CO was positively associated with birth and placental weight, while RVS showed a negative association with birth and placental weight. This study shows that maternal derangements in nutritional status and habits are associated with a compromised hemodynamic profile at term, with additional impacts on intrauterine growth.
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Affiliation(s)
- Chiara Lubrano
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (C.L.); (C.C.); (E.M.); (E.B.); (I.C.)
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospitals, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, 20154 Milan, Italy
| | - Francesca Parisi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (C.L.); (C.C.); (E.M.); (E.B.); (I.C.)
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Chiara Coco
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (C.L.); (C.C.); (E.M.); (E.B.); (I.C.)
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospitals, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, 20154 Milan, Italy
| | - Elisabetta Marelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (C.L.); (C.C.); (E.M.); (E.B.); (I.C.)
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospitals, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, 20154 Milan, Italy
| | - Eleonora Burello
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (C.L.); (C.C.); (E.M.); (E.B.); (I.C.)
- Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospitals, ASST Fatebenefratelli-Sacco, Università degli Studi di Milano, 20154 Milan, Italy
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (C.L.); (C.C.); (E.M.); (E.B.); (I.C.)
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Montaguti E, Cofano M, Diglio J, Fiorentini M, Pellegrino A, Lenzi J, Battaglia C, Pilu G. The prediction of hypertensive disorders by maternal hemodynamic assessment in the first trimester of pregnancy. J Matern Fetal Neonatal Med 2023; 36:2198063. [PMID: 37019628 DOI: 10.1080/14767058.2023.2198063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy and fetal growth restriction share common etiopathological origins and could be caused by maternal hemodynamic maladaptation to pregnancy. OBJECTIVE The aim of our study is to evaluate if there is a correlation between maternal hemodynamic detected by UltraSonic Cardiac Output Monitor (USCOM®) during the first trimester and the pregnancy outcome. STUDY DESIGN We recruited a nonconsecutive series of women in the first trimester of pregnancy with no previous history of hypertensive disorders. We measured the pulsatility index uterine arteries and performed a hemodynamic evaluation by USCOM® device. After delivery, we reported the development of hypertensive disorders or intrauterine fetal growth restriction later during gestation. RESULTS A total of 187 women were enrolled during the first trimester; 17 (9%) developed gestational hypertension or preeclampsia while 11 (6%) delivered a restricted growth fetus. Mean uterine artery pulsatility index above the 95th percentile was significantly more frequent in both women who developed hypertension and those with fetal growth restriction compared to controls. Hemodynamic parameters (reduced cardiac output and increased total vascular resistance) were significantly different in the group that developed hypertensive disorders, compared to uncomplicated pregnancy. ROC curves demonstrated the usefulness of uterine artery pulsatility index in the prediction of fetal growth restriction, while hemodynamic parameters were significantly associated to the development of hypertensive disorders. CONCLUSIONS Hemodynamic maladaptation to pregnancy may predispose to the development of hypertension, while we demonstrated a significative relationship between growth restriction and mean uterine pulsatility index. Further studies are needed to assess the value of hemodynamics evaluation in screening protocols of preeclampsia.
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Affiliation(s)
- Elisa Montaguti
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
| | - Maria Cofano
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
| | - Josefina Diglio
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
| | - Marta Fiorentini
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
| | - Anita Pellegrino
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Cesare Battaglia
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, Italy
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Fidan S, Zengin SÜ, Orhon M, Umuroğlu T. Comparative efficacy of finger versus forehead Plethysmographic Variability Index monitoring in pediatric surgical patients. Paediatr Anaesth 2023; 33:52-58. [PMID: 36168810 DOI: 10.1111/pan.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The Plethysmographic Variability Index can be measured by both finger and forehead probes. Vasoconstriction may jeopardize the reliability of finger PVI measurements in pediatric patients undergoing surgery. However, forehead vasculature exhibits more marked resistance to alterations in the vasomotor tonus. OBJECTIVE Our aim was to compare the Plethysmographic Variability Index measured via finger or forehead probes in mechanically ventilated pediatric surgery patients in terms of their ability to predict fluid responsiveness as well as to determine the best cut-off values for these two measurements. MATERIALS AND METHODS A total of 50 pediatric patients undergoing minor elective surgery were included after provision of parental consent and ethics committee approval. Perfusion index measured at the finger or forehead and Plethysmographic Variability Index monitoring comprised the primary assessments. Hemodynamic parameters monitored included perfusion index, Plethysmographic Variability Index, and cardiac output. A ≥ 15% increase in cardiac output following passive leg raise maneuver was considered to show fluid responsiveness. Two groups were defined based on fluid responsiveness: Group R (responsive) and Group NR (non-responsive). Student's t-test, Mann-Whitney U test, DeLong test, and ROC were used for statistical analysis. RESULTS The area under curve for finger and forehead Plethysmographic Variability Index prior to passive leg raise maneuver were 0.699 (p = .011) and 0.847 (p < .001), respectively. The sensitivity for finger and forehead measurements at a cut-off value of ≤14% was 92.9% and 96.4%, and 45.4% and 72.7%, respectively. CONCLUSION Although forehead and finger Plethysmographic Variability Index monitoring were similarly sensitive in predicting fluid responsiveness in pediatric surgical patients, the former method provided higher specificity. The best cut-off value for PVI measurements with forehead and finger probes was found to be 14%.
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Affiliation(s)
- Seyfullah Fidan
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Seniyye Ülgen Zengin
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Meliha Orhon
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Tümay Umuroğlu
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
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Mappa I, Luviso M, Tartaglia S, Maqina P, Lu JLA, Makatsariya A, Rizzo G. Maternal cardiovascular function in the prediction of fetal distress in labor: a prospective cohort study. J Matern Fetal Neonatal Med 2022; 35:7139-7145. [PMID: 34340644 DOI: 10.1080/14767058.2021.1945028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore the strength of association and the diagnostic accuracy of maternal hemodynamic parameters detected noninvasively in predicting an adverse perinatal outcome in labor. METHODS Prospective cohort study of singleton women undergoing antepartum care at 37-39 weeks of gestation. A noninvasive ultrasonic cardiac output monitor (USCOM®) was used for cardiovascular assessment. The study outcome was a composite score of adverse perinatal outcome, which included at least one of the following variables: Cesarean or instrumental delivery for abnormal fetal heart monitoring, umbilical artery pH <7.10 or admission to neonatal special care unit. Attending clinicians were blinded to maternal cardiovascular indices. Multivariate logistic regression and area under the curve (AUC) analyses were used to test the diagnostic accuracy of different maternal and ultrasound characteristics in predicting adverse perinatal outcome. RESULTS A total of 133 women were recruited. The rate of adverse perinatal outcome was 25.6% (34/133). Women who delivered without abnormal perinatal outcome (controls) were more likely to be parous, compared to those who had an adverse perinatal outcome (44.4 vs. 73.5%; p = .005). Control women had significantly lower systemic vascular resistance (SVR) (median, 1166 vs. 1352 dynes × s/cm5, p = .023) and SVR index (SVRI) (median, 2168 vs. 2627 dynes × s/cm5/m2, p = .039) compared to women who had an adverse perinatal outcome. In this latter group the prevalence of SV <50 ml was significantly higher than in the control group (38.2% (13/34) vs. 11.1%, (11/99) p = .0012). At multivariable logistic regression analysis, SVR (aOR 1.307; 95% CI 1.112-2.23), SV <50 ml (aOR 4.70; 95% CI 1.336-12.006) and parity (3.90: 95% CI 1.545-10.334) were the only variables independently associated with adverse perinatal outcome. A model considering only SVR showed an AUC of 0.631. Integration of SVR with SV <50 ml and parity significantly improves the diagnostic performance of SVR alone to predict adverse outcome (AUC 0.732; p = .016). CONCLUSION Pre-labor modifications of maternal cardiovascular variables are associated with adverse perinatal outcome. However, their predictive accuracy for perinatal compromise is low, and thus their use as standalone screening test for adverse perinatal outcome in singleton pregnancies at term is not supported.
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Affiliation(s)
- Ilenia Mappa
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata, Roma, Italy
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Roma, Italy
| | - Maria Luviso
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Roma, Italy
| | - Silvio Tartaglia
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata, Roma, Italy
| | - Pavjola Maqina
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Roma, Italy
| | - Jia Li Angela Lu
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata, Roma, Italy
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Giuseppe Rizzo
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata, Roma, Italy
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Roma, Italy
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
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Gutierrez Henares J, Gutierrez Henares R, Perry H, Khalil A, Thilaganathan B. Maternal cardiovascular potential and kinetic energy indices in pre-eclamptic and small-for-gestational-age pregnancies. Ultrasound Obstet Gynecol 2022; 59:613-618. [PMID: 34529288 DOI: 10.1002/uog.24768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Non-invasive assessment of maternal cardiovascular potential and kinetic energy can be used to derive potential-to-kinetic-energy ratio (PKR) and Smith-Madigan inotropic index (SMII), which reflect the balance between blood pressure and blood flow. The aim of this study was to evaluate PKR and SMII in pregnancies complicated by hypertensive disorders of pregnancy (HDP) and/or small-for-gestational-age (SGA) birth. METHODS This was a prospective study that enrolled women with a singleton pregnancy between 5 and 41 weeks' gestation. Women who developed HDP and/or SGA underwent cardiovascular profiling from 20 weeks. To establish reference ranges for PKR and SMII, women without any pre-existing medical problems at the time of booking who did not develop HDP, SGA or other complications during pregnancy were also recruited for cardiovascular profiling. Measurements of cardiovascular parameters were obtained using a non-imaging ultrasound cardiac output monitor. RESULTS A total of 688 women completed the study, including 626 controls, 21 cases with HDP, 19 cases with SGA and 22 cases with HDP and SGA. PKR was significantly elevated in pregnancies with placental dysfunction compared with controls (HDP only, 29.81 ± 9.5; HDP and SGA, 44.33 ± 24.27; SGA only, 31.05 ± 13.14; vs controls, 22.30 ± 7.93; all P < 0.05). SMII values were significantly lower only in cases affected by SGA alone when compared with controls (1.47 ± 0.23 W/m2 vs 1.75 ± 0.40 W/m2 ; P < 0.005). These differences remained statistically significant when the analysis was undertaken using multiples of the median values corrected for gestational age. CONCLUSIONS The findings of this study suggest that point-of-care non-invasive cardiovascular profiling using PKR and SMII may help distinguish between pregnancies affected by specific placental disorders and those exhibiting healthy cardiovascular adaptation to pregnancy. Women with HDP and/or SGA appear to have distinctive PKR and SMII profiles that reflect low kinetic energy in pregnancies with SGA and high potential energy in pregnancies affected by HDP. Finally, non-invasive assessment of potential and kinetic cardiovascular energy demonstrates physiological high-flow and low-resistance adaptation in uncomplicated pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Gutierrez Henares
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - R Gutierrez Henares
- Electronic Engineering, Malaga University, Campus de Teatinos, Málaga, Spain
| | - H Perry
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Doni D, Nucera S, Rigotti C, Arosio E, Cavalleri V, Ronconi M, Ventura ML, Fedeli T. Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor. Ital J Pediatr 2020; 46:112. [PMID: 32758264 PMCID: PMC7405450 DOI: 10.1186/s13052-020-00872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transition from intrauterine to extrauterine life is a critical phase during which several changes occur in cardiovascular system. In clinical practice, it is important to have a method that allows an easy, rapid and precise evaluation of hemodynamic status of a newborn for clinical management. We here propose a rapid, broadly applicable method to monitor cardiovascular function using ultrasonic cardiac output monitoring (USCOM). METHODS We here present data obtained from a cohort of healthy term newborns (n = 43) born by programmed cesarean section at Fondazione MBBM, Ospedale San Gerardo. Measurements were performed during the first hour of life, then at 6 + 2, at 12-24, and 48 h of life. We performed a screening echocardiography to identify a patent duct at 24 h and, if patent, it was repeated at 48 h of life. RESULTS We show that physiologically, during the first 48 h of life, blood pressure and systemic vascular resistance gradually increase, while there is a concomitant reduction in stroke volume, cardiac output, and cardiac index. The presence of patent ductus arteriosus significantly reduces cardiac output (p = 0.006) and stroke volume (p = 0.023). Furthermore, newborns born at 37 weeks of gestational age display significantly lower cardiac output (p < 0.001), cardiac index (p = 0.045) and stroke volume (p < 0.001) compared to newborns born at 38 and ≥ 39 weeks. Finally, birth-weight (whether adequate, small or large for gestational age) significantly affects blood pressure (p = 0.0349), stroke volume (p < 0.0001), cardiac output (p < 0.0001) and cardiac index (p = 0.0004). In particular, LGA infants display a transient increase in cardiac index, cardiac output and stroke volume up to 24 h of life; showing a different behavior from AGA and SGA infants. CONCLUSIONS Compared to previous studies, we expanded measurements to longer time-points and we analyzed the impact of commonly used clinical variables on hemodynamics during transition phase thus making our data clinically applicable in daily routine. We calculate reference values for each population, which can be of clinical relevance for quick bedside evaluation in neonatal intensive care unit.
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Affiliation(s)
- Daniela Doni
- Neonatal Intensive Care Unit, FMBBM, San Gerardo Hospital, Monza, Italy.
| | | | - Camilla Rigotti
- Neonatal Intensive Care Unit, FMBBM, San Gerardo Hospital, Monza, Italy
| | | | - Valeria Cavalleri
- Neonatal Intensive Care Unit, FMBBM, San Gerardo Hospital, Monza, Italy
| | | | | | - Tiziana Fedeli
- Neonatal Intensive Care Unit, FMBBM, San Gerardo Hospital, Monza, Italy
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Bussmann BM, Hulme W, Tang A, Harris T. Investigating the ability of non-invasive measures of cardiac output to detect a reduction in blood volume resulting from venesection in spontaneously breathing subjects. Scand J Trauma Resusc Emerg Med 2018; 26:104. [PMID: 30514343 PMCID: PMC6280441 DOI: 10.1186/s13049-018-0571-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/25/2018] [Indexed: 11/05/2022] Open
Abstract
Background Monitoring cardiac output (CO) in shocked patients provides key etiological information and can be used to guide fluid resuscitation to improve patient outcomes. Previously this relied on invasive monitoring, restricting its use in the Emergency Department (ED) setting. The development of non-invasive devices (such as LiDCOrapidv2 with CNAP™ and USCOM 1A), and ultrasound based measurements (Transthoracic echocardiography, inferior vena cava collapsibility index (IVCCI), carotid artery blood flow (CABF) and carotid artery corrected flow time (FTc)) enables stroke volume (SV) and CO to be measured non-invasively in the ED. We investigated the ability of these techniques to detect a change in CO resulting from a 500 ml reduction in circulating blood volume (CBV) following venesection in spontaneously breathing subjects. Additionally, we investigated if using incentive spirometry to standardise inspiratory effort improved the accuracy of IVC based measurements in spontaneously breathing subjects. Methods We recorded blood pressure, heart rate, IVCCI, CABF, FTc, transthoracic echocardiographic (TTE) SV and CO, USCOM 1A SV and CO, LIDCOrapidv2 SV, CO, Stroke volume variation (SVV) and pulse pressure variation (PPV) in 40 subjects immediately before and after venesection. The Log-Odds and coefficient of variation of the difference between pre- and post-venesection values for each technique were used to compare their ability to consistently detect CO changes resulting from a reduction in CBV resulting from venesection. Results TTE consistently detected a reduction in CO associated with venesection with an average decrease in measured CO of 0.86 L/min (95% CI 0.61 to 1.12) across subjects. None of the other investigated techniques changed in a consistent manner following venesection. The use of incentive spirometry improved the consistency with which IVC ultrasound was able to detect a reduction in CBV. Conclusions In a population of spontaneously breathing patients, TTE is able to consistency detect a reduction in CO associated with venesection.
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Affiliation(s)
| | - William Hulme
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Tang
- Department of anaesthesia at Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK
| | - Tim Harris
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, UK.,Queen Mary University of London, London, UK
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Tiralongo GM, Pisani I, Vasapollo B, Khalil A, Thilaganathan B, Valensise H. Effect of a nitric oxide donor on maternal hemodynamics in fetal growth restriction. Ultrasound Obstet Gynecol 2018; 51:514-518. [PMID: 28295749 DOI: 10.1002/uog.17454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect on maternal cardiovascular parameters of treatment with a nitric oxide (NO) donor and plasma volume expansion in pregnancies complicated by fetal growth restriction (FGR). METHODS Twenty-six pregnant women with a diagnosis of FGR were treated with transdermal patches of a NO donor and plasma volume expansion by co-administration of oral fluids. We compared the treated group to a historical control group of untreated FGR patients. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor system. RESULTS At diagnosis, the two groups were similar in terms of maternal and hemodynamic characteristics. In the treated group, we found a significant increase in maternal cardiac output and stroke volume and a decrease in systemic vascular resistance after 2 weeks of therapy. No significant differences were found 2 weeks after diagnosis in the untreated group. The treated group delivered infants with higher birth-weight centile than did the untreated control group. CONCLUSIONS The combined therapeutic approach of NO donor administration and plasma volume expansion in FGR apparently improves significantly maternal hemodynamic indices. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G M Tiralongo
- Department of Obstetrics and Gynaecology, University of Rome 'Tor Vergata', Rome, Italy
| | - I Pisani
- Department of Obstetrics and Gynaecology, University of Rome 'Tor Vergata', Rome, Italy
| | - B Vasapollo
- Department of Obstetrics and Gynaecology, Policlinico Casilino, Rome, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's Hospital, University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's Hospital, University of London, London, UK
| | - H Valensise
- Department of Obstetrics and Gynaecology, University of Rome 'Tor Vergata', Rome, Italy
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Li H, Critchley LAH, Zhang J. Does using two Doppler cardiac output monitors in tandem provide a reliable trend line of changes for validation studies? J Clin Monit Comput 2015; 30:559-67. [PMID: 26315476 DOI: 10.1007/s10877-015-9753-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Abstract
The demise of the pulmonary artery catheter as a gold standard in cardiac output measurement has created the need for new standard. Doppler cardiac output can be measured suprasternally (USCOM) and via the oesophagus (CardioQ). Use in tandem they may provide a reliable trend line of cardiac output changes against which new technologies can be assessed. Data from three similar clinical studies was pooled. Simultaneous USCOM and CardioQ readings, 13 (7-27), were performed every 15-30 min intraoperatively. Within individual patient regression analysis was performed. Data was normalized, CardioQ against USCOM, to eliminate the systematic error component following calibration. Bland-Altman and trend, concordance and polar analysis, were performed on the grouped data. Cardiac output was indexed (CI) to BSA. Data from 53 patients, aged 59 (26-81) years, scheduled for major surgery were included. Within-individual mean (SD) CI was 3.4 (0.6) L min(-1) m(-2). Correlation was good to excellent in 83 % of cases, R(2) > 0.80, and reasonable in 96 %, R(2) > 0.60. Percentage error was 38 %, and decreased to 14 % with normalization. The estimated 95 % precision for a single Doppler reading was ±10 %. Concordance rate was 96.6 % (confidence intervals 94.7-99.5 %) and above the >92 % threshold for good trending ability. Polar analysis also confirmed good trending ability. The regression line between Doppler methods was offset with a slope of 0.9, thus CardioQ CI readings increased relative to USCOM. Both Doppler methods trended cardiac output reliably. Used in tandem they provide a new standard to assess cardiac output trending.
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Affiliation(s)
- Huang Li
- Department of Anaesthesia and Surgical Intensive Care, Peking University First Hospital, Beijing, China
| | - Lester A H Critchley
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Jie Zhang
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR.
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Gregory SD, Cooney H, Diab S, Anstey C, Thom O, Fraser JF. In vitro evaluation of an ultrasonic cardiac output monitoring ( USCOM) device. J Clin Monit Comput 2016; 30:69-75. [PMID: 25749977 DOI: 10.1007/s10877-015-9685-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 02/27/2015] [Indexed: 12/22/2022]
Abstract
Non-invasive cardiac output monitoring techniques provide high yield, low risk mechanisms to identify and individually treat shock in the emergency setting. The non-invasive ultrasonic cardiac output monitoring (USCOM) device uses an ultrasound probe applied externally to the chest; however limitations exist with previous validation strategies. This study presents the in vitro validation of the USCOM device against calibrated flow sensors and compares user variability in simulated healthy and septic conditions. A validated mock circulation loop was used to simulate each condition with a range of cardiac outputs (2-10 l/min) and heart rates (50-95 bpm). Three users with varying degrees of experience using the USCOM device measured cardiac output and heart rate by placing the ultrasound probe on the mock aorta. Users were blinded to the condition, heart rate and cardiac output which were randomly generated. Results were reported as linear regression slope (β). All users estimated heart rate in both conditions with reasonable accuracy (β = 0.86-1.01), while cardiac output in the sepsis condition was estimated with great precision (β = 1.03-1.04). Users generally overestimated the cardiac output in the healthy simulation (β = 1.07-1.26) and reported greater difficulty estimating reduced cardiac output compared with higher values. Although there was some variability between users, particularly in the healthy condition (P < 0.01), all estimations were within a clinically acceptable range. In this study the USCOM provided a suitable measurement of cardiac output and heart rate when compared with our in vitro system. It is a promising technique to assist with the identification and treatment of shock.
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Pastore A, Geiger S, Baur D, Hausmann A, Tischer J, Horster S, Stemmler HJ. Cardiotoxicity After Anthracycline Treatment in Survivors of Adult Cancers: Monitoring by USCOM, Echocardiography and Serum Biomarkers. World J Oncol 2013; 4:18-25. [PMID: 29147326 PMCID: PMC5649915 DOI: 10.4021/wjon635w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 01/08/2023] Open
Abstract
Background Anthracyclines are agents with a well known documented anti-tumoral activity. Cardiac side effects are the principal toxicity. Here we evaluate and monitor the onset of late anthracycline-induced cardiotoxicity with real-time CW-Doppler ultrasound cardiac output monitoring (USCOM®) and echocardiography in combination with serum biomarkers. Methods Fifty-two patients without cardiac disease who had received an anthracycline-based regimen for various cancer types were included in this study. Patients’ hemodynamic parameters as stroke volume (SV USCOM (mL)) and ejection fraction (EF ECHOCARDIOGRAPHY (%)) were measured with USCOM and echocardiography and correlated to serum biomarkers (NT-pro-BNP and cTnT). Results Eighteen patients (34.6%) developed cardiac disease (NYHA I-III). An increasing cumulative anthracycline dose was associated with a decrease of the EF determined by echocardiography as well the SV by USCOM and with a higher NYHA class. Those patients who experienced cardiac disease showed a reduction of the EF and SV and increased serum biomarkers. Conclusions Real-time CW-Doppler USCOM, is a fast and reliable method to monitor late hemodynamic changes as a symptom of anthracycline-induced cardiotoxicity comparable to the findings by echocardiography and serum biomarkers.
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Affiliation(s)
- Alessandro Pastore
- Med. Dept. III, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
| | - Sandra Geiger
- Med. Dept. III, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
| | - Dorothee Baur
- Med. Dept. III, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
| | - Andreas Hausmann
- Med. Dept. III, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
| | - Johanna Tischer
- Med. Dept. III, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
| | - Sophia Horster
- Med. Dept. II, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
| | - Hans Joachim Stemmler
- Med. Dept. III, Ludwig-Maximilians University of Munich, Campus Grosshadern, Munich, Germany
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