Pulmonary artery vs. transpulmonary thermodilution for the assessment of cardiac output in mitral regurgitation

Staier, Klaus; Wilhelm, Markus; Wiesenack, Christoph; Thoma, Martin; Keyl, Cornelius

doi:10.1097/eja.0b013e3283542222

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…In trauma patients, cardiac output measurements from pulmonary artery catheter and transthoracic echocardiography were significantly related and agreed with moderate strength [9]. Similar results were observed in patients submitted to cardiac surgery, with good agreement between transesophageal echocardiography and transpulmonary thermodilution, even before correction of severe mitral regurgitation [10]. Of note, volumetric techniques of cardiac output measurement, even using modern three-dimensional imaging techniques, are less reliable and tend to underestimate the thermodilution cardiac output [11].…”

Section: Echocardiography In Shocksupporting

confidence: 69%

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Ultrasonic evaluation of the heart

Backer

2014

Current Opinion in Critical Care

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Section: Echocardiography In Shocksupporting

confidence: 69%

“…Cardiac output can reliably be measured with echocardiography using Doppler measurements of left ventricular outflow tract [8][9][10]. In trauma patients, cardiac output measurements from pulmonary artery catheter and transthoracic echocardiography were significantly related and agreed with moderate strength [9].…”

Section: Echocardiography In Shockmentioning

confidence: 87%

Ultrasonic evaluation of the heart

Backer

2014

Current Opinion in Critical Care

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“…Valve regurgitation, the backward flow in the heart when a cardiac valve does not completely close shut, has been found to have a significant effect on cardiac function [1]. Cardiac output in a regurgitant heart depends on regurgitant volume [2], an indicator of the severity of regurgitation.…”

Section: Introductionmentioning

confidence: 99%

Computational analysis of the effect of valvular regurgitation on ventricular mechanics using a 3D electromechanics model

et al. 2015

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Using a three-dimensional electromechanical model of the canine ventricles with dyssynchronous heart failure, we investigated the relationship between severity of valve regurgitation and ventricular mechanical responses. The results demonstrated that end-systolic tension in the septum and left ventricular free wall was significantly lower under the condition of mitral regurgitation (MR) than under aortic regurgitation (AR). Stroke work in AR was higher than that in MR. On the other hand, the difference in stroke volume between the two conditions was not significant, indicating that AR may cause worse pumping efficiency than MR in terms of consumed energy and performed work.

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“…The thermodilution technique has been successfully applied to measure regional blood flow in single blood vessel [ 25 ] as well as across a pulmonary artery catheter in order to assess global cardiac output [ 26 ]. Obviating the need for pulmonary artery catheterization by injection of a bolus of cold saline into the superior or inferior vena cava that is transported with the blood flow and detected by a thermistor inserted into the femoral artery, transpulmonary thermodilution has been proven to match thermodilution measurement of blood flow across the right ventricle using a pulmonary artery catheter in a perioperative setting [ 27 , 28 ], in patients with heart failure primarily due to coronary heart disease [ 11 ] and in patients with severe mitral regurgitation undergoing valve repair [ 29 ]. The measurement of cardiac output has further been validated against echocardiography in patients with severe AS [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Validation of transpulmonary thermodilution variables in hemodynamically stable patients with heart diseases

Hilty

Franzen

Wyss

et al. 2017

Ann. Intensive Care

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BackgroundTranspulmonary thermodilution is recommended in the treatment of critically ill patients presenting with complex shock. However, so far it has not been validated in hemodynamically stable patients with heart disease.MethodsWe assessed the validity of cardiac output, global end-diastolic volume index (GEDVI), an established marker of preload thought to reflect the volume of all four heart chambers, global ejection fraction (GEF) and cardiac function index (CFI) as variables of cardiac function, and extravascular lung water index (EVLWI) as indicator of pulmonary edema in 29 patients undergoing elective left and right heart catheterization including left ventricular angiography with stable coronary heart disease and normal cardiac function (controls, n = 11), moderate-to-severe aortic valve stenosis (AS, n = 10), or dilated cardiomyopathy (DCM, n = 8).ResultsCardiac output was similar in controls, AS, and DCM, with good correlation between transpulmonary thermodilution and pulmonary artery catheter using the Fick method (r = 0.69, p < 0.0001). Left ventricular end-diastolic volume was normal in controls and AS, but significantly higher in DCM (104 ± 37 vs 135 ± 63 vs 234 ± 24 ml, p < 0.01). GEDVI did not differentiate between patients with normal and patients with enlarged left ventricular end-diastolic volume (848 ± 128 vs 882 ± 213 ml m−2, p = 0.60). No difference in GEF and CFI was found between patients with normal and patients with reduced left ventricular ejection fraction. Patients with AS but not DCM had higher EVLWI than controls (9 ± 2 vs 12 ± 4 vs 11 ± 3 ml kg−1, p = 0.04), while there was only a trend in pulmonary artery occlusion pressure (8 ± 3 vs 10 ± 5 vs 14 ± 7 mmHg, p = 0.05).ConclusionsCardiac output measurement by transpulmonary thermodilution is unaffected by differences in ventricular size and outflow obstruction. However, GEDVI did not identify markedly enlarged left ventricular end-diastolic volumes, and neither GEF nor CFI reflected the increased heart chamber volumes and markedly impaired left ventricular function in patients with DCM. In contrast, EVLWI is probably a sensitive marker of subclinical pulmonary edema particularly in patients with elevated left-ventricular-filling pressure irrespective of differences in left ventricular function.

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Pulmonary artery vs. transpulmonary thermodilution for the assessment of cardiac output in mitral regurgitation

Abstract: The results suggest that even severe mitral regurgitation has no significant impact on the accuracy of COTP. The precision of COTP was reduced under the condition of mitral regurgitation.

Cited by 14 publications

References 29 publications

Ultrasonic evaluation of the heart

Ultrasonic evaluation of the heart

Computational analysis of the effect of valvular regurgitation on ventricular mechanics using a 3D electromechanics model

Validation of transpulmonary thermodilution variables in hemodynamically stable patients with heart diseases

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