Document Detail


Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease.
MedLine Citation:
PMID:  23287875     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Transcardiopulmonary thermodilution (TPTD, SV(TD)) as well as calibrated (SV(PC CAL)) and uncalibrated (SV(PC UNCAL)) arterial pulse contour analysis (PC) are increasingly promoted as less-invasive technologies to measure stroke volume (SV) but their reliability in aortic valve disease was unknown. The objective of this prospective study was to investigate the validity of three less-invasive techniques to assess SV in conditions involving aortic stenosis (AS) and valvuloplasty-induced aortic insufficiency (AI) compared with transesophageal echocardiography. METHODS: In 18 patients undergoing transcatheter aortic valve implantation, SV(TD) and SV(PC CAL) were determined using a central pressure signal via the brachial artery and SV(PC UNCAL) using a peripheral radial signal. RESULTS: In aortic valve dysfunction TPTD achieved adequate reproducibility (concordance correlation coefficient (CCC): AS 0.84; AI 0.82) and agreement (percentage error (PE): AS 26.3 %; AI 26.2 %) with the reference technique. In severe AS, SV(PC CAL) (PE 25.7 %; CCC 0.85) but not SV(PC UNCAL) (PE 50.4 %; CCC 0.38) was reliable. Neither calibrated nor uncalibrated PC (SV(PC CAL): PE 51.5 %; CCC 0.49; SV(PC UNCAL): PE 61.9 %; CCC 0.22) was valid in AI. Trending ability to hemodynamic changes, quantified by the ΔSV vector and the angle θ, was acceptable for each measurement modality. CONCLUSIONS: Transcardiopulmonary thermodilution is valid in aortic valve dysfunction. Calibration of PC substantially improves reliability in aortic valve disease. Calibrated PC is valid in severe AS. Valvuloplasty-induced AI seriously confounds PC measurements. In uncalibrated PC approaches, the relative SV trend is superior to single absolute values.
Authors:
Martin Petzoldt; Carsten Riedel; Jan Braeunig; Sebastian Haas; Matthias S Goepfert; Hendrik Treede; Stephan Baldus; Alwin E Goetz; Daniel A Reuter
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-4
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, m.petzoldt@uke.de.
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