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:  MEDLINE    
PURPOSE: Transcardiopulmonary thermodilution (TPTD, SVTD) as well as calibrated (SVPC CAL) and uncalibrated (SVPC 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, SVTD and SVPC CAL were determined using a central pressure signal via the brachial artery and SVPC 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, SVPC CAL (PE 25.7 %; CCC 0.85) but not SVPC UNCAL (PE 50.4 %; CCC 0.38) was reliable. Neither calibrated nor uncalibrated PC (SVPC CAL: PE 51.5 %; CCC 0.49; SVPC 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.
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:  2013-01-04
Journal Detail:
Title:  Intensive care medicine     Volume:  39     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-26     Completed Date:  2013-09-26     Revised Date:  2014-06-10    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  601-11     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Aortic Valve / physiopathology,  surgery
Cardiac Output / physiology*
Heart Defects, Congenital / diagnosis,  physiopathology,  surgery*
Heart Valve Diseases / diagnosis,  physiopathology,  surgery*
Heart Valve Prosthesis Implantation*
Prospective Studies
Stroke Volume / physiology
Thermodilution / methods
Comment In:
Intensive Care Med. 2013 Apr;39(4):787-9   [PMID:  23287877 ]
Intensive Care Med. 2014 May;40(5):767   [PMID:  24664153 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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