Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease
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Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease. / Petzoldt, Martin; Riedel, Carsten; Braeunig, Jan; Haas, Sebastian; Goepfert, Matthias S; Treede, Hendrik; Baldus, Stephan; Goetz, Alwin E; Reuter, Daniel A.
in: INTENS CARE MED, Jahrgang 39, Nr. 4, 01.04.2013, S. 601-11.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease
AU - Petzoldt, Martin
AU - Riedel, Carsten
AU - Braeunig, Jan
AU - Haas, Sebastian
AU - Goepfert, Matthias S
AU - Treede, Hendrik
AU - Baldus, Stephan
AU - Goetz, Alwin E
AU - Reuter, Daniel A
PY - 2013/4/1
Y1 - 2013/4/1
N2 - 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.
AB - 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.
KW - Aged, 80 and over
KW - Aortic Valve
KW - Cardiac Output
KW - Female
KW - Germany
KW - Heart Defects, Congenital
KW - Heart Valve Diseases
KW - Heart Valve Prosthesis Implantation
KW - Humans
KW - Male
KW - Prospective Studies
KW - Pulse
KW - Stroke Volume
KW - Thermodilution
U2 - 10.1007/s00134-012-2786-7
DO - 10.1007/s00134-012-2786-7
M3 - SCORING: Journal article
C2 - 23287875
VL - 39
SP - 601
EP - 611
JO - INTENS CARE MED
JF - INTENS CARE MED
SN - 0342-4642
IS - 4
ER -