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Ultrasound Cardiac Output Monitor (USCOM™) Measurements Prove Unreliable Compared to Cardiac Magnetic Resonance Imaging in Adolescents with Cardiac Disease

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Abstract

The purpose of this stuy is to prospectively assess the reliability of the ultrasound cardiac output monitor (USCOM™) for measuring stroke volume index and predicting left ventricular outflow tract diameter in adolescents with heart disease. Sixty consecutive adolescents with heart disease attending a tertiary medical center underwent USCOM™ assessment immediately after cardiac magnetic resonance imaging. USCOM™ measured stroke volume index and predicted left ventricular outflow tract diameter were compared to cardiac magnetic resonance imaging-derived values using Bland–Altman analysis. Ten patients with an abnormal left ventricular outflow tract were excluded from the analysis. An adequate USCOM™ signal was obtained in 49/50 patients. Mean stroke volume index was 46.1 ml/m2 by the USCOM™ (range 22–66.9 ml/m2) and 42.9 ml/m2 by cardiac magnetic resonance imaging (range 24.7–59.9 ml/m2). The bias (mean difference) was 3.2 ml/m2; precision (± 2SD of differences), 17 ml/m2; and mean percentage error, 38%. The mean (± 2SD) left ventricular outflow tract diameter was 0.445 ± 0.536 cm smaller by the USCOM™ algorithm prediction than by cardiac magnetic resonance imaging. Attempted adjustment of USCOM™ stroke volume index using cardiac magnetic resonance imaging left ventricular outflow tract diameter failed to improve agreement between the two modalities (bias 28.4 ml/m2, precision 44.1 ml/m2, percentage error 77.3%). Our study raises concerns regarding the reliability of USCOM™ for stroke volume index measurement in adolescents with cardiac disease, which did not improve even after adjusting for its inaccurate left ventricular outflow tract diameter prediction.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, 4920235, Petach Tikva, Israel

    Avichai Weissbach, Eytan Kaplan, Gili Kadmon & Elhanan Nahum

  2. Institute of Pediatric Cardiology, Schneider Children’s Medical Center of Israel, 4920235, Petach Tikva, Israel

    Amichay Rotstein & Einat Birk

  3. Department of Imaging, Schneider Children’s Medical Center of Israel, 4920235, Petach Tikva, Israel

    Yaniv Lakovsky

  4. Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel

    Avichai Weissbach, Amichay Rotstein, Yaniv Lakovsky, Eytan Kaplan, Gili Kadmon, Einat Birk & Elhanan Nahum

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  1. Avichai Weissbach
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  2. Amichay Rotstein
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  3. Yaniv Lakovsky
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  4. Eytan Kaplan
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  5. Gili Kadmon
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  6. Einat Birk
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  7. Elhanan Nahum
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Contributions

Weissbach conceptualized and designed the study, coordinated and supervised data collection, carried out the USCOM™ measurements, drafted the initial manuscript, carried out the statistical analyses, and reviewed and revised the manuscript. Rotstein, Lakovsky, and Birk took significant part in study design, CMRI measurements, data collection, and reviewed and critically revised the manuscript. Kadmon and Kaplan contributed to the study design, data collection, data analysis, and critical revision of the manuscript. Nahum conceptualized and contributed to study design, data analysis, and reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Avichai Weissbach.

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Weissbach, A., Rotstein, A., Lakovsky, Y. et al. Ultrasound Cardiac Output Monitor (USCOM™) Measurements Prove Unreliable Compared to Cardiac Magnetic Resonance Imaging in Adolescents with Cardiac Disease. Pediatr Cardiol 42, 692–699 (2021). https://doi.org/10.1007/s00246-020-02531-8

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  • DOI: https://doi.org/10.1007/s00246-020-02531-8

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