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Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease

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Abstract

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.

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Conflicts of interest

AEG and DAR are members of the Medical Advisory Board of Pulsion Medical Systems. DAR has received honoraria for lectures from Edwards Lifesciences. The study was financed solely by institutional sources.

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Authors and Affiliations

  1. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Martin Petzoldt, Carsten Riedel, Jan Braeunig, Sebastian Haas, Matthias S. Goepfert, Alwin E. Goetz & Daniel A. Reuter

  2. Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany

    Hendrik Treede

  3. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany

    Stephan Baldus

Authors
  1. Martin Petzoldt
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  2. Carsten Riedel
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  9. Daniel A. Reuter
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Correspondence to Martin Petzoldt.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-012-2802-y.

Electronic supplementary material

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134_2012_2786_MOESM1_ESM.tif

Supplementary material 1 (TIFF 375 kb) Online Resource 1 Regression and correlation analysis, scatter plots, X-axis SV measured with transesophageal echocardiography (SVTEE), Y-axis SV calculated with transcardiopulmonary thermodilution (SVTD, top), calibrated (SVPC CAL, middle), and uncalibrated arterial pulse contour analysis (SVPC UNCAL, bottom) at predefined measurement times from the left to the right with normal prosthetic valve function (post-interventional), with severe aortic stenosis (pre-interventional), and with aortic insufficiency (post-valvuloplasty)

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Petzoldt, M., Riedel, C., Braeunig, J. et al. Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease. Intensive Care Med 39, 601–611 (2013). https://doi.org/10.1007/s00134-012-2786-7

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  • DOI: https://doi.org/10.1007/s00134-012-2786-7

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