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Automated echocardiography for measuring and tracking cardiac output after cardiac surgery: a validation study

  • Peter Juhl-OlsenEmail author
  • Søren H. Smith
  • Anders M. Grejs
  • Martin R. S. Jørgensen
  • Rajesh Bhavsar
  • Simon T. Vistisen
Original Research
  • 15 Downloads

Abstract

Echocardiographic measurement of cardiac output with automated software analyses of spectral curves in the left ventricular outflow tract has been introduced. This study aimed to assess the precision and accuracy of cardiac output measurements as well as the ability to track cardiac output changes over time comparing the automated echocardiographic method with the continuous pulmonary artery thermodilution cardiac output technique and the manual echocardiographic method in cardiac surgery patients. Cardiac output was measured simultaneously with all three methods in 50 patients on the morning after cardiac surgery. A second comparison was performed 90–180 min later. Precisions for each method were measured. Bias and limits of agreement (LoA) between methods were assessed and concordance- and polar plots were used for evaluating trending of cardiac output. When comparing the automated echocardiographic method with the thermodilution technique, the mean bias was 0.72 L/min with LoA − 1.89; 3.33 L/min corresponding to a percentage error of 46%. The concordance rate was 47%. The mean bias between the automated- and the manual echocardiographic methods was − 0.06 L/min (95% LoA − 2.33; 2.21 L/min, percentage error 42%). The concordance rate was 79%. The automated echocardiographic method did not meet the criteria for interchangeability with the thermodilution technique or the manual echocardiographic method. Trending ability was poor when compared to the continuous thermodilution technique, but moderate when compared to the manual echocardiographic method.

Trial registry number: NCT03372863. Retrospectively registered December 14th 2017.

Keywords

Cardiac output Echocardiography Ultrasonography Thoracic surgery Haemodynamics 

List of abbreviations

CCO

Continuous cardiac output

CI

Confidence interval

CO

Cardiac output

CV

Coefficient of variation

LoA

Limits of agreement

LVOT

Left ventricular outflow tract

PAC

Pulmonary artery catheter

ROI

Region of interest

VTI

Velocity time integral

Notes

Acknowledgements

The authors wish to thank the staff at the postoperative intensive care unit, Aarhus University Hospital, for their invaluable assistance in patient inclusion and execution of the protocol. Likewise, the authors thank GE Healthcare for making available a Venue R1 ultrasound system for the study.

Funding

None.

Compliance with ethical standards

Conflict of interests

Peter Juhl-Olsen has received minor funds from GE Healthcare and Novartis for teaching courses on critical care. GE Healthcare provided the Venue R1 ultrasound system free of charge for the study without influence on study design, study execution, data interpretation or any aspect of the manuscript writing. All other authors declare that they have not conflict of interests.

Supplementary material

10877_2019_413_MOESM1_ESM.tiff (700 kb)
Polar plots for comparison of the automated software echocardiographic method (automated CO), the manual echocardiographic method (manual CO) and continuous cardiac output (CCO) for measuring cardiac output (CO). Individual comparisons are given and both standard and modified polar plots are presented. Standard polar plots include data outside a 10% central exclusion zone of the polar plots as proposed [19]. Modified polar plots reuses the 15% central exclusion zone of the four-quadrant plots. Biases (red lines) and limits of agreement (black lines) for the polar lot are given in the manuscript. The first scan was performed on the morning after surgery. The second scan was performed one to 3 h later following routine physiotherapy and mobilisation. Supplementary material 1 (TIFF 699 kb)

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of AnaesthesiologyAarhus University HospitalAarhusDenmark
  2. 2.Department of Clinical MedicineAarhus UniversityAarhusDenmark
  3. 3.Department of Intensive CareAarhus University HospitalAarhusDenmark
  4. 4.Department of Anaesthesiology & Intensive CareHospital of Southern JutlandAabenraaDenmark

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