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Does obesity affect the non-invasive measurement of cardiac output performed by electrical cardiometry in children and adolescents?

Journal of Clinical Monitoring and Computing volume 32, pages 45–52 (2018)Cite this article

Abstract

Electrical cardiometry (EC) is a non-invasive and inexpensive method for hemodynamic assessment and monitoring. However, its feasibility for widespread clinical use, especially for the obese population, has yet to be determined. In this study, we evaluated the agreement and reliability of EC compared to transthoracic Doppler echocardiography (TTE) in normal, overweight, and obese children and adolescents. We measured stroke volume (SV) and cardiac output (CO) of 131 participants using EC and TTE simultaneously. We further divided these participants according to BMI percentiles for subanalyses: <85% normal weight (n = 41), between 85 and 95% overweight (n = 7), and >95% obese (n = 83). Due to small sample size of the overweight group, we combined overweight and obese groups (OW+OB) with no significant change in results (SV and CO) before and after combining groups. There were strong correlations between EC and TTE measurements of SV (r = 0.869 and r = 0.846; p < 0.0001) and CO (r = 0.831 and r = 0.815; p < 0.0001) in normal and OW+OB groups, respectively. Bias and percentage error for CO measurements were 0.240 and 29.7%, and 0.042 and 29.5% in the normal and OW+OB groups, respectively. Indexed values for SV were lower in the OW+OB group than in the normal weight group when measured by EC (p < 0.0001) but no differences were seen when measured by TTE (p = 0.096). In all weight groups, there were strong correlations and good agreement between EC and TTE. However, EC may underestimate hemodynamic measurements in obese participants due to fat tissue.

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References

  1. Liebman F, Pearl J, Bagno S. The electrical conductance properties of blood in motion. Phys Med Biol. 1962;7(2):177.

    Article  CAS  PubMed  Google Scholar 

  2. Liebman F, Bagno S. The behavior of the red blood cells in flowing blood which accounts for conductivity changes. Biomed Sci Instrum. 1968;4:25.

    CAS  PubMed  Google Scholar 

  3. Sakamoto K, Kanai H. Electrical characteristics of flowing blood. IEEE Trans on Biomed Eng. 1979;26(12):686–95.

    Article  CAS  Google Scholar 

  4. Visser IKR. Electric properties of flowing blood and impedance cardiography. Ann Biomed Eng. 1989;17(5):463–73.

    Article  CAS  PubMed  Google Scholar 

  5. Fujii M, Nakajima K, Sakamoto K, Kanai H. Orientation and deformation of erythrocytes in flowing blood. Ann N Y Acad Sci. 1999;873(1):245–61.

    Article  CAS  PubMed  Google Scholar 

  6. Hoetink A, Faes TJ, Visser K, Heethaar RM. On the flow dependency of the electrical conductivity of blood. IEEE transactions on Biomedical Engineering. 2004;51(7):1251–61.

    Article  CAS  PubMed  Google Scholar 

  7. Gaw RL, Cornish BH, Thomas BJ (2007) The electrical impedance of pulsatile blood flowing through rigid tubes: an experimental investigation. In: Scharfetter H, Merwa R (eds) 13th International Conference on Electrical Bioimpedance and the 8th Conference on Electrical Impedance Tomography: ICEBI 2007, August 29th - September 2nd 2007, Graz, Austria. Springer, Berlin, pp 73–6. doi:10.1007/978-3-540-73841-1_22.

    Google Scholar 

  8. Gaw RL, Cornish BH, Thomas BJ. The electrical impedance of pulsatile blood flowing through rigid tubes: a theoretical investigation. IEEE Trans Biomed Eng. 2008;55(2):721–7.

    Article  CAS  PubMed  Google Scholar 

  9. Bernstein DP. Impedance cardiography: Pulsatile blood flow and the biophysical and electrodynamic basis for the stroke volume equations. J Electr Bioimpedance. 2010;1(1):2–17.

    Article  Google Scholar 

  10. Thiele RH, Bartels K, Gan TJ. Cardiac output monitoring: a contemporary assessment and review. Crit Care Med. 2015;43(1):177–85.

    Article  PubMed  Google Scholar 

  11. Staelens A, Tomsin K, Grieten L, Oben J, Mesens T, Spaanderman M, Jacquemyn Y, Gyselaers W. Non-invasive assessment of gestational hemodynamics: benefits and limitations of impedance cardiography versus other techniques. Expert Rev Med Devices. 2013;10(6):765–79.

    Article  CAS  PubMed  Google Scholar 

  12. Siedlecka J, Siedlecki P, Bortkiewicz A. Impedance cardiography-old method, new opportunities. Part I. Clinical applications. Int J Occup Med Environ Health. 2015;28(1):27–33.

    PubMed  Google Scholar 

  13. Brown CV, Martin MJ, Shoemaker WC, Wo CC, Chan L, Azarow K, Demetriades D. The effect of obesity on bioimpedance cardiac index. Am J Surg. 2005;189(5):547–51.

    Article  PubMed  Google Scholar 

  14. Rauch R, Welisch E, Lansdell N, Burrill E, Jones J, Robinson T, Bock D, Clarson C, Filler G, Norozi K. Non-invasive measurement of cardiac output in obese children and adolescents: comparison of electrical cardiometry and transthoracic Doppler echocardiography. J Clin Monit Comput. 2013;27(2):187–93.

    Article  PubMed  Google Scholar 

  15. van der Meer B, de Vries JP, Schreuder W, Bulder E, Eysman L, de Vries PM. Impedance cardiography in cardiac surgery patients: abnormal body weight gives unreliable cardiac output measurements. Acta Anaesthesiol Scand. 1997;41(6):708–12.

    Article  PubMed  Google Scholar 

  16. Woltjer H, Bogaard H, Van der Spoel H, De Vries P. The influence of weight on stroke volume determination by means of impedance cardiography in cardiac surgery patients. Intensive Care Med. 1996;22(8):766–71.

    Article  CAS  PubMed  Google Scholar 

  17. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC Growth Charts for the United States: methods and development. Vital and health statistics Series 11, Data from the national health survey (246):1–190.

  18. Norozi K, Beck C, Osthaus W, Wille I, Wessel A, Bertram H. Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth. 2008;100(1):88–94.

    Article  CAS  PubMed  Google Scholar 

  19. Bernstein D, Lemmens H. Stroke volume equation for impedance cardiography. Med Biol Eng Comput. 2005;43(4):443–50.

    Article  CAS  PubMed  Google Scholar 

  20. Mukaka M. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Bland JM, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327(8476):307–10.

    Article  Google Scholar 

  22. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15(2):85–91.

    Article  CAS  PubMed  Google Scholar 

  23. Chew MS, Poelaert J. Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature. Intensive Care Med. 2003;29(11):1889–94.

    Article  PubMed  Google Scholar 

  24. Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies–with specific reference to the measurement of cardiac output. Crit Care. 2009;13(1):1–6.

    Article  Google Scholar 

  25. Du Bois D, Du Bois E. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989;5(5):303.

    PubMed  Google Scholar 

  26. de Simone G, Devereux RB, Daniels SR, Mureddu G, Roman MJ, Kimball TR, Greco R, Witt S, Contaldo F. Stroke volume and cardiac output in normotensive children and adults assessment of relations with body size and impact of overweight. Circulation. 1997;95(7):1837–43.

    Article  PubMed  Google Scholar 

  27. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–815.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Egan JR, Festa M, Cole AD, Nunn GR, Gillis J, Winlaw DS. Clinical assessment of cardiac performance in infants and children following cardiac surgery. Intensive Care Med. 2005;31(4):568–73.

    Article  PubMed  Google Scholar 

  29. Suehiro K, Joosten A, Murphy LS-L, Desebbe O, Alexander B, Kim S-H, Cannesson M. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis. J Clin Monit Comput. 2016;30(5):603–20.

    Article  PubMed  Google Scholar 

  30. Erlandsson K, Odenstedt H, Lundin S, Stenqvist O. Positive end-expiratory pressure optimization using electric impedance tomography in morbidly obese patients during laparoscopic gastric bypass surgery. Acta Anaesthesiol Scand. 2006;50(7):833–9.

    Article  CAS  PubMed  Google Scholar 

  31. Song R, Rich W, Kim J, Finer N, Katheria A. The use of electrical cardiometry for continuous cardiac output monitoring in preterm neonates: a validation study. Am J Perinatol. 2014;31(12):1105–10.

    Article  CAS  PubMed  Google Scholar 

  32. Absi MA, Lutterman J, Wetzel GT. Noninvasive cardiac output monitoring in the pediatric cardiac intensive care unit. Curr Opin Cardiol. 2010;25(2):77–9.

    Article  PubMed  Google Scholar 

  33. Blohm ME, Obrecht D, Hartwich J, Mueller GC, Kersten JF, Weil J, Singer D. Impedance cardiography (electrical velocimetry) and transthoracic echocardiography for non-invasive cardiac output monitoring in pediatric intensive care patients: a prospective single-center observational study. Crit Care. 2014;18(6):1–9.

    Article  Google Scholar 

  34. Hapfelmeier A, Cecconi M, Saugel B. Cardiac output method comparison studies: the relation of the precision of agreement and the precision of method. J Clin Monit Comput. 2016;30(2):149–55.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Elizabeth Burrill (NP) and Jody Jones (RDMS) for their support recruiting patients and performing echocardiography; and Adam A. Dempsey for his assistance with manuscript revisions.

Funding

This study was partially supported by research grants from Western University (ADF-5609-8), Children’s Health Research Institute (LHRF 7712), Innovation Fund of the Alternative Funding Plan of the Academic Health Sciences Centres of Ontario (AMOSO, #INN 12-003) and grant from Children’s Health Foundation, London, Ontario to Dr. K. Norozi.

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Authors and Affiliations

  1. Division of Paediatric Cardiology, Department of Paediatrics, Western University, 800 Commissioners Rd E, PO Box 5010, London, N6A 5W9s, Canada

    Luis Altamirano-Diaz, Eva Welisch, Michael Miller & Kambiz Norozi

  2. Children’s Health Research Institute, London, Canada

    Luis Altamirano-Diaz, Eva Welisch, Michael Miller & Kambiz Norozi

  3. Paediatric Cardiopulmonary research laboratory, London Health science centre, London, Canada

    Luis Altamirano-Diaz, Eva Welisch, Teresa Sohee Park & Kambiz Norozi

  4. Department of Paediatrics, Rems-Murr Hospital, Winnenden, Germany

    Ralf Rauch

  5. Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany

    Kambiz Norozi

  6. Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany

    Kambiz Norozi

Authors
  1. Luis Altamirano-Diaz
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  2. Eva Welisch
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  3. Ralf Rauch
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  4. Michael Miller
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  5. Teresa Sohee Park
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  6. Kambiz Norozi
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Correspondence to Kambiz Norozi.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Western University Health Science Research Ethics Board (REB # 16266E). All children and adolescents gave written consent to participate in this study. For those under 16 years of age, we obtained written consent from caregivers.

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Altamirano-Diaz, L., Welisch, E., Rauch, R. et al. Does obesity affect the non-invasive measurement of cardiac output performed by electrical cardiometry in children and adolescents?. J Clin Monit Comput 32, 45–52 (2018). https://doi.org/10.1007/s10877-017-9994-1

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  • DOI: https://doi.org/10.1007/s10877-017-9994-1

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