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01.04.2013 | Original

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

verfasst von: Martin Petzoldt, Carsten Riedel, Jan Braeunig, Sebastian Haas, Matthias S. Goepfert, Hendrik Treede, Stephan Baldus, Alwin E. Goetz, Daniel A. Reuter

Erschienen in: Intensive Care Medicine | Ausgabe 4/2013

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Abstract

Purpose

Transcardiopulmonary thermodilution (TPTD, SV_TD) as well as calibrated (SV_{PC CAL}) and uncalibrated (SV_{PC 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, SV_TD and SV_{PC CAL} were determined using a central pressure signal via the brachial artery and SV_{PC 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, SV_{PC CAL} (PE 25.7 %; CCC 0.85) but not SV_{PC UNCAL} (PE 50.4 %; CCC 0.38) was reliable. Neither calibrated nor uncalibrated PC (SV_{PC CAL}: PE 51.5 %; CCC 0.49; SV_{PC 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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Titel: Stroke volume determination using transcardiopulmonary thermodilution and arterial pulse contour analysis in severe aortic valve disease
verfasst von: Martin Petzoldt
Carsten Riedel
Jan Braeunig
Sebastian Haas
Matthias S. Goepfert
Hendrik Treede
Stephan Baldus
Alwin E. Goetz
Daniel A. Reuter
Publikationsdatum: 01.04.2013
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 4/2013
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2786-7

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