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Reliability of Peak Exercise Stroke Volume Assessment by Impedance Cardiography in Patients with Residual Right Outflow Tract Lesions After Congenital Heart Disease Repair

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Abstract

Global ventricular response to exercise may be useful in follow-up of patients with residual right outflow tract lesions after congenital heart disease repair. In this context, impedance cardiography is considered accurate for stroke volume (SV) measurement during exercise testing, however, to date, only partial assessment of its reliability has been reported. We retrospectively evaluated relative and absolute reliability of peak SV by impedance cardiography during exercise using intraclass correlation (ICC) and standard error of measurement (SEM) in this population. Peak SV was measured in 30 young patients (mean age 14.4 years ± 2.1) with right ventricular outflow tract reconstruction who underwent two cardiopulmonary exercise tests at a mean one-year interval. SV was measured using a signal morphology impedance cardiography analysis device (PhysioFlow®) and was indexed to body surface area. ICC of peak indexed SV measurement was 0.80 and SEM was 10.5%. High heterogeneity was seen when comparing patients according to peak indexed SV; in patients with peak SV < 50 ml/m2 (15 patients), ICC rose to 0.95 and SEM dropped to 2.7%, while in patients with a peak SV > 50 ml/m2 relative and absolute reliability decreased (ICC = 0.45, SEM = 12.2%). Peak exercise SV assessment by a PhysioFlow® device represents a highly reliable method in patients with residual right outflow tract lesions after congenital heart disease repair, especially in patients with peak SV < 50 ml/m2. In this latter group, a peak SV decrease > 7.3% (corresponding to the minimum “true” difference) should be considered a clinically-relevant decrease in global ventricular performance and taken into account when deciding whether to perform residual lesion removal.

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Acknowledgements

We thank Anne Marie Luangpraseuth, a nurse in the pediatric cardiology department, and the ARCFA for financial support for editing services provided by Dr Sarah MacKenzie.

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Authors and Affiliations

  1. Pediatric Cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker Hospital for Sick Children, Assistance publique des Hôpitaux de Paris, Paris, France

    Antoine Legendre & D. Bonnet

  2. Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    D. Bonnet

  3. Faculté des Sciences du Sport, Laboratoire MOVE (EA 6413), Université de Poitiers, Poitiers, France

    L. Bosquet

Authors
  1. Antoine Legendre
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  2. D. Bonnet
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  3. L. Bosquet
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Correspondence to Antoine Legendre.

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Antoine Legendre, Damien Bonnet, Laurent Bosquet declares that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As a retrospective study, no formal consent was required.

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Legendre, A., Bonnet, D. & Bosquet, L. Reliability of Peak Exercise Stroke Volume Assessment by Impedance Cardiography in Patients with Residual Right Outflow Tract Lesions After Congenital Heart Disease Repair. Pediatr Cardiol 39, 45–50 (2018). https://doi.org/10.1007/s00246-017-1725-3

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  • DOI: https://doi.org/10.1007/s00246-017-1725-3

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