Comparison of Cardiac Output of Both 2-Dimensional and 3-Dimensional Transesophageal Echocardiography With Transpulmonary Thermodilution During Cardiac Surgery

David Jeffrey Canty, Martin Kim, Ranjan Guha, Tuan Pham, Alistair G. Royse, Sandy Errey-Clarke, Julian A. Smith, Colin F. Royse

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: To compare agreement and variability of cardiac output measurement of 2-dimensional (2D) and 3D transesophageal echocardiography (TEE) with thermodilution before and after bypass. Design: Prospective observational study. Setting: Two tertiary hospitals. Interventions: Cardiac output (CO) was measured simultaneously with thermodilution and TEE by multiplying either the left ventricular outflow tract area (LVOTA) or aortic valve area (AVA), the velocity-time integral (VTI) of flow at the same site, and heart rate. The LVOTA was calculated using diameter for 2D TEE. Planimetry was used for 3D TEE. The AVA was measured using planimetry. Participants: The study comprised 82 adult patients undergoing coronary or valve surgery. Measurements and Main Results: One hundred fifty-four complete sets of measurements were obtained (82 prebypass and 72 postbypass). All TEE methods had acceptable correlation and absence of proportional or fixed bias except for the left ventricular outflow tract (LVOT) VTI modal trace method, which had poor correlation and proportional but not fixed bias (regression coefficient [95% confidence interval], bias [percentage of mean CO]): 2D LVOT VTI modal trace 0.67 (0.54-0.80), –36.4%; 2D LVOT VTI outer edge trace 0.96 (0.80-1.12), –15.3%; 2D AVA planimetry 0.96 (0.75-1.18), +4.9%; 3D LVOT area planimetry 1.18 (0.96-1.41), +0.8%; 3D AVA planimetry 1.20 (0.93-1.46), +0.4%. All TEE methods had wide levels of agreement compared with thermodilution (–3.94 to +0.23 L/min, –2.83 to +1.28 L/min, –2.23 to +2.73 L/min, –2.35 to +2.42 L/min, and –2.57 to +2.61 L/min, respectively). Measurement variability was superior for all TEE methods compared with thermodilution before but not after bypass. Conclusions: Although limits of agreement of CO measurement with 3D TEE and thermodilution are wide, 2D planimetry of the AVA and continuous wave Doppler may be substituted for thermodilution before and after bypass.

Original languageEnglish
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
Publication statusAccepted/In press - 30 Jul 2019

Keywords

  • cardiac output
  • cardiac surgery
  • monitoring
  • pulmonary artery thermodilution
  • transesophageal echocardiography

Cite this

@article{8984a8e2e0dd4849bfa5ae096f4e9eed,
title = "Comparison of Cardiac Output of Both 2-Dimensional and 3-Dimensional Transesophageal Echocardiography With Transpulmonary Thermodilution During Cardiac Surgery",
abstract = "Objectives: To compare agreement and variability of cardiac output measurement of 2-dimensional (2D) and 3D transesophageal echocardiography (TEE) with thermodilution before and after bypass. Design: Prospective observational study. Setting: Two tertiary hospitals. Interventions: Cardiac output (CO) was measured simultaneously with thermodilution and TEE by multiplying either the left ventricular outflow tract area (LVOTA) or aortic valve area (AVA), the velocity-time integral (VTI) of flow at the same site, and heart rate. The LVOTA was calculated using diameter for 2D TEE. Planimetry was used for 3D TEE. The AVA was measured using planimetry. Participants: The study comprised 82 adult patients undergoing coronary or valve surgery. Measurements and Main Results: One hundred fifty-four complete sets of measurements were obtained (82 prebypass and 72 postbypass). All TEE methods had acceptable correlation and absence of proportional or fixed bias except for the left ventricular outflow tract (LVOT) VTI modal trace method, which had poor correlation and proportional but not fixed bias (regression coefficient [95{\%} confidence interval], bias [percentage of mean CO]): 2D LVOT VTI modal trace 0.67 (0.54-0.80), –36.4{\%}; 2D LVOT VTI outer edge trace 0.96 (0.80-1.12), –15.3{\%}; 2D AVA planimetry 0.96 (0.75-1.18), +4.9{\%}; 3D LVOT area planimetry 1.18 (0.96-1.41), +0.8{\%}; 3D AVA planimetry 1.20 (0.93-1.46), +0.4{\%}. All TEE methods had wide levels of agreement compared with thermodilution (–3.94 to +0.23 L/min, –2.83 to +1.28 L/min, –2.23 to +2.73 L/min, –2.35 to +2.42 L/min, and –2.57 to +2.61 L/min, respectively). Measurement variability was superior for all TEE methods compared with thermodilution before but not after bypass. Conclusions: Although limits of agreement of CO measurement with 3D TEE and thermodilution are wide, 2D planimetry of the AVA and continuous wave Doppler may be substituted for thermodilution before and after bypass.",
keywords = "cardiac output, cardiac surgery, monitoring, pulmonary artery thermodilution, transesophageal echocardiography",
author = "Canty, {David Jeffrey} and Martin Kim and Ranjan Guha and Tuan Pham and Royse, {Alistair G.} and Sandy Errey-Clarke and Smith, {Julian A.} and Royse, {Colin F.}",
year = "2019",
month = "7",
day = "30",
doi = "10.1053/j.jvca.2019.06.007",
language = "English",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "Elsevier",

}

Comparison of Cardiac Output of Both 2-Dimensional and 3-Dimensional Transesophageal Echocardiography With Transpulmonary Thermodilution During Cardiac Surgery. / Canty, David Jeffrey; Kim, Martin; Guha, Ranjan; Pham, Tuan; Royse, Alistair G.; Errey-Clarke, Sandy; Smith, Julian A.; Royse, Colin F.

In: Journal of Cardiothoracic and Vascular Anesthesia, 30.07.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Comparison of Cardiac Output of Both 2-Dimensional and 3-Dimensional Transesophageal Echocardiography With Transpulmonary Thermodilution During Cardiac Surgery

AU - Canty, David Jeffrey

AU - Kim, Martin

AU - Guha, Ranjan

AU - Pham, Tuan

AU - Royse, Alistair G.

AU - Errey-Clarke, Sandy

AU - Smith, Julian A.

AU - Royse, Colin F.

PY - 2019/7/30

Y1 - 2019/7/30

N2 - Objectives: To compare agreement and variability of cardiac output measurement of 2-dimensional (2D) and 3D transesophageal echocardiography (TEE) with thermodilution before and after bypass. Design: Prospective observational study. Setting: Two tertiary hospitals. Interventions: Cardiac output (CO) was measured simultaneously with thermodilution and TEE by multiplying either the left ventricular outflow tract area (LVOTA) or aortic valve area (AVA), the velocity-time integral (VTI) of flow at the same site, and heart rate. The LVOTA was calculated using diameter for 2D TEE. Planimetry was used for 3D TEE. The AVA was measured using planimetry. Participants: The study comprised 82 adult patients undergoing coronary or valve surgery. Measurements and Main Results: One hundred fifty-four complete sets of measurements were obtained (82 prebypass and 72 postbypass). All TEE methods had acceptable correlation and absence of proportional or fixed bias except for the left ventricular outflow tract (LVOT) VTI modal trace method, which had poor correlation and proportional but not fixed bias (regression coefficient [95% confidence interval], bias [percentage of mean CO]): 2D LVOT VTI modal trace 0.67 (0.54-0.80), –36.4%; 2D LVOT VTI outer edge trace 0.96 (0.80-1.12), –15.3%; 2D AVA planimetry 0.96 (0.75-1.18), +4.9%; 3D LVOT area planimetry 1.18 (0.96-1.41), +0.8%; 3D AVA planimetry 1.20 (0.93-1.46), +0.4%. All TEE methods had wide levels of agreement compared with thermodilution (–3.94 to +0.23 L/min, –2.83 to +1.28 L/min, –2.23 to +2.73 L/min, –2.35 to +2.42 L/min, and –2.57 to +2.61 L/min, respectively). Measurement variability was superior for all TEE methods compared with thermodilution before but not after bypass. Conclusions: Although limits of agreement of CO measurement with 3D TEE and thermodilution are wide, 2D planimetry of the AVA and continuous wave Doppler may be substituted for thermodilution before and after bypass.

AB - Objectives: To compare agreement and variability of cardiac output measurement of 2-dimensional (2D) and 3D transesophageal echocardiography (TEE) with thermodilution before and after bypass. Design: Prospective observational study. Setting: Two tertiary hospitals. Interventions: Cardiac output (CO) was measured simultaneously with thermodilution and TEE by multiplying either the left ventricular outflow tract area (LVOTA) or aortic valve area (AVA), the velocity-time integral (VTI) of flow at the same site, and heart rate. The LVOTA was calculated using diameter for 2D TEE. Planimetry was used for 3D TEE. The AVA was measured using planimetry. Participants: The study comprised 82 adult patients undergoing coronary or valve surgery. Measurements and Main Results: One hundred fifty-four complete sets of measurements were obtained (82 prebypass and 72 postbypass). All TEE methods had acceptable correlation and absence of proportional or fixed bias except for the left ventricular outflow tract (LVOT) VTI modal trace method, which had poor correlation and proportional but not fixed bias (regression coefficient [95% confidence interval], bias [percentage of mean CO]): 2D LVOT VTI modal trace 0.67 (0.54-0.80), –36.4%; 2D LVOT VTI outer edge trace 0.96 (0.80-1.12), –15.3%; 2D AVA planimetry 0.96 (0.75-1.18), +4.9%; 3D LVOT area planimetry 1.18 (0.96-1.41), +0.8%; 3D AVA planimetry 1.20 (0.93-1.46), +0.4%. All TEE methods had wide levels of agreement compared with thermodilution (–3.94 to +0.23 L/min, –2.83 to +1.28 L/min, –2.23 to +2.73 L/min, –2.35 to +2.42 L/min, and –2.57 to +2.61 L/min, respectively). Measurement variability was superior for all TEE methods compared with thermodilution before but not after bypass. Conclusions: Although limits of agreement of CO measurement with 3D TEE and thermodilution are wide, 2D planimetry of the AVA and continuous wave Doppler may be substituted for thermodilution before and after bypass.

KW - cardiac output

KW - cardiac surgery

KW - monitoring

KW - pulmonary artery thermodilution

KW - transesophageal echocardiography

UR - http://www.scopus.com/inward/record.url?scp=85069857805&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2019.06.007

DO - 10.1053/j.jvca.2019.06.007

M3 - Article

AN - SCOPUS:85069857805

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

ER -