Cardiac output measurements via echocardiography versus thermodilution: A systematic review and meta-analysis

Abstract

Echocardiography, as a noninvasive hemodynamic evaluation technique, is frequently used in critically ill patients. Different opinions exist regarding whether it can be interchanged with traditional invasive means, such as the pulmonary artery catheter thermodilution (TD) technique. This systematic review aimed to analyze the consistency and interchangeability of cardiac output measurements by ultrasound (US) and TD. Five electronic databases were searched for studies including clinical trials conducted up to June 2019 in which patients’ cardiac output was measured by ultrasound techniques (echocardiography) and TD. The methodological quality of the included studies was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), which was tailored according to our systematic review in Review Manager 5.3. A total of 68 studies with 1996 patients were identified as eligible. Meta-analysis and subgroup analysis were used to compare the cardiac output (CO) measured using the different types of echocardiography and different sites of Doppler use with TD. No significant differences were found between US and TD (random effects model: mean difference [MD], -0.14; 95% confidence interval, -0.30 to 0.02; P = 0.08). No significant differences were observed in the subgroup analyses using different types of echocardiography and different sites except for ascending aorta (AA) (random effects model: mean difference [MD], -0.37; 95% confidence interval, -0.74 to -0.01; P = 0.05) of Doppler use. The median of bias and limits of agreement were -0.12 and ±0.94 L/min, respectively; the median of correlation coefficient was 0.827 (range, 0.140–0.998). Although the difference in CO between echocardiography by different types or sites and TD was not entirely consistent, the overall effect of meta-analysis showed that no significant differences were observed between US and TD. The techniques may be interchangeable under certain conditions.

The Effect of Dietary Inorganic Nitrate Supplementation on Cardiac Function during Submaximal Exercise in Men with Heart Failure with Reduced Ejection Fraction (HFrEF): A Pilot Study

“…Direct measurements require an invasive study design that was beyond the capability of this project. There is congruity between direct measures of cardiac function and echocardiograph measurements during exercise, but the use of direct measurement of cardiac function and structure should be considered in future trials [26,27]. Finally, while there were significant increases in plasma nitrite, the actual percentage change was still relatively small and could suggest an underlying defect in the nitrate reducing pathway of individuals with HFrEF.…”

Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings

“…The consensus on circulatory shock and hemodynamic monitoring by the Task Force of the European Society of Intensive Care Medicine provides a similar recommendation as well [9]. Besides its recommendation, it is important to note that there is conflicting evidence regarding the interchangeability between echocardiography and the pulmonary artery catheter or CO monitors for estimating the SV or CO, with some studies not showing a good correlation between them [10][11][12][13] and many studies showing the opposite [14][15][16][17][18].…”

Comparison of cardiac output measured by carotid artery Doppler ultrasound and echocardiography in patients admitted to Golestan and Imam Khomeyni Hospitalsl in Ahvaz

“…Over the past 2 decades, hemodynamic monitoring and cardiac output measurement in ICUs have turned to non invasive approaches. [ 1 2 ] Non invasive monitoring of cardiac output can be valuable in evaluating patient's volumetric conditions, especially in intensive care settings where patients’ hemodynamics are rapidly changing. [ 3 4 ] Traditionally, a pulmonary artery catheter is needed to measure cardiac output, which is an invasive procedure and has several complications.…”