Estimation of cardiac output and pulmonary vascular resistance by contrast echocardiography transit time measurement: a prospective pilot study

Abstract

BackgroundStudies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC).Methods27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR.ResultsThe transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r = -0.61, p < 0.001). The transit time from peak opacification of the right ventricle to first appearance in the left ventricle moderately correlated with PVR (r = 0.46, p < 0.01). Previously described echocardiographic methods for the determination of CO (Huntsman method) and PVR (Abbas and Haddad methods) did not correlate with RHC-determined values (p = 0.20 for CO, p = 0.18 and p = 0.22 for PVR, respectively). The contrast transit time method demonstrated reliable intra- (p < 0.0001) and inter-observer correlation (p < 0.001).ConclusionsWe describe a novel method for the quantification of CO and estimation of PVR using contrast echocardiography transit time. This technique adds to the methodologies used for noninvasive hemodynamic assessment, but requires further validation to determine overall applicability.

Noninvasive pulmonary transit time: A new parameter for general cardiac performance

“…CEUS‐derived PTT correlates well with true volumes in an in‐vitro setup, with PTT measured via MRI and with levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) . Choi et al . showed that cardiac output measured by right heart catheterization correlates with transit times measured with contrast echocardiography.…”

“…14,15 CEUS-derived PTT correlates well with true volumes in an in-vitro setup, 16 with PTT measured via MRI and with levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP). 1 Choi et al 17 showed that cardiac output measured by right heart catheterization correlates with transit times measured with contrast echocardiography. This was shown earlier already by Sherman et al, 18 assessing intracardiac hemodynamics using CEUS validated against right heart catheterization and survival.…”

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

“…Interestingly, the Opotowsky method had a superior receiver-operating characteristic curve for discrimination of PVR >3 Wood units compared with the Abbas method. 41 Finally, Choi et al 42 showed that Definity dye transit time from peak opacification of right ventricle to first appearance in the left ventricle could be used to estimate PVR and cardiac output. In that study, the transit time for the contrast to travel from the right ventricle to the left ventricle was directly proportional to PVR and inversely proportional to cardiac output.…”

“…In that study, the transit time for the contrast to travel from the right ventricle to the left ventricle was directly proportional to PVR and inversely proportional to cardiac output. Importantly, the transit time described by Choi et al 42 is a measure of blood flow, whereas pPTT is a surrogate measure of pressure pulse wave velocity. Consistent with this, and unlike the dye transit time, pPTT was inversely proportional to PVR and directly proportional to right ventricular function.…”

Avaliação da dinâmica normal da circulação do meio de contraste em estruturas vasculares nos exames de tomografia computadorizada das artérias coronárias

“…No final do século XX e nas primeiras décadas do século XXI, observam-se publicações de novos trabalhos investigando os tempos de trânsito circulatórios, desta vez avaliados por meio de métodos de imagem modernos, notadamente ressonância magnética, tomografia computadorizada e ultrassonografia (13,15,22,23,(28)(29)(30). Além do valor diagnóstico associado à avaliação dos TTC, o estudo da dinâmica do meio de contraste permite prever de forma mais consistente os tempos de aquisição de imagens (16,17,19,20,29).…”