Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients

Blancas, Rafael; Martínez-González, Óscar; Ballesteros, Daniel; Núñez, A. Gil; Luján, J.; Rodríguez-Serrano, Diego Aníbal; Hernandez, Antonio; Martinez-Diaz, C; Parra, C. Martín; Matamala, B. López; Alonso, M.Á.; Chana, M.

doi:10.1016/j.medin.2017.11.012

Cited by 19 publications

(13 citation statements)

References 13 publications

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“…As the stroke decreases slightly between each phase of hemorrhage, the resulting variation of VTI may be less significant than its inter and intra-operator variability. It has already been suggested that cardiac index calculated from manual VTI measures in 2D cardiac ultrasonography had a weak correlation with cardiac index by thermodilution, [23][24][25] and also when compared with automatic VTI measures. 26 Second, dynamic echocardiographic parameters, such as ΔVTI, are dependent on tidal volume.…”

Section: Discussionmentioning

confidence: 99%

Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

Grau-Mercier

Coisy

Markarian

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND: Assessment of the volemic loss is a major challenge during the management of hemorrhagic shock. Echocardiography is an increasingly used noninvasive tool for hemodynamic assessment. In mechanically ventilated patients, some studies suggest that respiratory variations of mean subaortic time-velocity integral (ΔVTI) would be predictive of fluid filling response. An experimental model of controlled hemorrhagic shock provides a precise approach to study correlation between blood volume and cardiac ultrasonographic parameters. OBJECTIVES:The main objective was to analyze the ΔVTI changes during hemorrhage in an anesthetized-piglet model of controlled hemorrhagic shock.The secondary objective was to evaluate ΔVTI during the resuscitation process after hemorrhage and other echocardiographic parameters changes during the whole protocol. METHODS:Twenty-four anesthetized and ventilated piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to two resuscitation groups: fluid filling group resuscitated with saline solution and noradrenaline group resuscitated with saline solution and noradrenaline. Echocardiography and hemodynamic measures, including pulsed pressure variations (PPV), were performed at different stages of the protocol. RESULTS:The correlation coefficient between ΔVTI and PPV with the volume of bleeding during the hemorrhagic phase were respectively 0.24 (95% confidence interval ,0.08-0.39; p < 0.01) and 0.57 (95% CI, 0.44-0.67; p < 0.01). Two parameters had a moderate correlation coefficient with hemorrhage volume (over 0.5): mean subaortic time-velocity index (VTI) and mitral annulus diastolic tissular velocity (E′). CONCLUSION: In this hemorrhagic shock model, ΔVTI had a low correlation with the volume of bleeding, but VTI and E′ had a correlation with blood volume comparable to that of PPV.

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Section: Discussionmentioning

confidence: 99%

Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

Grau-Mercier

Coisy

Markarian

et al. 2022

J Trauma Acute Care Surg

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“…To the best of our knowledge, this is the first study comparing LVOT VTI measured via TEE with SVI measured by continuous thermodilution. A previous study demonstrated a lack of correlation between LVOT VTI measured by TTE and SVI measured by PAC or PiCCO [ 11 ]. We hypothesized that the limited view using TTE contributed to the poor correlation between LVOT VTI and SVI.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, LVOT VTI has been proposed as a surrogate to estimate stroke volume index (SVI) based on the assumption that the LVOT diameter is constant in each person [ 5 ]. However, a previous study demonstrated that LVOT VTI measured by transthoracic echocardiography (TTE) and SVI measured using a PAC or a pulse index contour cardiac output (PiCCO) monitor did not correlate well in intensive care unit patients [ 11 ]. Transesophageal echocardiography (TEE) is the more precise method to calculate cardiac output (CO) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Is There a Correlation Between Left Ventricular Outflow Tract Velocity Time Integral and Stroke Volume Index in Patients Undergoing Cardiac Surgery?

Isogai¹,

Ogasawara²

2022

Cureus

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IntroductionLeft ventricular outflow tract velocity time integral (LVOT VTI) is a promising surrogate for stroke volume (SV). However, there is controversy in the literature regarding its correlation with thermodilution or newer cardiac output measurement techniques. This study was conducted to determine the correlation between LVOT VTI determined by transesophageal echocardiography (TEE) with stroke volume index (SVI) calculated by thermodilution. MethodsConsecutive patients older than 17 years undergoing elective cardiac surgery with pulmonary artery catheter (PAC) and TEE monitoring between September 2021 and February 2022 were included in this prospective, descriptive, single-center study. LVOT VTI was measured using TEE after induction of anesthesia but before skin incision and at least four hours after initial LVOT VTI measurement. SVI was simultaneously measured using the continuous thermodilution technique with a PAC. The correlation between LVOT VTI and SVI was determined with Pearson's correlation index. ResultsTwelve patients were included and 21 paired measurements were compared. Mean SVI was 31.62 ± 10.71 mL/m 2 and mean LVOT VTI was 14.74 ± 4.79 cm. The Pearson's correlation index for the two measurements was r = 0.257, p = 0.262. ConclusionThis prospective study demonstrated a weak correlation between LVOT VTI and SVI in patients undergoing cardiac surgery.

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“…PiCCO uses a combination of trans-cardiopulmonary thermodilution and pulse contour wave analysis to calculate SVI and CI. Previous studies have shown reasonable levels of accuracy and precision as compared to PAC [16,17,18,19] and in one recent multicentre study PiCCO and PAC thermodilution were used as identical reference standards [20]. A recent meta-analysis reported both echocardiographic and PiCCO derived CO to have superior precision when compared to PAC as a reference standard as opposed to other minimally or non-invasive methods [21].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cardiac Index Measurements in Intensive Care Patients using Continuous Wave versus Pulsed Wave Echo-Doppler compared to Pulse Contour Cardiac Output

Parulekar¹,

Powys-Lybbe

Bassett³

et al. 2022

Preprint

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Purpose:Cardiac index (CI) assessments are commonly used in critical care to define shock aetiology and guide resuscitation. Echocardiographic assessment is non-invasive and has high levels of agreement with thermodilution assessment of CI. CI assessment is derived from the velocity time integral (VTI) assessed using pulsed wave (PW) doppler at the level of the left ventricular outflow tract (LVOT) divided by body mass index (BMI). Continuous wave (CW) doppler offers an alternative means to assess VTI and may offer better assessment at high velocities. Methods:We performed a single centre, prospective, observational study in a 15-bed intensive care unit (ICU) in a busy district general hospital. Patients had simultaneous measurements of cardiac index by Pulse Contour Cardiac Output (PiCCO) (thermodilution), transthoracic (TTE) LVOT PW-VTI and TTE AV CW-VTI. Mean differences were measured with Bland-Altman (B-A) limits of agreement (LOA) and Percentage Error (PE) calculations.Results:Data was collected on 52 patients. Mean CIs were: AV CW 2.7 L/min/m2 (range 0.78 – 5.11, SD 0.92). LVOT PW 2.33 L/min/m2 (range 0.77 – 5.40, SD 0.90) and PiCCO 2.86 L/min/m2 (range 1.50 – 5.56, SD 0.93). AV CW VTI and PiCCO mean difference was -0.16 L/min/m2 PE 43.5%. LVOT PW VTI and PiCCO had a mean difference of -0.54 L/min/m2 PE 38.6%. AV CW VTI and LVOT PW VTI had a mean difference of 0.38 L/min/m2 PE 46.0%. Conclusions:CI derived from both AV CW-VTI and LVOT PW-VTI methods underestimate CI compared to PiCCO, with the AV method having closer values overall to PiCCO. AV CW-VTI may offer a more accurate assessment of CI.

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Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients

Cited by 19 publications

References 13 publications

Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets

Is There a Correlation Between Left Ventricular Outflow Tract Velocity Time Integral and Stroke Volume Index in Patients Undergoing Cardiac Surgery?

Comparison of Cardiac Index Measurements in Intensive Care Patients using Continuous Wave versus Pulsed Wave Echo-Doppler compared to Pulse Contour Cardiac Output

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