Noninvasive echocardiographic cardiac power output predicts mortality in cardiac intensive care unit patients

Burstein, Barry; Anand, Vidhu; Ternus, Bradley; Tabi, Meir; Anavekar, Nandan S.; Borlaug, Barry A.; Barsness, Gregory W.; Kane, Garvan C.; Oh, Jae K.; Jentzer, Jacob C.

doi:10.1016/j.ahj.2021.12.007

Cited by 18 publications

(10 citation statements)

References 38 publications

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“…TTE or TEE can detect the hemodynamic state in a non-invasive manner. Thus, the results of the present study and TTE or TEE ndings could be correlated [31].…”

Section: Discussionsupporting

confidence: 55%

Assessment of fluid responsiveness using cardiac power index in the prone position: a pilot study

Min

2023

Preprint

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Background Fluid therapy guidelines tend to be evaluated using indicators representative of preload, and they have yet to be assessed from the standpoint of contractility. We hypothesized that the cardiac power index (CPI) might affect fluid responsiveness in settings where postural change triggers hemodynamic changes. Methods Twenty-eight patients who underwent lumbar spine surgery in the prone position on a jack’s table were enrolled in this study. Hemodynamic variables were measured before and after the position change and after the colloid bolus (5 mg/kg) in the prone position. Fluid responsiveness was defined as an increase in the stroke volume index (SVI) ≥ 10%. Results After a position change, the responder's CPI (mean ± sd) significantly decreased after a change to the prone position (0.45 ± 0.04 W/m2 vs. 0.34 ± 0.02 W/m2, p = 0.024). Cardiac index (CI, mean ± sd) decreased from 2.39 ± 0.15 l/min/m2 to 1.95 ± 0.16 l/min/m2 (p = 0.045). CPI was 0.50 ± 0.04 W/m2 in the non-responders and 0.34 ± 0.02 W/m2 in the responders (p = 0.002) in the prone position. After fluid loading, in the responder, CI increased from 1.95 ± 0.16l/min/m2 to 2.22 ± 0.16l/min/m2 (p = 0.025), and SVI increased from 27.62 ± 2.2 ml/m2 to 34.5 ± 2.06 ml/m2 (p = 0.001). CPI increased from 0.34 ± 0.02 W/m2 to 0.4 ± 0.03 W/m2 (p = 0.045) in the responders. However, CI decreased from 2.5 ± 0.18l/min/m2 to 2.29 ± 0.18 l/min/m2 (p = 0.009), and SVI (mean ± sd) decreased from 31.05 ± 1.78 ml/m2 to 28.55 ± 1.63 ml/m2 (p = 0.004) in the non-responders. CPI decreased from 0.5 ± 0.04W/m2 to 0.42 ± 0.03W/m2 (p = 0.015). The prone's CPI could predict fluid responsiveness under the receiver operating characteristic curve of 0.78 (95% CI, 0.60–0.95; p = 0.025). An optimal cut-off value of CPI in the prone was < 0.43 W/m2 (100% sensitivity and 65% specificity). Conclusion CPI may support and guide fluid management in the prone position. However, more data are required to confirm these findings.

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“…TTE or TEE can detect the hemodynamic state in a non-invasive manner. Thus, the results of the present study and TTE or TEE ndings could be correlated [31].…”

Section: Discussionsupporting

confidence: 55%

Assessment of fluid responsiveness using cardiac power index in the prone position: a pilot study

Min

2023

Preprint

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“…CPO is measured in watts and calculated as follows: CPO ¼ (cardiac output Ã mean arterial pressure)/451 In a retrospective derived population similar to the previous ones, an inverse correlation between CPO and hospital mortality was observed, with CPO less than 0.6 W having almost 20% hospital mortality [adjusted OR 1.573 (95% CI 1.132-2.186), P ¼ 0.007], whereas patients with CPO at least 1 W had less than 5% hospital mortality. However, The AUC values for CPO and LVEF were similar (0.642 vs. 0.635, P ¼ 0.71); CPO did not outperform MAP alone (0.64 vs. 0.62, P ¼ 0.09) and cardiac output (CO) was the only associated with hospital mortality as compared with MAP [adjusted OR 0.92 per 1 l/min higher (95% CI 0.85-0.99), P ¼ 0.02; P ¼ 0.60 for MAP] [35].…”

Section: Cardiac Power Output/indexmentioning

confidence: 99%

“…The role of RAP in the evaluation of CPO has been questioned [36]. In the previously discussed population, when CPO was calculated by subtracting RAP from MAP in the numerator, a slightly but significantly increased discrimination for in-hospital mortality was observed when compared with the standard CPO calculation (AUC 0.67 vs. 0.64, P < 0.001) [35].…”

Section: Thoracic Ultrasoundmentioning

confidence: 99%

Multimodality imaging in cardiogenic shock: state-of-the art

Tavazzi

Corradi

Vandenbriele

et al. 2023

Current Opinion in Critical Care

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Purpose of review There is emerging evidence on the role of the multimodality imaging in the setting of cardiogenic shock. The utility of different imaging modalities, along with their pitfalls and limitations, and their integration in a multiparametric approach are discussed in the current review. Recent findings The evaluation of congestion and perfusion in patients with shock has allowed a better understanding of the underlying physiopathological mechanisms. Integration of echocardiography, using more physiological parameters, with lung ultrasound, as well as the Doppler evaluation of abdominal blood flow dynamics, has led to a better stratification in patinas with hemodynamic instability. Summary Although validation of the integrated approaches and single parameters are needed, the physiopathological-driven approach using ultrasound in patients with cardiogenic shock on top of the clinical and biochemical evaluation, may aid to a quicker and more detailed evaluation of patient's phenotype.

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“…The LVSW and CPO are parameters of overall LV function, but the LVSWM and CPOM represent the performance of unit myocardium or myocardial workload. Previous studies on the LVSW index, CPO index, or peak CPOM quantified with stress echocardiography has displayed important prognostic values of these parameters in cardiovascular disease [35][36][37][38][39][40][41][42]. Thus, it is hoped that this work will stimulate further research on these important measures of LV myocardial performance to improve the accuracy of cardiac function assessment and therefore to optimize clinical decisions in cardiovascular disease.…”

Section: Perspectivesmentioning

confidence: 82%

Sex differences in left ventricular stroke work and cardiac power output per unit myocardium relate to blood pressure in apparently healthy adults

Yin

2023

PLoS ONE

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Background Left ventricular stroke work per unit myocardium (LVSWM) and cardiac power output per unit myocardium (CPOM) are important measures of myocardial workload. The sex differences in the myocardial workload and its correlation with blood pressure remain largely unclear. Objectives The purpose of this study is to investigate the sex differences in LVSWM and CPOM, and to relate them to blood pressure in a cohort of apparently healthy adults. Methods The LVSWM and CPOM were estimated in 596 age- and heart rate-matched apparently healthy adults (298 men) using transthoracic echocardiography combined with cuff-measured brachial blood pressure. The data were compared between sexes, and the sex differences in LVSWM and CPOM were related to blood pressure. Results After adjustment for the blood pressure, the LVSWM and CPOM were higher in women than in men [75.0 (73.7–76.4) vs 64.9 (63.5–66.2) cJ/100g for LVSWM, and 912.4 (894.1–930.6) vs 780.2 (762.0–798.5) milliwatt/100g for CPOM, respectively; all P<0.001]. After adjustment for the LVSWM and CPOM, the mean systolic and diastolic blood pressure were 7.4 mm Hg and 5.2 mm Hg higher in men than in women, respectively (all P<0.001). Conclusions For any given blood pressure, the workload per unit myocardium is higher in apparently healthy women than in their male counterparts. A sex-specific definition of normal blood pressure with a relatively lower threshold for women can minimize the sex differences in the myocardial workload, which might reduce the potentially comparatively higher risk of heart failure in women.

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Noninvasive echocardiographic cardiac power output predicts mortality in cardiac intensive care unit patients

Cited by 18 publications

References 38 publications

Assessment of fluid responsiveness using cardiac power index in the prone position: a pilot study

Assessment of fluid responsiveness using cardiac power index in the prone position: a pilot study

Multimodality imaging in cardiogenic shock: state-of-the art

Sex differences in left ventricular stroke work and cardiac power output per unit myocardium relate to blood pressure in apparently healthy adults

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