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Accuracy of Echocardiographic Cardiac Index Assessment in Subjects with Preserved Left Ventricular Ejection Fraction
Author(s) -
Maeder Micha T.,
Karapanagiotidis Sofie,
Dewar Elizabeth M.,
Kaye David M.
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12928
Subject(s) - cardiology , medicine , ejection fraction , index (typography) , heart failure , computer science , world wide web
We aimed to determine the accuracy of the echocardiographic assessment of cardiac index ( CI ) in subjects with preserved left ventricular ejection fraction ( LVEF ). Methods Thirty‐three subjects with LVEF >50%, normal sinus rhythm, and a broad spectrum of hemodynamic profiles underwent echocardiography immediately followed by right heart catheterization. As gold standards, CI was assessed using thermodilution [ CI ( TD )] and the Fick method [ CI (F)]. Echocardiographic CI was assessed by four methods: from the left ventricular outflow tract ( LVOT ) velocity time integral and the LVOT diameter as measured [ CI ( LVOT m)] as well as estimated from body surface area [ CI ( LVOT e)], and from stroke volume indices assessed using the biplane [ CI ( BP )] and monoplane [ CI ( MP )] methods. Results The mean CI ( TD ), CI (F), CI ( LVOT m), CI ( LVOT e), CI ( BP ), and CI ( MP ) were 3.0 ± 0.9, 3.1 ± 0.7, 2.8 ± 0.6, 3.3 ± 0.6, 2.0 ± 0.6, and 2.2 ± 0.7 L/min/m 2 . There were modest correlations between CI ( TD ) and CI (F) and all four noninvasive measures of CI with r 2 values ranging from 0.09 to 0.30. CI ( LVOT m) underestimated CI ( TD ) and CI (F) by 0.3 and 0.3 L/min/m 2 , CI ( LVOT e) overestimated CI ( TD ) and CI (F) by 0.3 and 0.2 L/min/m 2 , and CI ( BP ) and CI ( MP ) underestimated CI ( TD ) and CI (F) by 1.1 and 1.1 L/min/m 2 and 0.9 and 0.9 L/min/m 2 , respectively, with large limits of agreement for all comparisons. Conclusions In subjects with nondilated left ventricles with preserved LVEF , flow‐ or volume‐based measures of CI by 2D echocardiography may not accurately reflect CI ( TD ) and CI (F). Further larger studies are required to verify our findings and to evaluate the accuracy of contrast and 3D echocardiography in this setting.