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.
Highlights
Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR)
Investigators using other imaging modalities have suggested using transit times to assess these measures [11,12,13]. In this prospective pilot study, we tested the hypothesis that transit time assessment during contrastenhanced echocardiography could accurately estimate both PVR and CO compared to the gold-standard of right heart catheterization (RHC) in patients without evidence of structural right heart disease
The average age was 60 ± 13 years, 52 percent were female, and the most common indication for RHC was for evaluation of suspected pulmonary hypertension
Summary
Studies 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). Non-invasive correlation between the pulmonary transit rate, as measured by the time to first echocardiographic presence in the left ventricle, with thermodilution cardiac output. This technique, has not been validated in humans. Investigators using other imaging modalities have suggested using transit times to assess these measures [11,12,13] In this prospective pilot study, we tested the hypothesis that transit time assessment during contrastenhanced echocardiography could accurately estimate both PVR and CO compared to the gold-standard of RHC in patients without evidence of structural right heart disease
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