Relationship between bioreactance and magnetic resonance imaging stroke volumes

Abstract

Editor—Monitoring of cardiac output has wide clinical application in surgery, anaesthesia, emergency care, and cardiology.1Truijen J van Lieshout JJ Wesselink WA Westerhof BE Noninvasive continuous hemodynamic monitoring.J Clin Monit Comput. 2012; 26: 267-278Crossref PubMed Scopus (108) Google Scholar, 2Marik PE Noninvasive cardiac output monitors: a state-of the-art review.J Cardioth Vasc Anesth. 2013; 27: 121-134Abstract Full Text Full Text PDF PubMed Scopus (214) Google Scholar, 3Sinclair S James S Singer M Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial.Br Med J. 1997; 315: 909-912Crossref PubMed Scopus (615) Google Scholar, 4Gan TJ Soppitt A Maroof M et al.Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery.Anesthesiology. 2002; 97: 820-826Crossref PubMed Scopus (778) Google Scholar, 5Venn R Steele A Richardson P Poloniecki J Grounds M Newman P Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures.Br J Anaesh. 2002; 88: 65-71Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar, 6Tan LB Cardiac pumping capability and prognosis in heart failure.Lancet. 1986; 2: 1360-1363Abstract PubMed Scopus (128) Google Scholar, 7Williams SG Cooke GA Wright DJ et al.Peak exercise cardiac power output; a direct indicator of cardiac function strongly predictive of prognosis in chronic heart failure.Eur Heart J. 2001; 22: 1496-1503Crossref PubMed Scopus (173) Google Scholar, 8Lang CC Karlin P Haythe J Lim TK Mancini DM Peak cardiac power output, measured noninvasively, is a powerful predictor of outcome in chronic heart failure.Circ Heart Fail. 2009; 2: 33-38Crossref PubMed Scopus (92) Google Scholar The ‘gold-standard’ reference methods (i.e. thermodilution and direct Fick) are invasive and are associated with inherent risks, such as infections, arrhythmias, and bleeding.9Sandham JD Hull RD Brant RF et al.A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.New Engl J Med. 2003; 348: 5-14Crossref PubMed Scopus (1177) Google Scholar Cardiac magnetic resonance imaging (MRI) has been suggested to be a non-invasive ‘gold-standard’ method,10Heatlie GJ Pointon K Cardiac magnetic resonance imaging.Postgrad Med J. 2004; 80: 19-22Crossref PubMed Scopus (10) Google Scholar but its complexity and cost prevent its use in routine clinical practice. Bioreactance is a novel non-invasive, continuous monitoring method, which estimates cardiac output by analysing the frequency of relative phase shift of electronic current applied across the thorax.11Keren H Burkhoff D Squara P Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance.Am J Physiol Heart Circ Physiol. 2007; 293: H583-H589Crossref PubMed Scopus (236) Google Scholar12Squara P Denjean D Estagnasie P Brusset A Dib JC Dubois C Noninvasive cardiac output monitoring (NICOM): a clinical validation.Intensive Care Med. 2007; 33: 1191-1194Crossref PubMed Scopus (251) Google Scholar Several studies have demonstrated its clinical application and performance,11Keren H Burkhoff D Squara P Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance.Am J Physiol Heart Circ Physiol. 2007; 293: H583-H589Crossref PubMed Scopus (236) Google Scholar, 12Squara P Denjean D Estagnasie P Brusset A Dib JC Dubois C Noninvasive cardiac output monitoring (NICOM): a clinical validation.Intensive Care Med. 2007; 33: 1191-1194Crossref PubMed Scopus (251) Google Scholar, 13Rich JD Archer SL Rich S Evaluation of noninvasively measured cardiac output in patients with pulmonary hypertension.Am J Respir Crit Care Med. 2011; 183: A6440Google Scholar, 14Marik PE Levitov A Young A Andrews L The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients.Chest. 2013; 143: 364-370Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar, 15Cheung H Dong Q Dong R Yu B Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring (NICOM) and thermodilution in patients undergoing off-pump coronary artery bypass surgery.J Anesth. 2015; 29: 416-420Crossref PubMed Scopus (24) Google Scholar, 16Jones TW Houghton D Cassidy S MacGowan GA Trenell MI Jakovljevic DG Bioreactance is a reliable method for estimating cardiac output at rest and during exercise.Br J Anaesth. 2015; 115: 386-391Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 17Jakovljevic DG Moore S Hallsworth K Fattakhova G Thoma C Trenell MI Comparison of cardiac output determined by bioimpedance and bioreactance methods at rest and during exercise.J Clin Monit Comput. 2012; 26: 63-68Crossref PubMed Scopus (31) Google Scholar but its comparison with MRI has not been evaluated yet. The aims of the present study were as follows: (i) to compare values of stroke volume estimated by bioreactance and MRI methods; and (ii) to assess the relationship and agreement between the two methods. After Ethics Committee approval, 25 healthy female individuals took part in the study [age 48 (18 sd) yr, range 25–78 yr, height 1.63 (0.07 sd) m, weight 62.7 (10.2 sd) kg, and BMI 23.9 (4.4 sd) kg m−2]. In a cross-over design, each subject underwent measurements using cardiac MRI and bioreactance methods on consecutive days. Cardiac MRI was performed using a 3 T Philips Achieva and a six-channel cardiac coil (both from Philips, Best, The Netherlands), as previously described.18Jakovljevic DG Papakonstantinou L Blamire AM et al.Effect of physical activity on age-related changes in cardiac function and performance in women.Circ Cardiovasc Imag. 2015; 8 (pii: e002086)PubMed Google Scholar The bioreactance method (NICOM; Cheetah Medical, Wilmington, DE, USA) was used to assess haemodynamic variables continuously during a 10 min period while subjects rested in a semi-recumbent position.16Jones TW Houghton D Cassidy S MacGowan GA Trenell MI Jakovljevic DG Bioreactance is a reliable method for estimating cardiac output at rest and during exercise.Br J Anaesth. 2015; 115: 386-391Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 17Jakovljevic DG Moore S Hallsworth K Fattakhova G Thoma C Trenell MI Comparison of cardiac output determined by bioimpedance and bioreactance methods at rest and during exercise.J Clin Monit Comput. 2012; 26: 63-68Crossref PubMed Scopus (31) Google Scholar, 18Jakovljevic DG Papakonstantinou L Blamire AM et al.Effect of physical activity on age-related changes in cardiac function and performance in women.Circ Cardiovasc Imag. 2015; 8 (pii: e002086)PubMed Google Scholar, 19Jakovljevic DG Trenell MI MacGowan GA Bioimpedance and bioreactance methods for monitoring cardiac output.Best Pract Res Clin Anaesth. 2014; 28: 381-394Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar The difference between MRI and bioreactance was assessed using Student's paired t-test. Pearson's product–moment coefficient of correlation was used to assess the relationship between MRI and bioreactance stroke volume values, Bland–Altman analysis performed to agreement. Statistical significance was indicated by P<0.05, and data are presented as the mean (sd). The mean difference between the MRI and bioractance stroke volumes was 6 ml beat−1 [68 (11) vs 74 (15) ml beat−1, P<0.01], with bioreactance demonstrating on average 8% higher values than MRI. Pearson's correlation coefficient revealed a strong positive correlation between the two methods (r=0.84, P<0.01; Fig. 1). In addition to the mean difference, Bland–Altman analysis also revealed lower and upper limits of agreement of −9 and 19 ml beat−1, respectively. This is the first study to compare the stroke volume obtained by bioreactance and cardiac MRI. A strong relationship between the stroke volume estimates of bioreactance and MRI, and a relatively small mean difference, suggests that bioreactance could potentially be used in wider clinical practice where the use of gold-standard invasive or non-invasive methods is not viable. This is particularly important in clinical settings where it is necessary to estimate the haemodynamic response to a physiological or pharmacological challenge, such as fluid responsiveness, passive leg lifing, surgery, drug titration, and anaesthesia. The present findings suggest that bioreactance cannot be used interchangeably with MRI. However, this should not preclude its use in clinical practice, where its advantages over the gold-standard methods have been well documented and its reliability in challenging haemodynamic scenarios has been confirmed.11Keren H Burkhoff D Squara P Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance.Am J Physiol Heart Circ Physiol. 2007; 293: H583-H589Crossref PubMed Scopus (236) Google Scholar, 12Squara P Denjean D Estagnasie P Brusset A Dib JC Dubois C Noninvasive cardiac output monitoring (NICOM): a clinical validation.Intensive Care Med. 2007; 33: 1191-1194Crossref PubMed Scopus (251) Google Scholar, 13Rich JD Archer SL Rich S Evaluation of noninvasively measured cardiac output in patients with pulmonary hypertension.Am J Respir Crit Care Med. 2011; 183: A6440Google Scholar, 14Marik PE Levitov A Young A Andrews L The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients.Chest. 2013; 143: 364-370Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar, 15Cheung H Dong Q Dong R Yu B Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring (NICOM) and thermodilution in patients undergoing off-pump coronary artery bypass surgery.J Anesth. 2015; 29: 416-420Crossref PubMed Scopus (24) Google Scholar, 16Jones TW Houghton D Cassidy S MacGowan GA Trenell MI Jakovljevic DG Bioreactance is a reliable method for estimating cardiac output at rest and during exercise.Br J Anaesth. 2015; 115: 386-391Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 17Jakovljevic DG Moore S Hallsworth K Fattakhova G Thoma C Trenell MI Comparison of cardiac output determined by bioimpedance and bioreactance methods at rest and during exercise.J Clin Monit Comput. 2012; 26: 63-68Crossref PubMed Scopus (31) Google Scholar