Skip to main content
Top
Published in: Journal of Clinical Monitoring and Computing 5/2016

01-10-2016 | Original Research

A validation study of electrical cardiometry in pregnant patients using transthoracic echocardiography as the reference standard

Authors: Erin Martin, Adanna Anyikam, Jerasimos Ballas, Kristen Buono, Kristin Mantell, Thao Huynh-Covey, Thomas Archer

Published in: Journal of Clinical Monitoring and Computing | Issue 5/2016

Login to get access

Abstract

To validate electrical cardiometry (EC) in pregnant patients using transthoracic echocardiography (TTE) as the reference standard. To improve EC accuracy via a one-time, measurement of left ventricular outflow tract (LVOT) diameter. 44 non-laboring, resting women with singleton, viable pregnancies underwent simultaneous EC and TTE measurements. Data were analyzed using Bland–Altman analysis. Entry multiple regression with stepwise elimination was used to develop a model for improved prediction of stroke volume by TTE (SVTTE) using EC. Bootstrapping and an 11-fold cross validation were used to test the model. Heart rate by TTE and EC had a mean bias of 3.3 beats/min and mean percentage error of 10.7 %. Envelope time and left ventricular ejection time had a mean bias of −4.9 ms and mean percentage error 12.7 %. Stroke volumes by the two techniques had a mean bias of 15.6 mL and mean percentage error of 43.7 %. A model, SVEC_Modified, predicting SVTTE was developed using LVOT area, stroke volume by electrical cardiometry and weight. SVTTE and SVEC_Modified had a mean bias of −0.83 mL and mean percentage error of 22 %. EC accurately measures heart rate and duration of systole when compared with TTE. Stroke volume measurements correlate but have a high bias and percentage error. Knowledge of LVOT area, by a one-time, measurement with TTE, could improve prediction of stroke volume by EC.
Appendix
Available only for authorised users
Literature
1.
go back to reference Heringlake M, Handke U, Hanke T, et al. Lack of agreement between thermodilution and electrical velocimetry cardiac output measurements. Intensive Care Med. 2007;33:2168–72.CrossRefPubMed Heringlake M, Handke U, Hanke T, et al. Lack of agreement between thermodilution and electrical velocimetry cardiac output measurements. Intensive Care Med. 2007;33:2168–72.CrossRefPubMed
2.
go back to reference Noori S, Drabu B, Soleymani S, et al. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch Dis Child Fetal Neonatal Ed. 2012;97(5):F340–3.CrossRefPubMed Noori S, Drabu B, Soleymani S, et al. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch Dis Child Fetal Neonatal Ed. 2012;97(5):F340–3.CrossRefPubMed
3.
go back to reference Osthaus WA, Huber D, Beck C, et al. Comparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets. Pediatr Anesth. 2007;17:749–55.CrossRef Osthaus WA, Huber D, Beck C, et al. Comparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets. Pediatr Anesth. 2007;17:749–55.CrossRef
4.
go back to reference Petter H, Erik A, Björn E, et al. Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution. Clin Physiol Funct Imaging. 2011;31(1):39–47.CrossRefPubMed Petter H, Erik A, Björn E, et al. Measurement of cardiac output with non-invasive Aesculon impedance versus thermodilution. Clin Physiol Funct Imaging. 2011;31(1):39–47.CrossRefPubMed
5.
go back to reference Schmidt C, Theilmeier G, Van Aken H, et al. Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output. Br J Anaesth. 2005;95:603–10.CrossRefPubMed Schmidt C, Theilmeier G, Van Aken H, et al. Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output. Br J Anaesth. 2005;95:603–10.CrossRefPubMed
6.
go back to reference Archer TL, Conrad BE, Tarsa M, et al. Electrical velocimetry demonstrates the increase in cardiac output and decrease in systemic vascular resistance accompanying cesarean delivery and oxytocin administration. J Clin Anesth. 2012;24:79–82.CrossRefPubMed Archer TL, Conrad BE, Tarsa M, et al. Electrical velocimetry demonstrates the increase in cardiac output and decrease in systemic vascular resistance accompanying cesarean delivery and oxytocin administration. J Clin Anesth. 2012;24:79–82.CrossRefPubMed
7.
go back to reference Archer TL, Conrad BE. Electrical velocimetry follows the hemodynamics of drug therapy and aortocaval compression in preeclampsia. Int J Obstet Anesth. 2011;20:91–2.CrossRefPubMed Archer TL, Conrad BE. Electrical velocimetry follows the hemodynamics of drug therapy and aortocaval compression in preeclampsia. Int J Obstet Anesth. 2011;20:91–2.CrossRefPubMed
8.
go back to reference Archer TL. Electrical velocimetry elucidates the hemodynamics of hypertension caused by indigo carmine. J Clin Anesth. 2011;23:166–71.CrossRefPubMed Archer TL. Electrical velocimetry elucidates the hemodynamics of hypertension caused by indigo carmine. J Clin Anesth. 2011;23:166–71.CrossRefPubMed
9.
go back to reference Archer TL, Suresh P, Shapiro AE. Cardiac output measurement, by means of electrical velocimetry, may be able to determine optimum maternal position during gestation, labour and caesarean delivery, by preventing vena caval compression and maximising cardiac output and placental perfusion pressure. Anaesth Intensive Care. 2011;39:308–11.PubMed Archer TL, Suresh P, Shapiro AE. Cardiac output measurement, by means of electrical velocimetry, may be able to determine optimum maternal position during gestation, labour and caesarean delivery, by preventing vena caval compression and maximising cardiac output and placental perfusion pressure. Anaesth Intensive Care. 2011;39:308–11.PubMed
10.
go back to reference Burlingame J, Ohana P, Aaronoff M, et al. Noninvasive cardiac monitoring in pregnancy: impedance cardiography versus echocardiography. J Perinatol. 2013;33:675–80.CrossRefPubMedPubMedCentral Burlingame J, Ohana P, Aaronoff M, et al. Noninvasive cardiac monitoring in pregnancy: impedance cardiography versus echocardiography. J Perinatol. 2013;33:675–80.CrossRefPubMedPubMedCentral
11.
go back to reference Clark SL, Southwick J, Pivarnik JM, et al. A comparison of cardiac index in normal term pregnancy using thoracic electrical bioimpedance and oxygen extraction (Fick) techniques. Obstet Gynecol. 1994;83:669–72.CrossRefPubMed Clark SL, Southwick J, Pivarnik JM, et al. A comparison of cardiac index in normal term pregnancy using thoracic electrical bioimpedance and oxygen extraction (Fick) techniques. Obstet Gynecol. 1994;83:669–72.CrossRefPubMed
12.
go back to reference Easterling TR, Benedetti TJ, Carlson KL, et al. Measurement of cardiac output in pregnancy by thermodilution and impedance techniques. Br J Obstet Gynaecol. 1990;96:67–9.CrossRef Easterling TR, Benedetti TJ, Carlson KL, et al. Measurement of cardiac output in pregnancy by thermodilution and impedance techniques. Br J Obstet Gynaecol. 1990;96:67–9.CrossRef
13.
go back to reference Masaki DI, Greenspoon JS, Ouzonian JG. Measurement of cardiac output in pregnancy by thoracic electrical bioimpedance and thermodilution. Am J Obstet Gynecol. 1989;161:680–4.CrossRefPubMed Masaki DI, Greenspoon JS, Ouzonian JG. Measurement of cardiac output in pregnancy by thoracic electrical bioimpedance and thermodilution. Am J Obstet Gynecol. 1989;161:680–4.CrossRefPubMed
14.
go back to reference Scardo JA, Ellings J, Vermillion ST, et al. Validation of bioimpedance estimates of cardiac output in preeclampsia. Am J Obstet Gynecol. 2000;183:911–3.CrossRefPubMed Scardo JA, Ellings J, Vermillion ST, et al. Validation of bioimpedance estimates of cardiac output in preeclampsia. Am J Obstet Gynecol. 2000;183:911–3.CrossRefPubMed
15.
go back to reference Connors AF Jr, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996;276:889–97.CrossRefPubMed Connors AF Jr, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA. 1996;276:889–97.CrossRefPubMed
17.
go back to reference Kaul S, et al. Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr. 1994;7(6):598–606.CrossRefPubMed Kaul S, et al. Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr. 1994;7(6):598–606.CrossRefPubMed
18.
go back to reference McLean AS, et al. Estimation of cardiac output by noninvasive echocardiographic techniques in the critically ill subject. Anaesth Intensive Care. 1997;25:250–4.PubMed McLean AS, et al. Estimation of cardiac output by noninvasive echocardiographic techniques in the critically ill subject. Anaesth Intensive Care. 1997;25:250–4.PubMed
19.
go back to reference Dabaghi SF, et al. Comparison of echocardiographic assessment of cardiac hemodynamics in the intensive care unit with right-sided cardiac catheterization. Am J Cardiol. 1995;76:392–5.CrossRefPubMed Dabaghi SF, et al. Comparison of echocardiographic assessment of cardiac hemodynamics in the intensive care unit with right-sided cardiac catheterization. Am J Cardiol. 1995;76:392–5.CrossRefPubMed
20.
go back to reference Dubin J, et al. Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J. 1990;120:116–23.CrossRefPubMed Dubin J, et al. Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J. 1990;120:116–23.CrossRefPubMed
21.
go back to reference Belfort MA, et al. Rapid echocardiographic assessment of left and right heart hemodynamics in critically ill obstetric patients. Am J Obstet Gynecol. 1994;171(4):884–92.CrossRefPubMed Belfort MA, et al. Rapid echocardiographic assessment of left and right heart hemodynamics in critically ill obstetric patients. Am J Obstet Gynecol. 1994;171(4):884–92.CrossRefPubMed
22.
go back to reference Lee W, et al. Noninvasive maternal stroke volume and cardiac output determinations by pulsed Doppler echocardiography. Am J Obstet Gynecol. 1988;158:505–10.CrossRefPubMed Lee W, et al. Noninvasive maternal stroke volume and cardiac output determinations by pulsed Doppler echocardiography. Am J Obstet Gynecol. 1988;158:505–10.CrossRefPubMed
23.
go back to reference Critchley LAH and Critchley JAJH. A meta-analysis of studies using bias and precision to compare cardiac output measurement techniques. J Clin Monit. 1999;15:85–91.CrossRef Critchley LAH and Critchley JAJH. A meta-analysis of studies using bias and precision to compare cardiac output measurement techniques. J Clin Monit. 1999;15:85–91.CrossRef
24.
go back to reference Lee JH, et al. Evaluation of corrected flow time in oesophageal Doppler as a predictor of fluid responsiveness. Br J Anaesth. 2007;99:343–8.CrossRefPubMed Lee JH, et al. Evaluation of corrected flow time in oesophageal Doppler as a predictor of fluid responsiveness. Br J Anaesth. 2007;99:343–8.CrossRefPubMed
25.
go back to reference Singer M, et al. Continuous hemodynamic monitoring by esophageal Doppler. Crit Care Med. 1989;17:447–52.CrossRefPubMed Singer M, et al. Continuous hemodynamic monitoring by esophageal Doppler. Crit Care Med. 1989;17:447–52.CrossRefPubMed
26.
go back to reference Madan AK, et al. Esophageal Doppler ultrasound monitor versus pulmonary artery catheter in the hemodynamic management of critically ill surgical patients. J Trauma. 1999;46:607–12.CrossRefPubMed Madan AK, et al. Esophageal Doppler ultrasound monitor versus pulmonary artery catheter in the hemodynamic management of critically ill surgical patients. J Trauma. 1999;46:607–12.CrossRefPubMed
27.
go back to reference Singer M, Bennett ED. Noninvasive optimization of left ventricular filling using esophageal Doppler. Crit Care Med. 1991;19:1132–7.CrossRefPubMed Singer M, Bennett ED. Noninvasive optimization of left ventricular filling using esophageal Doppler. Crit Care Med. 1991;19:1132–7.CrossRefPubMed
Metadata
Title
A validation study of electrical cardiometry in pregnant patients using transthoracic echocardiography as the reference standard
Authors
Erin Martin
Adanna Anyikam
Jerasimos Ballas
Kristen Buono
Kristin Mantell
Thao Huynh-Covey
Thomas Archer
Publication date
01-10-2016
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 5/2016
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-015-9771-y

Other articles of this Issue 5/2016

Journal of Clinical Monitoring and Computing 5/2016 Go to the issue