Estimation of left ventricular systolic function by single transpulmonary thermodilution.
OBJECTIVE
The single-indicator transpulmonary thermodilution technique (PiCCO system) provides two derived indices of cardiac systolic function: the cardiac function index and the global ejection fraction. We used transesophageal echocardiography to compare theses indices with left ventricular fractional area of change only for patients with no isolated right ventricular dysfunction. (The global cardiac systolic function may be decreased despite preserved left ventricular function in this situation.)


METHODS
Prospective, open, clinical study.


METHODS
Intensive care unit (ICU) in a university hospital.


METHODS
Thirty-three mechanically ventilated patients.


METHODS
Left ventricular fractional area of change (LVFAC) was measured using transesophageal echocardiography. The cardiac function index (CFI) and the global ejection fraction (GEF) were determined from transpulmonary thermodilution-derived cardiac output and thoracic volumes.


RESULTS
Transesophageal echocardiography identified 3 patients with isolated right ventricular failure (PiCCO underestimated LVFAC in this situation). Significant correlations were established between LVFAC and CFI (r=0.87, n=30, p<0.0001) or GEF (r=0.82, n=30, p<0.0001). The mean differences between measured LVFAC and LVFAC estimated with CFI or GEF were 0.8+/-8.5% (range: -17 to 14%) and 0.8+/-9.0% (range: -21 to 19%), respectively. Area under the receiver operating characteristics curves for the estimation of LVFAC >/=40% using CFI or GEF was 0.92. CFI >4 and GEF >18% estimated LVFAC >/=40% with respective sensitivities of 86 and 88% and specificities of 88 and 79%. Significant correlations were established between changes of LVFAC and CFI/GEF over time.


CONCLUSIONS
In mechanically ventilated ICU patients, PiCCO-derived cardiac function index and global ejection fraction provide reliable estimations of LV systolic function but may underestimate it in the cases of isolated right ventricular failure.
Combes
Alain
A
Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47, boulevard de l'Hôpital, 75651 Paris Cedex 13, France. alain.combes@psl.ap-hop-paris.fr
Berneau
Jean-Baptiste
JB
Luyt
Charles-Edouard
CE
Trouillet
Jean-Louis
JL
D018806:APACHE; D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D013815:Thermodilution / Q000379:methods; D016277:Ventricular Function, Left / Q000502:physiology*