Echocardiographic automated cardiac output measurement of pulmonary output and quantification of intracardiac shunt.
BACKGROUND
The quantification of intracardiac shunt (ICS) with echocardiographic pulsed-wave Doppler (PWD) method using pulmonary-to-systemic flow ratio (QP/QS ratio) remains difficult and may induce false quantification of pulmonary output. We sought to validate the recent echocardiographic automated cardiac output measurement (ACM) for the calculation of pulmonary output and the quantification of ICS in adults.


METHODS
One hundred and twenty consecutive patients were divided in 1) 40 patients who underwent echocardiographic and invasive explorations (group I) with groups IA (quantification of ICS using ACM, PWD and invasive oximetric methods in 20 patients) and IB (calculation of pulmonary output with ACM, PWD and thermodilution methods in 20 patients); 2) 80 patients underwent calculation of aortic and pulmonary outputs using echocardiographic ACM and PWD methods (group II).


RESULTS
The feasibility of ACM and conventional PWD methods for the calculation of pulmonary output was respectively 93.3% and 90%. Correlations between ACM and invasive pulmonary output were strong (r2=0.92 vs. r2=0.80 for PWD). The best correlation and agreement between invasive and echocardiographic QP/QS ratio were observed with ACM (r=0.96 vs. r=0.82 for PWD). Intracardiac shunts were best-classified with ACM, as compared to PWD (respectively 94% and 72%); sensitivities and specificities for evaluation of significant ICS were 92.3% and 100% with ACM (85% and 40% with PWD).


CONCLUSIONS
This study shows that ACM is a reliable and accurate echocardiographic method for calculating pulmonary output and quantifying ICS in adults and may be routinely performed in clinical practice.
Mansencal
Nicolas
N
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Ambroise Paré University Hospital, Boulogne, Service de Cardiologie, 9 avenue Charles de Gaulle, 92100 Boulogne, France. nicolas.mansencal@apr.ap-hop-paris.fr
Martin
Fabrice
F
Farcot
Jean-Christian
JC
Digne
Franck
F
Joseph
Thierry
T
Pilliére
Rémy
R
Redheuil
Alban
A
Lacombe
Pascal
P
Dubourg
Olivier
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity; D002302:Cardiac Output; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011652:Pulmonary Circulation; D012680:Sensitivity and Specificity