title: Evaluation of cardiac function index as measured by transpulmonary thermodilution as an indicator of left ventricular ejection fraction in cardiogenic shock.
abstract: BACKGROUND
  The PiCCO transpulmonary thermodilution technique provides two indices of cardiac systolic function, the cardiac function index (CFI) and the global ejection fraction (GEF). Both appear to be correlated with left ventricular ejection fraction (LVEF) measured by echocardiography in patients with circulatory failure, especially in septic shock. The aim of the present study was to test the reliability of CFI as an indicator of LVEF in patients with cardiogenic shock.
  
  
  METHODS
  In thirty-five patients with cardiogenic shock, we performed (i) simultaneous measurements of echocardiography LVEF and cardiac function index assessed by transpulmonary thermodilution (n=72) and (ii) transpulmonary thermodilution before/after increasing inotropic agents (n=18).
  
  
  RESULTS
  Mean LVEF was 31% (+/-11.7), CFI 3/min (+/-1), and GEF 14.2% (+/-6). CFI and GEF were both positively correlated with LVEF (P<0.0001, r2=0.27). CFI and GEF were significantly increased with inotropic infusion (resp., P=0.005, P=0.007). A cardiac function index<3.47/min predicted a left ventricular ejection fraction≤35% (sensitivity 81.1% and specificity 63%). In patients with right ventricular dysfunction, CFI was not correlated with LVEF.
  
  
  CONCLUSIONS
  CFI is correlated with LVEF provided that patient does not present severe right ventricular dysfunction. Thus, the PiCCO transpulmonary thermodilution technique is useful for the monitoring of inotropic therapy during cardiogenic shock.
authors.affiliation: CHU Nancy, Service de Reanimation Medicale Brabois, Pole Cardiovasculaire et Reanimation Medicale, Hopital Brabois, 54511 Vandoeuvre-les-Nancy, France.
authors.forename: Jessica
authors.initials: J
authors.lastname: Perny
authors.affiliation: CHU Nancy, Service de Reanimation Medicale Brabois, Pole Cardiovasculaire et Reanimation Medicale, Hopital Brabois, 54511 Vandoeuvre-les-Nancy, France ; INSERM, CHU Nancy, Groupe Choc Inserm, U1116, Faculté de Médecine, 54511 Vandoeuvre-les-Nancy, France ; Université de Lorraine, 54000 Nancy, France.
authors.forename: Antoine
authors.identifier: 0000-0002-5443-2074
authors.initials: A
authors.lastname: Kimmoun
authors.affiliation: CHU Nancy, Service de Reanimation Medicale Brabois, Pole Cardiovasculaire et Reanimation Medicale, Hopital Brabois, 54511 Vandoeuvre-les-Nancy, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.affiliation: CHU Nancy, Service de Reanimation Medicale Brabois, Pole Cardiovasculaire et Reanimation Medicale, Hopital Brabois, 54511 Vandoeuvre-les-Nancy, France ; INSERM, CHU Nancy, Groupe Choc Inserm, U1116, Faculté de Médecine, 54511 Vandoeuvre-les-Nancy, France ; Université de Lorraine, 54000 Nancy, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012769:Shock / Q000473:pathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000473:pathology*; D013318:Stroke Volume; D013599:Systole; D013815:Thermodilution; D016277:Ventricular Function, Left