title: Dynamic device properties of pulse contour cardiac output during transcatheter aortic valve implantation.
abstract: This prospective single-center study aimed to determine the responsiveness and diagnostic performance of continuous cardiac output (CCO) monitors based on pulse contour analysis compared with invasive mean arterial pressure (MAP) during predefined periods of acute circulatory deterioration in patients undergoing transcatheter aortic valve implantation (TAVI). The ability of calibrated (CCO(CAL)) and self-calibrated (CCO(AUTOCAL)) pulse contour analysis to detect the hemodynamic response to 37 episodes of balloon aortic valvuloplasty enabled by rapid ventricular pacing was quantified in 13 patients undergoing TAVI. A "low" and a "high" cut-off limit were predefined as a 15 or 25 % decrease from baseline respectively. We found no significant differences between CCO(CAL) and MAP regarding mean response time [low cut-off: 8.6 (7.1-10.5) vs. 8.9 (7.3-10.8) s, p = 0.76; high cut-off: 11.4 (9.7-13.5) vs. 12.6 (10.7-14.9) s, p = 0.32] or diagnostic performance [area under the receiver operating characteristics curve (AUC): 0.99 (0.98-1.0) vs. 1.0 (0.99-1.0), p = 0.46]. But CCOCAL had a significantly higher amplitude response [95.0 (88.7-98.8) % decrease from baseline] than MAP [41.2 (30.0-52.9) %, p < 0.001]. CCOAUTOCAL had a significantly lower AUC [0.83 (0.73-0.93), p < 0.001] than MAP. Moreover, CCO(CAL) detected hemodynamic recovery significantly earlier than MAP. In conclusion, CCO(CAL) and MAP provided equivalent responsiveness and diagnostic performance to detect acute circulatory depression, whereas CCO(AUTOCAL) appeared to be less appropriate. In contrast to CCO(CAL) the amplitude response of MAP was poor. Consequently even small response amplitudes of MAP could indicate severe decreases in CO.
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, m.petzoldt@uke.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Petzoldt
authors.forename: Carsten
authors.initials: C
authors.lastname: Riedel
authors.forename: Jan
authors.initials: J
authors.lastname: Braeunig
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haas
authors.forename: Matthias S
authors.initials: MS
authors.lastname: Goepfert
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D019540:Area Under Curve; D063126:Balloon Valvuloplasty; D002138:Calibration; D002302:Cardiac Output / Q000502:physiology*; D003199:Computer Systems; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012815:Signal Processing, Computer-Assisted; D013815:Thermodilution; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome