title: Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured by Three-Dimensional Echocardiography Can Predict Decreases in Brain Natriuretic Peptide.
abstract: OBJECTIVE
  First, to examine the perioperative association between increased cardiac index (CI) measured using three-dimensional echocardiography (CI3D), two-dimensional echocardiography (CI2D), and FloTrac/Vigileo (CIFT) (Edwards Lifesciences, Irvine, CA) after cardiac resynchronization therapy (CRT) and decreased brain natriuretic peptide (BNP) 6 months after CRT. Second, to evaluate the accuracy and tracking ability of CI2D and CIFT.
  
  
  METHODS
  A prospective clinical study.
  
  
  METHODS
  A cardiac surgery operating room in a single cardiovascular center.
  
  
  METHODS
  Forty-five patients undergoing elective CRT lead implantation.
  
  
  METHODS
  CIFT and CI2D were determined simultaneously before and after CRT using CI3D as the reference method.
  
  
  RESULTS
  BNP was measured before CRT and 6 months after CRT. Areas under the receiver operator characteristic curves (AUCs) were calculated for each method of measurement to predict BNP decrease. AUC was largest for CI3D (AUC = 0.735, p = 0.017). Bland-Altman analysis revealed that the percentage error was 58% for CIFT and 28% for CI2D. A polar plot analysis showed that the mean angular bias was -7.26° and 0.64°, the radial limits of agreement were 70° and 29.4°, and the concordance rate was 67.7% and 93.8% for CIFT and CI2D, respectively.
  
  
  CONCLUSIONS
  CI significantly increased after CRT in patients whose BNP level decreased 6 months after CRT. However, only CI3D could predict decreases in BNP 6 months after CRT. Although CI2D was acceptable compared with CI3D, the tracking ability of CI changes was just below acceptable. CIFT has a wide limit of agreement with CI3D, with a poor tracking ability.
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center. Electronic address: takuma@ncvc.go.jp.
authors.forename: Takuma
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sakurai
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Katsura
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Morishima
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Maekawa
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Furumoto
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kono
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Egawa
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Medicine, Division of Arrhythmia, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Okamura
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshitani
authors.affiliation: Department of Anesthesiology, National Cerebral and Cardiovascular Center.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ohnishi
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output / Q000502:physiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012372:ROC Curve; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: CRT; cardiac output; cardiac resynchronization therapy; echocardiography; heart failure; measurement techniques; monitoring; ultrasound