title: Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates.
abstract: This prospective single-center observational study compared impedance cardiography [electrical velocimetry (EV)] with transthoracic echocardiography (TTE, based on trans-aortic flow) and analyzed the influence of physiological shunts, such as patent ductus arteriosus (PDA) or patent foramen ovale (PFO), on measurement accuracy. Two hundred and ninety-one triplicate simultaneous paired left ventricular stroke volume (LVSV) measurements by EV (LVSVEV) and TTE (LVSVTTE) in 99 spontaneously breathing neonates (mean weight 3270 g; range 1227-4600 g) were included. For the whole cohort, the mean absolute LVSVEVwas 5.5 mL, mean LVSVTTEwas 4.9 mL, resulting in an absolute Bland-Altman bias of -0.7 mL (limits of agreement LOA -3.0 to 1.7 mL), relative bias -12.8 %; mean percentage error MPE 44.9 %; true precision TPEV33.4 % (n = 99 aggregated data points). In neonates without shunts (n = 32): mean LVSVEV5.0 mL, mean LVSVTTE4.6 mL, Bland-Altman bias -0.4 mL (LOA -2.8 to 2.0 mL), relative bias -8.2 %; MPE 50.7 %; TPEV40.9 %. In neonates with shunts (PDA and/or PFO; n = 67): mean LVSVEV5.8 mL, mean LVSVTTE5.0 mL, bias -0.8 mL (LOA -3.1 to 1.5 mL), relative bias -14.8 %, MPE 41.9 %, TPEV29.3 %. Accuracy was affected by PDA and/or PFO, with a significant increase in the relative difference in LVSVEVversus LVSVTTE: Subjects without shunts -2.9 % (n = 91), PFO alone -9.6 % (n = 125), PDA alone -14.0 % (n = 12), and PDA and PFO -18.5 % (n = 63). Physiological shunts (PDA and/or PFO) in neonates affect measurement accuracy and cause overestimation of LVSVEVcompared with LVSVTTE.
authors.affiliation: Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. m.blohm@uke.de.
authors.forename: Martin Ernst
authors.initials: ME
authors.lastname: Blohm
authors.affiliation: Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Hartwich
authors.affiliation: Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Obrecht
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Jan Felix
authors.initials: JF
authors.lastname: Kersten
authors.affiliation: Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Dominique
authors.initials: D
authors.lastname: Singer
mesh_terms: D002307:Cardiography, Impedance / Q000379:methods*; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012212:Rheology / Q000379:methods; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
keywords: Echocardiography; Impedance cardiography; Neonate; Patent ductus arteriosus; Patent foramen ovale; Stroke volume