title: Does obesity affect the non-invasive measurement of cardiac output performed by electrical cardiometry in children and adolescents?
abstract: Electrical cardiometry (EC) is a non-invasive and inexpensive method for hemodynamic assessment and monitoring. However, its feasibility for widespread clinical use, especially for the obese population, has yet to be determined. In this study, we evaluated the agreement and reliability of EC compared to transthoracic Doppler echocardiography (TTE) in normal, overweight, and obese children and adolescents. We measured stroke volume (SV) and cardiac output (CO) of 131 participants using EC and TTE simultaneously. We further divided these participants according to BMI percentiles for subanalyses: <85% normal weight (n = 41), between 85 and 95% overweight (n = 7), and >95% obese (n = 83). Due to small sample size of the overweight group, we combined overweight and obese groups (OW+OB) with no significant change in results (SV and CO) before and after combining groups. There were strong correlations between EC and TTE measurements of SV (r = 0.869 and r = 0.846; p < 0.0001) and CO (r = 0.831 and r = 0.815; p < 0.0001) in normal and OW+OB groups, respectively. Bias and percentage error for CO measurements were 0.240 and 29.7%, and 0.042 and 29.5% in the normal and OW+OB groups, respectively. Indexed values for SV were lower in the OW+OB group than in the normal weight group when measured by EC (p < 0.0001) but no differences were seen when measured by TTE (p = 0.096). In all weight groups, there were strong correlations and good agreement between EC and TTE. However, EC may underestimate hemodynamic measurements in obese participants due to fat tissue.
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics, Western University, 800 Commissioners Rd E, PO Box 5010, London, N6A 5W9s, Canada.|Children's Health Research Institute, London, Canada.|Paediatric Cardiopulmonary research laboratory, London Health science centre, London, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Altamirano-Diaz
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics, Western University, 800 Commissioners Rd E, PO Box 5010, London, N6A 5W9s, Canada.|Children's Health Research Institute, London, Canada.|Paediatric Cardiopulmonary research laboratory, London Health science centre, London, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Welisch
authors.affiliation: Department of Paediatrics, Rems-Murr Hospital, Winnenden, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Rauch
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics, Western University, 800 Commissioners Rd E, PO Box 5010, London, N6A 5W9s, Canada.|Children's Health Research Institute, London, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Miller
authors.affiliation: Paediatric Cardiopulmonary research laboratory, London Health science centre, London, Canada.
authors.forename: Teresa Sohee
authors.initials: TS
authors.lastname: Park
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics, Western University, 800 Commissioners Rd E, PO Box 5010, London, N6A 5W9s, Canada. kambiz.norozi@lhsc.on.ca.|Children's Health Research Institute, London, Canada. kambiz.norozi@lhsc.on.ca.|Paediatric Cardiopulmonary research laboratory, London Health science centre, London, Canada. kambiz.norozi@lhsc.on.ca.|Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, Hannover, Germany. kambiz.norozi@lhsc.on.ca.|Department of Paediatric Cardiology and Intensive Care Medicine, University of Goettingen, Goettingen, Germany. kambiz.norozi@lhsc.on.ca.
authors.forename: Kambiz
authors.identifier: http://orcid.org/0000-0001-8806-6183
authors.initials: K
authors.lastname: Norozi
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D050177:Overweight / Q000503:physiopathology*; D063766:Pediatric Obesity / Q000503:physiopathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018401:Sample Size; D013318:Stroke Volume
keywords: Cardiac output; Electrical cardiometry; Hemodynamic monitoring; Obesity; Transthoracic Doppler echocardiography