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Pulse densitometer indocyanine green dilution curves: a simple applicable and accurate method for determination of
Arend Bergstra1, Elke S Hoendermis, Melle D Talsma
1Thorax Center-Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.bergstra@thorax.umcg.nl
Insights
Non-invasive pulse densitometry (PD) accurately quantifies intracardiac shunts in congenital heart disease patients. This new method offers a reliable alternative to invasive procedures for hemodynamic evaluation.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Imaging
Background:
- Hemodynamic evaluation is critical for managing congenital heart disease.
- While non-invasive tools exist, cardiac catheterization remains essential for precise measurements.
- A new non-invasive technique, pulse densitometry (PD), was explored for shunt quantification.
Purpose of the Study:
- To assess the feasibility of non-invasive pulse densitometry (PD) for quantifying intracardiac shunts.
- To compare PD results with established methods: cuvette densitometry (CD) and oximetry (OX).
- To evaluate PD's accuracy in patients with congenital heart disease and intracardiac shunts.
Main Methods:
- A measurement method comparison study was conducted.
- Dye dilution curves were recorded using PD and CD in 12 patients with intracardiac shunts.
- Oximetry was performed, and left-to-right shunt percentages were calculated and compared.
Main Results:
- PD showed a mean difference of 2.8 +/- 10.0% of pulmonary blood flow (Qp) compared to CD.
- PD demonstrated a mean difference of 0.8 +/- 9.8% of Qp compared to oximetry.
- The technique proved effective across a range of shunt sizes in pediatric and adult patients.
Conclusions:
- Transcutaneous pulse dye densitometry provides an easy and accurate method for quantifying intracardiac left-to-right shunts.
- PD is a viable non-invasive alternative for hemodynamic assessment in congenital heart disease.
- This technique simplifies shunt quantification in both pediatric and adult populations.
Objective:
Adequate hemodynamic evaluation is crucial in the management of patients with congenital heart disease. Although non-invasive diagnostic tools have reduced the need for invasive procedures, cardiac catheterization is still mandatory for absolute quantification of pressures, flows and vascular resistances in selected patients. We therefore investigated the feasibility of a new technique, non-invasive pulse densitometry (PD) in patients with intracardiac shunts and compared its results with the established standards: cuvette densitometry (CD) and oximetry (OX).
Design:
Measurement method comparison study.
Outcome Measure:
In 12 patients with intracardiac shunt, dye dilution curves, using both pulse and cuvette densitometry, were recorded and oximetry was performed. Left-to-right shunt expressed as percentage of pulmonary blood flow Qp, was calculated from dye dilution and oximetry. In 4 patients with atrial septal defect, dye dilution curves were also recorded after closure of the defect with a device.
Results:
The mean difference +/- SD between the shunt derived from PD and CD was 2.8 +/- 10.0% of Qp, 95% confidence interval -2.5 to 8.2. (Shunt-PD vs. Shunt-CD was 32.3 +/- 23.9% vs. 29.5 +/- 23.9% of Qp resp., n = 16). The mean difference +/- SD between the shunt derived from PD and OX was 0.8 +/- 9.8% of Qp, 95% confidence interval -5.4 to 7.0 (Shunt-PD vs. Shunt-OX was 41.5 +/- 20.3% vs. 40.7 +/- 19.7% of Qp resp., n = 12).
Conclusion:
Transcutaneous recording of dye dilution curves with a pulse dye densitometer allows easy and accurate quantification of intracardiac left-to-right shunt flows over a wide range in both children and adults with congenital heart diseases.
