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Errors in measurements of stroke volume for invasive and echo-Doppler evaluations of valvular regurgitant fractions.
S Iliceto1, G D'Ambrosio, A Amico
1Division of Cardiology, University of Bari, Italy.
Insights
This study compared cardiac catheterization (CATH) and 2D echo-Doppler (ED) for measuring stroke volumes (SV) to assess valvular regurgitation. Both methods showed systematic errors, with ED and CATH differences of 11.9 +/- 16.7 ml and 19.6 +/- 20.1 ml, respectively.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Accurate stroke volume (SV) measurement is crucial for calculating valvular regurgitant fractions.
- Cardiac catheterization (CATH) and 2D echo-Doppler (ED) are common methods, but their comparative accuracy for SV is debated.
- A 'gold standard' for SV measurement in this context is lacking, necessitating studies on error analysis.
Purpose of the Study:
- To compare the accuracy of CATH and ED in determining stroke volumes (SV) for calculating aortic and mitral regurgitant fractions.
- To estimate the systematic and random errors associated with both CATH and ED methods for SV measurement.
- To evaluate the reproducibility of SV measurements using computer simulations based on known variabilities.
Main Methods:
- Comparison of SV measurements between CATH (thermodilution, angiography) and ED (aortic/mitral annulus, time velocity integrals) in patients without valvular regurgitation.
- Calculation of the mean difference and standard deviation between SV measurements from the two methods to quantify errors.
- Computer simulations using 50,000 hypothetical patients to assess the contribution of measurement reproducibility to random errors in CATH and ED.
Main Results:
- A mean difference of 11.9 +/- 16.7 ml was observed for ED, while CATH showed a difference of 19.6 +/- 20.1 ml.
- Significant systematic errors were identified in both ED and CATH methods.
- Computer simulations indicated specific variability percentages for different CATH and ED measurement components.
Conclusions:
- Both CATH and ED exhibit systematic errors when measuring stroke volumes for regurgitant fraction calculations.
- The study quantifies the differences and errors inherent in each method, aiding in clinical interpretation.
- Understanding these errors is vital for accurate echocardiographic and invasive hemodynamic assessments.
Abstract:
The aim of this study was to compare cardiac catheterization (CATH) with 2D echo-Doppler (ED) in clinically evaluating the stroke volumes (SV) needed to calculate aortic and mitral regurgitant fractions (aortic and mitral SV for the ED method, thermodilution and angiographic SV for the CATH). As there is no 'gold standard' for this kind of measurement, only subjects without valvular regurgitation were considered. In these subjects, though the two SV measurements needed to calculate the regurgitant volume should have been identical, there was, in fact a difference due to the systematic and random errors of the methods. We calculated the mean value and the standard deviation of this difference in a series of patients without valvular regurgitation in order to obtain an estimate of both systematic and random errors. In 20 patients studied by ED a difference of 11.9 +/- 16.7 ml was found. In 36 patients studied by cardiac catheterization the difference was 19.6 +/- 20.1 ml. A significant systematic error was found for both ED and the invasive method; The transmitral SV tended to be larger than the aortic and the angiographic SV larger than that obtained by thermodilution. To try to determine the extent to which the random errors could be attributed to the reproducibility of the measurements, we carried out computer simulations. The SVs of 50 000 hypothetical patients were randomly generated and then attributed a random error calculated on the basis of the variability of the CATH (thermodilution 4%, angiography 10%) and the ED measurements (aortic annulus 6%, mitral annulus 18%, mitral time velocity integral 10%, aortic time velocity integral 8%).(ABSTRACT TRUNCATED AT 250 WORDS)
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