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Accuracy of Echocardiographic Cardiac Index Assessment in Subjects with Preserved Left Ventricular Ejection Fraction
Micha T Maeder1,2,3, Sofie Karapanagiotidis1,2, Elizabeth M Dewar1,2
1Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Insights
Echocardiography methods for cardiac index (CI) in patients with preserved ejection fraction showed poor accuracy compared to gold standards. Further research is needed to validate alternative echocardiographic techniques.
Area of Science:
- Cardiology
- Medical Imaging
- Hemodynamics
Background:
- Assessing cardiac index (CI) is crucial for hemodynamic evaluation.
- Preserved left ventricular ejection fraction (LVEF) can present diagnostic challenges.
- Accuracy of echocardiography for CI in this population requires investigation.
Purpose of the Study:
- To evaluate the accuracy of various 2D echocardiography methods for determining cardiac index (CI).
- To compare echocardiographic CI measurements against gold standards (thermodilution and Fick method) in subjects with preserved LVEF.
Main Methods:
- Thirty-three subjects with LVEF >50% underwent simultaneous echocardiography and right heart catheterization.
- Cardiac index (CI) was measured using thermodilution [CI (TD)] and Fick method [CI (F)] as gold standards.
- Echocardiographic CI was assessed via left ventricular outflow tract (LVOT) measurements [CI (LVOTm), CI (LVOTe)] and stroke volume indices [CI (BP), CI (MP)].
Main Results:
- All four echocardiographic CI methods showed modest correlations with gold standards (r² values 0.09–0.30).
- Significant under- or overestimation of CI was observed across all echocardiographic methods compared to thermodilution and Fick.
- Large limits of agreement were found between echocardiographic CI and gold standard methods.
Conclusions:
- 2D echocardiographic measures of CI may not accurately reflect thermodilution (TD) or Fick (F) values in patients with preserved LVEF.
- Further studies are needed to assess contrast-enhanced and 3D echocardiography for CI assessment in this cohort.
Introduction:
We aimed to determine the accuracy of the echocardiographic assessment of cardiac index (CI) in subjects with preserved left ventricular ejection fraction (LVEF).
Methods:
Thirty-three subjects with LVEF >50%, normal sinus rhythm, and a broad spectrum of hemodynamic profiles underwent echocardiography immediately followed by right heart catheterization. As gold standards, CI was assessed using thermodilution [CI (TD)] and the Fick method [CI (F)]. Echocardiographic CI was assessed by four methods: from the left ventricular outflow tract (LVOT) velocity time integral and the LVOT diameter as measured [CI (LVOTm)] as well as estimated from body surface area [CI (LVOTe)], and from stroke volume indices assessed using the biplane [CI (BP)] and monoplane [CI (MP)] methods.
Results:
The mean CI (TD), CI (F), CI (LVOTm), CI (LVOTe), CI (BP), and CI (MP) were 3.0 ± 0.9, 3.1 ± 0.7, 2.8 ± 0.6, 3.3 ± 0.6, 2.0 ± 0.6, and 2.2 ± 0.7 L/min/m(2) . There were modest correlations between CI (TD) and CI (F) and all four noninvasive measures of CI with r(2) values ranging from 0.09 to 0.30. CI (LVOTm) underestimated CI (TD) and CI (F) by 0.3 and 0.3 L/min/m(2) , CI (LVOTe) overestimated CI (TD) and CI (F) by 0.3 and 0.2 L/min/m(2) , and CI (BP) and CI (MP) underestimated CI (TD) and CI (F) by 1.1 and 1.1 L/min/m(2) and 0.9 and 0.9 L/min/m(2) , respectively, with large limits of agreement for all comparisons.
Conclusions:
In subjects with nondilated left ventricles with preserved LVEF, flow- or volume-based measures of CI by 2D echocardiography may not accurately reflect CI (TD) and CI (F). Further larger studies are required to verify our findings and to evaluate the accuracy of contrast and 3D echocardiography in this setting.
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