Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured by Three-Dimensional Echocardiography Can
Takuma Maeda1, Ryo Sakurai1, Katsura Nakagawa1
1Department of Anesthesiology, National Cerebral and Cardiovascular Center.
Insights
Cardiac index (CI) increased after cardiac resynchronization therapy (CRT) and predicted decreased brain natriuretic peptide (BNP). Three-dimensional echocardiography (CI3D) accurately predicted BNP decrease, while CI2D and CIFT showed limited tracking ability.
Area of Science:
- Cardiovascular physiology
- Echocardiography
- Biomarkers
Background:
- Cardiac resynchronization therapy (CRT) improves cardiac function.
- Brain natriuretic peptide (BNP) is a key biomarker for heart failure.
- Accurate monitoring of cardiac index (CI) is crucial for assessing CRT effectiveness.
Purpose of the Study:
- To investigate the association between perioperative CI and 6-month post-CRT BNP levels.
- To evaluate the accuracy and tracking ability of different CI measurement methods (CI3D, CI2D, CIFT).
- To determine which CI method best predicts BNP decrease after CRT.
Main Methods:
- Prospective clinical study involving 45 patients undergoing CRT.
- Simultaneous measurement of CI using three-dimensional echocardiography (CI3D) as reference, two-dimensional echocardiography (CI2D), and FloTrac/Vigileo (CIFT).
- BNP levels measured before and 6 months after CRT; receiver operator characteristic (ROC) and Bland-Altman analyses performed.
Main Results:
- CI3D demonstrated the largest area under the ROC curve (AUC=0.735, p=0.017) in predicting BNP decrease.
- CI2D showed acceptable agreement with CI3D (28% error, 93.8% concordance).
- CIFT exhibited poor tracking ability and wide limits of agreement with CI3D (58% error, 67.7% concordance).
Conclusions:
- Increased CI post-CRT is associated with decreased BNP levels at 6 months.
- Only CI3D accurately predicts BNP reduction after CRT.
- CI2D offers acceptable accuracy, while CIFT demonstrates inadequate tracking of CI changes.
Objectives:
First, to examine the perioperative association between increased cardiac index (CI) measured using three-dimensional echocardiography (CI3D), two-dimensional echocardiography (CI2D), and FloTrac/Vigileo (CIFT) (Edwards Lifesciences, Irvine, CA) after cardiac resynchronization therapy (CRT) and decreased brain natriuretic peptide (BNP) 6 months after CRT. Second, to evaluate the accuracy and tracking ability of CI2D and CIFT.
Design:
A prospective clinical study.
Setting:
A cardiac surgery operating room in a single cardiovascular center.
Participants:
Forty-five patients undergoing elective CRT lead implantation.
Interventions:
CIFT and CI2D were determined simultaneously before and after CRT using CI3D as the reference method.
Measurements And Main Results:
BNP was measured before CRT and 6 months after CRT. Areas under the receiver operator characteristic curves (AUCs) were calculated for each method of measurement to predict BNP decrease. AUC was largest for CI3D (AUC = 0.735, p = 0.017). Bland-Altman analysis revealed that the percentage error was 58% for CIFT and 28% for CI2D. A polar plot analysis showed that the mean angular bias was -7.26° and 0.64°, the radial limits of agreement were 70° and 29.4°, and the concordance rate was 67.7% and 93.8% for CIFT and CI2D, respectively.
Conclusions:
CI significantly increased after CRT in patients whose BNP level decreased 6 months after CRT. However, only CI3D could predict decreases in BNP 6 months after CRT. Although CI2D was acceptable compared with CI3D, the tracking ability of CI changes was just below acceptable. CIFT has a wide limit of agreement with CI3D, with a poor tracking ability.
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