Thermodilution Assessment of Cardiac Index in Patients With Tricuspid Regurgitation

Disparities between thermodilution (TD) and Fick measurements of cardiac index (CI) are common in real-world clinical practice. Published studies about the effect of tricuspid regurgitation (TR) on TD are small and describe conflicting results. We tested the correlation between TD and Fick across a wide range of TR severity, in a larger group of patients undergoing right heart catheterization (RHC). We aimed to determine if TD is an acceptable alternative to Fick in patients with TR in clinical practice.

We retrospectively evaluated patients undergoing RHC at a single center over a 10-month period, and included those with recent (<90 days) echocardiograms. TD was measured during RHC and Fick was calculated using estimated oxygen consumption. The primary outcome was the correlation between TD and Fick CIs. We performed regression modeling to evaluate predictors of the difference between TD and Fick.

A total of 349 patients were included, 40% of whom had at least moderate TR. The correlation between TD and Fick was strong (r=0.765) and did not significantly differ in those with none to mild TR (r=0.73) and those with moderate to severe TR (r=0.80). Atrial fibrillation or atrial flutter was the only variable significantly associated with the difference between CI by Fick and TD (P=.04).

The correlation between TD and Fick was strong and unaffected by TR severity.