J Clin Monit Comput - Dynamic device properties of pulse contour cardiac output during transcatheter aortic valve implantation.

Tópicos

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Resumo

This prospective single-center study aimed to determine the responsiveness and diagnostic performance of continuous cardiac output (CCO) monitors based on pulse contour analysis compared with invasive mean arterial pressure (MAP) during predefined periods of acute circulatory deterioration in patients undergoing transcatheter aortic valve implantation (TAVI). The ability of calibrated (CCO(CAL)) and self-calibrated (CCO(AUTOCAL)) pulse contour analysis to detect the hemodynamic response to 37 episodes of balloon aortic valvuloplasty enabled by rapid ventricular pacing was quantified in 13 patients undergoing TAVI. A "low" and a "high" cut-off limit were predefined as a 15 or 25 % decrease from baseline respectively. We found no significant differences between CCO(CAL) and MAP regarding mean response time [low cut-off: 8.6 (7.1-10.5) vs. 8.9 (7.3-10.8) s, p = 0.76; high cut-off: 11.4 (9.7-13.5) vs. 12.6 (10.7-14.9) s, p = 0.32] or diagnostic performance [area under the receiver operating characteristics curve (AUC): 0.99 (0.98-1.0) vs. 1.0 (0.99-1.0), p = 0.46]. But CCOCAL had a significantly higher amplitude response [95.0 (88.7-98.8) % decrease from baseline] than MAP [41.2 (30.0-52.9) %, p < 0.001]. CCOAUTOCAL had a significantly lower AUC [0.83 (0.73-0.93), p < 0.001] than MAP. Moreover, CCO(CAL) detected hemodynamic recovery significantly earlier than MAP. In conclusion, CCO(CAL) and MAP provided equivalent responsiveness and diagnostic performance to detect acute circulatory depression, whereas CCO(AUTOCAL) appeared to be less appropriate. In contrast to CCO(CAL) the amplitude response of MAP was poor. Consequently even small response amplitudes of MAP could indicate severe decreases in CO.

Resumo Limpo

prospect singlecent studi aim determin respons diagnost perform continu cardiac output cco monitor base puls contour analysi compar invas mean arteri pressur map predefin period acut circulatori deterior patient undergo transcathet aortic valv implant tavi abil calibr ccocal selfcalibr ccoautoc puls contour analysi detect hemodynam respons episod balloon aortic valvuloplasti enabl rapid ventricular pace quantifi patient undergo tavi low high cutoff limit predefin decreas baselin respect found signific differ ccocal map regard mean respons time low cutoff vs s p high cutoff vs s p diagnost perform area receiv oper characterist curv auc vs p ccocal signific higher amplitud respons decreas baselin map p ccoautoc signific lower auc p map moreov ccocal detect hemodynam recoveri signific earlier map conclus ccocal map provid equival respons diagnost perform detect acut circulatori depress wherea ccoautoc appear less appropri contrast ccocal amplitud respons map poor consequ even small respons amplitud map indic sever decreas co

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