Abstract
Introduction: The aim was to evaluate the agreement between cardiac output estimates obtained by electrical cardiometry (EC) and transthoracic echocardiography (TTE) in very preterm infants. Methods: This is a single-center prospective observational study in infants born<32 weeks gestational age within 48 h of birth. Continuous EC was recorded and simultaneous TTE obtained on day 1 and day 2 of life. Blinded TTE measurements were performed within a 10 s timeframe using beat-to-beat EC data. The primary outcome was %error of left ventricular (LV) output in milliliters per kilogram per minute (cardiac index (CI)) obtained by TTE compared to LV-CI from EC. Secondary outcome parameters were bias, %bias, limits of agreement and include measures of right ventricular (RV) output and LV systolic time intervals. Results: Analysis was performed for 34 infants (median (IQR) gestational age 29 + 0 (24 + 5 to 30 + 6) weeks + days, birthweight 960 (748 to 1,490) grams) including 44 pairwise LV output measurements on 24 participants (22 on day 1 and day 2). The %error was 54% for LV-CI (EC: 214 (38) mL/kg/min vs. TTE: 163 (47) mL/kg/min). The %error was 78% for RV-CI (EC: 213 (37) mL/kg/min vs. TTE: 241 (77) mL/kg/min). While only LV-CI values affected LV-CI bias, signal quality, heart rate, and RV-CI values affected RV-CI bias. Conclusion: EC is not interchangeable with TTE to estimate indices of LV or RV output in very preterm infants within the first 48 h postnatally. EC may not measure LV output distinctly in very preterm infants with intra- and extracardiac shunts.
References
1.
O’Neill
R
, Dempsey
EM
, Garvey
AA
, Schwarz
CE
. Non-invasive cardiac output monitoring in neonates
. Front Pediatr
. 2020
;8
:614585
. .2.
Schwarz
CE
, O’Toole
JM
, Livingstone
V
, Pavel
AM
, Dempsey
EM
. Signal quality of electrical cardiometry and perfusion index in very preterm infants
. Neonatology
. 2021
;118
(6
):672
–7
. .3.
Noori
S
, Drabu
B
, Soleymani
S
, Seri
I
. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography
. Arch Dis Child Fetal Neonatal Ed
. 2012 Sep
;97
(5
):F340
–3
. .4.
Song
R
, Rich
W
, Kim
JH
, Finer
NN
, Katheria
AC
. The use of electrical cardiometry for continuous cardiac output monitoring in preterm neonates: a validation study
. Am J Perinatol
. 2014 Dec
;31
(12
):1105
–10
. .5.
Torigoe
T
, Sato
S
, Nagayama
Y
, Sato
T
, Yamazaki
H
. Influence of patent ductus arteriosus and ventilators on electrical velocimetry for measuring cardiac output in very-low/low birth weight infants
. J Perinatol
. 2015 Jul
;35
(7
):485
–9
. .6.
Hassan
MA
, Bryant
MB
, Hummler
HD
. Comparison of cardiac output measurement by electrical velocimetry with echocardiography in extremely low birth weight neonates
. Neonatology
. 2021
;119
(1
):18
–25
. .7.
Van Wyk
L
, Smith
J
, Lawrenson
J
, Lombard
CJ
, de Boode
WP
. Bioreactance cardiac output trending ability in preterm infants: a single centre, longitudinal study
. Neonatology
. 2021
;118
(5
):600
–8
. .8.
Mertens
L
, Seri
I
, Marek
J
, Arlettaz
R
, Barker
P
, McNamara
P
, Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training: writing group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC)
. Eur J Echocardiogr
. 2011 Oct
;12
(10
):715
–36
. .9.
de Waal
K
, Kluckow
M
, Evans
N
. Weight corrected percentiles for blood vessel diameters used in flow measurements in preterm infants
. Early Hum Dev
. 2013 Dec
;89
(12
):939
–42
. .10.
de Boode
WP
, van der Lee
R
, Horsberg Eriksen
B
, Nestaas
E
, Dempsey
E
, Singh
Y
, The role of neonatologist performed echocardiography in the assessment and management of neonatal shock
. Pediatr Res
. 2018 Jul
;84
(S1
):57
–67
. .11.
Healy
DB
, Dempsey
EM
, O’Toole
JM
, Schwarz
CE
. In-silico evaluation of anthropomorphic measurement variations on electrical cardiometry in neonates
. Children
. 2021
;8
(10
):936
. .12.
Martin Bland
J
, Altman
DG
. Statistical methods for assessing agreement between two methods of clinical measurement
. Lancet
. 1986 Feb 8
;327
(8476
):307
–10
. .13.
Van Wyk
L
, Smith
J
, Lawrenson
J
, de Boode
WP
. Agreement of cardiac output measurements between bioreactance and transthoracic echocardiography in preterm infants during the transitional phase: a single-centre, prospective study
. Neonatology
. 2020 Feb
;117
(3
):271
–8
. .14.
Wetterslev
M
, Moller-Sorensen
H
, Johansen
RR
, Perner
A
. Systematic review of cardiac output measurements by echocardiography vs. thermodilution: the techniques are not interchangeable
. Intensive Care Med
. 2016 Aug
;42
(8
):1223
–33
. .15.
Parker
RA
, Weir
CJ
, Rubio
N
, Rabinovich
R
, Pinnock
H
, Hanley
J
, Application of mixed effects limits of agreement in the presence of multiple sources of variability: exemplar from the comparison of several devices to measure respiratory rate in COPD patients
. PLoS One
. 2016
;11
(12
):e0168321
. .16.
Parker
RA
, Scott
C
, Inacio
V
, Stevens
NT
. Using multiple agreement methods for continuous repeated measures data: a tutorial for practitioners
. BMC Med Res Methodol
. 2020 Jun 12
;20
(1
):154
. .17.
Evans
N
, Kluckow
M
. Early determinants of right and left ventricular output in ventilated preterm infants
. Arch Dis Child Fetal Neonatal Ed
. 1996 Mar
;74
(2
):F88
–94
. .18.
Van Wyk
L
, Gupta
S
, Lawrenson
J
, de Boode
WP
. Accuracy and trending ability of electrical biosensing technology for non-invasive cardiac output monitoring in neonates: a systematic qualitative review
. Front Pediatr
. 2022
;10
:851850
. .19.
Ficial
B
, Finnemore
AE
, Cox
DJ
, Broadhouse
KM
, Price
AN
, Durighel
G
, Validation study of the accuracy of echocardiographic measurements of systemic blood flow volume in newborn infants
. J Am Soc Echocardiogr
. 2013 Dec
;26
(12
):1365
–71
. .20.
Chew
MS
, Poelaert
J
. Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature
. Intensive Care Med
. 2003 Nov
;29
(11
):1889
–94
. .21.
Tsai-Goodman
B
, Martin
RP
, Marlow
N
, Skinner
JR
. The repeatability of echocardiographic determination of right ventricular output in the newborn
. Cardiol Young
. 2001 Mar
;11
(2
):188
–94
. .22.
Schwarz
CE
, Preusche
A
, Baden
W
, Poets
CF
, Franz
AR
. Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study
. BMC Pediatr
. 2016 Jan 26
;16
(1
):18
. .23.
Skinner
JR
, Boys
RJ
, Heads
A
, Hey
EN
, Hunter
S
. Estimation of pulmonary arterial pressure in the newborn: study of the repeatability of four Doppler echocardiographic techniques
. Pediatr Cardiol
. 1996 Nov–Dec
;17
(6
):360
–9
. .24.
van Dijk
APJ
, Hopman
JCW
, Klaessens
JHGM
, van der Werf
T
, Daniels
O
. The intra- and inter-operator variability of Echo-Doppler measurements for noninvasive pulmonary arterial pressure determination in congenital heart disease
. Eur J Ultrasound
. 1996
;4
(2
):91
–8
. .25.
Dehkordi
P
, Khosrow-Khavar
F
, Di Rienzo
M
, Inan
OT
, Schmidt
SE
, Blaber
AP
, Comparison of different methods for estimating cardiac timings: a comprehensive multimodal echocardiography investigation
. Front Physiol
. 2019
;10
:1057
. .26.
Johnson
GL
, Breart
GL
, Gewitz
MH
, Brenner
JI
, Lang
P
, Dooley
KJ
, Echocardiographic characteristics of premature infants with patent ductus arteriosus
. Pediatrics
. 1983 Dec
;72
(6
):864
–71
. .27.
Gill
AB
, Weindling
AM
. Echocardiographic assessment of cardiac function in shocked very low birthweight infants
. Arch Dis Child
. 1993 Jan
;68
(1 Spec No
):17
–21
. .28.
de Sitter
A
, Verdaasdonk
RM
, Faes
TJC
. Do mathematical model studies settle the controversy on the origin of cardiac synchronous trans-thoracic electrical impedance variations? A systematic review
. Physiol Meas
. 2016 Sep
;37
(9
):R88
–108
. .© 2022 S. Karger AG, Basel
2022
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
