Pilot study on hemodynamic monitoring in patients with advanced heart failure - comparison of non-invasive versus invasive hemodynamic monitoring
S Macura, F Schoenrath, I StoykovAbstract
Background
For evaluation of LVAD eligibility, transplant listing, and especially for high-urgency allocation in the Eurotransplant region, serial invasive right heart catheterizations are mandated to assess and reevaluate inotropic dependency, however these procedures are associated with relevant cumulative risks such as bleeding, vascular injury, arrhythmias, infection, and thromboembolism. Non-invasive haemodynamic monitoring technologies, including electrical cardiometry, pulse contour analysis, and echocardiography (via stroke volume estimated by LVOT VTI ), may reduce the need for repeated invasive procedures if they can provide cardiac output (CO) estimates that are sufficiently close to thermodilution, the invasive reference standard. To date, comprehensive evaluations comparing RHC with non-invasive methods in advanced heart failure remain limited.
Purpose
This prospective pilot study aimed to compare different approaches to non-invasive CO estimation with invasive right heart catheterization – derived CO measurements (with both thermodilution and FICKs equation) in advanced heart failure patients in a quartenary heart failure center.
Results
All CO estimations were performed in 10 patients on our advanced heart failure unit during routine right heart catheter. Patients with severe tricuspid regurgitation or congential heart disease were not included in this study. Median delta CO (L/min) versus thermodilution was +1.80 (IQR 2.13) for the electrical cardiometry (EC), −0.40 (IQR 1.53) for pulse contour analysis (PCCO), and −0.455 (IQR 1.44) for TTE, corresponding to percentage medians of +43.00%, −9.37%, and −11.41%, respectively. The results using the Fick’s Equation showed similar trend with medians of + 1.33 [IQR 2.19](+30.3%) for EC, -1.00 IQR [1.80](-17,8%) for PCCO and -0.74 [IQR 1.66](-15,7%) for TTE. The Wilcoxon test showed significant median differences in delta CO values (PCCO vs. EC and EC vs. TTE: p=0.005; indicating consistent underestimation by PCCO).
Conclusion
In advanced HF patients evaluated for heart transplantation, non-invasive pulse contour analysis and TTE may provide sufficient cardiac output estimates. Since a trend towards systemic underestimation of CO was seen, those tools might present useful screening tools with little risk to overlook patients in low cardiac output state. Further studies are needed.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.