Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured by Three-Dimensional Echocardiography Can Predict Decreases in Brain Natriuretic Peptide

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• 作者：Takuma Maeda ; MD^* ; ^{takuma@ncvc.go.jp" class="auth_mail" title="E-mail the corresponding author} ; Ryo Sakurai ; MD^* ; Katsura Nakagawa ; MD^* ; Kuniko Morishima ; MD^* ; Masayuki Maekawa ; MD^* ; Kyoko Furumoto ; MD^* ; Toshihiko Kono ; MD^* ; Atsushi Egawa ; MD^* ; Yosuke Kubota ; MD^* ; Shinya Kato ; MD^* ; Hideo Okamura ; MD^&dagger ; ; Kenji Yoshitani ; MD^* ; Yoshihiko Ohnishi ; MD^*
• 关键词：heart failure ; measurement techniques ; cardiac output ; monitoring ; echocardiography ; ultrasound ; cardiac resynchronization therapy ; CRT
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：599-605
• 全文大小：398 K

文摘

First, to examine the perioperative association between increased cardiac index (CI) measured using three-dimensional echocardiography (CI_3D), two-dimensional echocardiography (CI_2D), and FloTrac/Vigileo (CI_FT) (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 CI_2D and CI_FT.

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

CI_FT and CI_2D were determined simultaneously before and after CRT using CI_3D 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 CI_3D (AUC = 0.735, p = 0.017). Bland-Altman analysis revealed that the percentage error was 58% for CI_FT and 28% for CI_2D. 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 CI_FT and CI_2D, respectively.

Conclusions

CI significantly increased after CRT in patients whose BNP level decreased 6 months after CRT. However, only CI_3D could predict decreases in BNP 6 months after CRT. Although CI_2D was acceptable compared with CI_3D, the tracking ability of CI changes was just below acceptable. CI_FT has a wide limit of agreement with CI_3D, with a poor tracking ability.