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To compare the accuracy and trending ability of the cardiac index (CI) measured by FloTrac/Vigileo™ (CI FT ) or derived by the Fick equation (CI Fick ) using E-CAiOVX (enables continuous monitoring of oxygen consumption) with that measured by thermodilution (CI TD ) in patients with off-pump coronary artery bypass surgery. Twenty-two patients undergoing elective off-pump coronary artery bypass surgery were included. CI FT and CI Fick were determined simultaneously at six time-points during off-pump coronary artery bypass surgery. At each time-point, phenylephrine (50 µg) was administered to increase systematic vascular resistance, with CI measured before and after administration (CI TD used as reference method). Agreement of each method was evaluated by Bland-Altman analysis, while trending ability was evaluated by four-quadrant plot analysis and polar plot analysis. By Bland-Altman analysis, CI FT and CI Fick showed percentage errors of 49.5% and 78.6%, respectively, compared with CI TD . Subgroup analysis showed a percentage error between CO FT and CO TD of 28.9% in patients with a CI ≥ 2.4 L/min/m 2 , and 78.1% in patients with a CI ≥ 2.4 L/min/m 2 . The concordance rate of four-quadrant plot analysis was 93.3% for CI FT and 66.7% for CI Fick in datasets where CI TD  ≥ 2.4 L/min/m 2 before and after phenylephrine administration were included. CI FT and CI Fick had wide limits of agreement with CI TD , and were below acceptable limits for tracking phenylephrine-induced CI changes. However, subgroup analysis showed improved accuracy and trending ability of CI FT when only points where CI TD  ≥ 2.4 L/min/m 2 were included, while there was no improvement in CI Fick accuracy or trending ability.

Objectives: The goal of this study was to compare cardiac output derived from the FloTrac/Vigileo™ system (CO(FT)) with cardiac output measured by 3-dimensional transesophageal echocardiography (CO3D) in patients with severe heart failure undergoing cardiac resynchronization therapy. The impact of preoperative systemic vascular resistance index on the accuracy of the FloTrac/Vigileo™ system also was investigated., Design: Prospective clinical study., Setting: Cardiac surgery operating room of a single cardiovascular center., Participants: Forty-one patients undergoing elective cardiac resynchronization therapy lead implantation., Interventions: CO3D as the reference method and CO(FT) were determined simultaneously after induction of anesthesia., Measurements and Main Results: Linear regression analysis showed a poor correlation between CO3D and CO(FT) (R² = 0.16). Bland-Altman plots showed wide limits of agreement between CO3D and CO(FT.). Bias was 0.60 ± 0.63 L/min with a high percentage error of 58.2%. Subgroup analysis showed that the percentage error between CO3D and CO(FT) was 74.1% in patients with a cardiac index<2.2 L/min/m(2) and 17.2% in patients with a cardiac index ≥ 2.2 L/min/m(2). Systemic vascular resistance index was significantly higher in patients with a cardiac index<2.2 L/min/m(2) (3,037 ± 820 v 2,461 ± 878; p = 0.039)., Conclusions: The FloTrac/Vigileo™ system is not accurate in patients with low cardiac output, especially those with a cardiac index<2.2 L/min/m(2). A high systemic vascular resistance index in patients with low cardiac index may contribute to this inaccuracy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To compare cardiac output (CO) measurements acquired using the Flotrac/Vigileo system (Edwards Lifesciences, Irvine, CA) and CO measured by transesophageal echocardiography using the product of the aortic valve area, the time integral of flow at the same site, and the heart rate during abdominal aortic aneurysm (AAA) surgery., Design: A prospective clinical study., Setting: Cardiac surgery operating room of 1 heart center hospital., Participants: Twenty patients undergoing elective AAA surgery., Interventions: CO was determined simultaneously using the Flotrac/Vigileo system (CO(AP)) and transesophageal echocardiography (CO(TEE)) as the reference method at 8 time points during AAA surgery., Measurements and Main Results: One hundred sixty simultaneous datasets were obtained. The authors observed a significant correlation between CO(AP) and CO(TEE) values (R = 0.56, p < 0.001). Bland-Altman analysis of CO(AP) and CO(TEE) showed a bias of 0.12 L/min and limits of agreement from -1.66 to 1.90 L/min, with a percentage error of 41%. Just after aortic clamping, CO(AP) significantly increased, but CO(TEE) decreased in comparison with previous measurements. There was a significant association among changes in CO(AP) and pulse pressure, heart rate, and central venous pressure (CVP). However, changes in CO(TEE) were only associated with variations in heart rate., Conclusions: CO(AP) values were not clinically acceptable for use in AAA surgery because of wide variations during aortic clamping and declamping. Changes in pulse pressure, heart rate, and CVP were associated with significant changes in CO(AP), whereas only changes in heart rate showed associated changes in CO(TEE)., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Cardiac output (CO) determination using transesophageal Doppler is based on the measurement of descending aortic blood flow. Because cerebral blood flow is dependent on PaCO2, an increase in PaCO2 would result in an increase of CO because of the increase in cerebral blood flow and vice versa. We enrolled 30 patients undergoing off-pump coronary artery graft surgery in the study. The CO was determined by both transesophageal Doppler and thermodilution while PaCO2 was maintained at either 30 mmHg or 40 mmHg in random order. The CO by thermodilution was significantly higher at PaCO2 of 40 mmHg (4.17 +/- 0.94 L/min) than at 30 mmHg (3.78 +/- 0.85 L/min). On the other hand, there were no significant differences in CO by transesophageal Doppler: 3.85 +/- 0.76 L/min at PaCO2 of 40 mmHg and 3.77 +/- 0.74 at 30 mmHg. Bland-Altman analysis yielded bias and precision of -0.32 and 0.49 L/min at PaCO2 of 40 mmHg, and -0.01 and 0.34 L/min at 30 mmHg. These results indicate that both methods of CO measurement are in agreement at 30 mmHg of PaCO2, but the thermodilution method provides higher values at 40 mmHg of PaCO2.

Objectives: The CNAP system is a noninvasive monitor that provides a continuous arterial pressure waveform using an inflatable finger cuff. The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of noninvasive pulse contour monitors. The aim of this study was to evaluate the accuracy and trending ability of cardiac index derived by the CNAP system (CI CN) in patients undergoing AAA surgery. Design: Prospective clinical study. Setting: Cardiac surgery operating room in a single cardiovascular center. Participants: Twenty patients who underwent elective AAA surgery. Interventions: CI CN and cardiac index measured using 3-dimensional images (CI 3D) were determined simultaneously at 8 points during the surgery. At aortic clamping and unclamping, the authors tested the trending ability of CI CN using 4-quadrant plot analysis and polar plot analysis. Measurements and Main Results: The authors found a wide limit of agreement between CI CN and CI 3D (percentage error: 85.0%). The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CI CN− CI 3D)/CI 3D ], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CI CN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. Conclusions: CI CN is not interchangeable with CI 3D in patients undergoing AAA surgery. The trending ability for CI CN at aortic clamping and unclamping was below the acceptable limit. These inaccuracies might be secondary to the high systemic vascular resistance index during AAA surgery. [ABSTRACT FROM AUTHOR]

To investigate the accuracy and trending ability of ClearSight (Edwards Lifesciences, Irvine, CA) in patients with reduced ejection fraction (<55%) undergoing off-pump coronary artery bypass graft (CABG) surgery by comparing the ClearSight-derived cardiac index (CI CS) with the cardiac index measured with thermodilution using a pulmonary artery catheter. In addition, the accuracy and trending ability of ClearSight for blood pressure measurement was investigated by comparing the mean arterial pressure (MAP) derived by ClearSight (MAPcs) with invasive intra-arterial pressure. Prospective clinical study. Cardiac surgery operating room in a single cardiovascular center. The study comprised 20 patients who underwent elective CABG surgery. MAP and cardiac index were measured simultaneously at 6 time points intraoperatively. Trending ability was investigated at the following 2 points: (1) before and after placing the patient in the Trendelenburg position and (2) before and after atrial pacing with a targeted heart rate increase of 20%. Bland–Altman analysis showed that the percentage error between CI CS and the cardiac index measured with thermodilution was 40.2% and the percentage error between MAPcs and MAP was 24.6%. Four-quadrant plot analysis showed that the tracking ability of CI CS with the Trendelenburg position and atrial pacing was below the good trending ability cutoff (92%). However, the concordance rate of the 4-quadrant plot analysis showed a good trending ability for MAPcs. The polar plot analysis showed the same trend. CI CS was not sufficiently accurate in patients with reduced ejection fraction undergoing off-pump CABG surgery. However, ClearSight was clinically acceptable for MAP regarding its accuracy and trending ability in patients with reduced ejection fraction. [ABSTRACT FROM AUTHOR]

Background: There are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique. Methods: A prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor. Results: Ten cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased. Conclusion: In VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients. [ABSTRACT FROM AUTHOR]

Purpose: The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CIFT) with that measured by three-dimensional echocardiography (CI3D).Methods: Twenty-six patients undergoing elective AAA surgery were included in this study. CIFT and CI3D were determined simultaneously in eight points including before and after aortic clamp. We used CI3D as the reference method.Results: In the Bland-Altman analysis, CIFT had a wide limit of agreement with CI3D showing a percentage error of 46.7%. Subgroup analysis showed that the percentage error between CO3D and COFT was 56.3% in patients with cardiac index < 2.5 L/min/m2 and 28.4% in patients with cardiac index ≥ 2.5 L/min/m2. SVRI was significantly higher in patients with cardiac index < 2.5 L/min/m2 (1703 ± 330 vs. 2757 ± 798; p < 0.001). The tracking ability of fourth generation of FloTrac/Vigileo™ after aortic clamp was not clinically acceptable (26.9%).Conclusions: The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit. [ABSTRACT FROM AUTHOR]

Objectives To determine the accuracy and trending ability of the fourth-generation FloTrac/Vigileo in patients with low cardiac index by comparing FloTrac/Vigileo-derived cardiac index with that measured by 3-dimensional echocardiography. Design Prospective clinical study. Setting Cardiac surgery operating room in a single cardiovascular center. Participants Twenty-five patients undergoing elective cardiac resynchronization therapy lead implantation. Interventions FloTrac/Vigileo-derived cardiac index and 3-dimensional echocardiography-derived cardiac index were determined simultaneously before and after phenylephrine bolus and cardiac resynchronization therapy using 3-dimensional echocardiography-derived cardiac index as the reference method. Measurements and Main Results Cardiac index measured by the fourth-generation FloTrac/Vigileo had a wide limit of agreement with that measured by 3-dimensional echocardiography, with a percentage error of 59.1%. The tracking ability of the unit after both phenylephrine administration and cardiac resynchronization therapy were measured by concordance rate, and both were below the acceptable limit (72.7% and 85%, respectively). Conclusions The degree of accuracy of the fourth-generation FloTrac/Vigileo in patients with low cardiac index was not acceptable, and high systemic vascular resistance in patients with low cardiac index may have contributed to this inaccuracy. The tracking ability of the fourth-generation FloTrac/Vigileo after phenylephrine administration or cardiac resynchronization therapy was below acceptable limits. [ABSTRACT FROM AUTHOR]

Objectives 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. [ABSTRACT FROM AUTHOR]