Hassan-Tash Pedram, Ismail Umar, Kirkpatrick Iain D C, Ravandi Amir, Jassal Davinder S, Hiebert Brett, Kass Malek, Krasuski Richard A, Shah Ashish H
St Boniface Hospital Albrechtsen Research Centre, Institute of Cardiovascular Sciences, University of Manitoba Winnipeg, Manitoba, Canada.
Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, Manitoba, Manitoba, Canada.
Curr Probl Cardiol. 2023 Feb;48(2):101457. doi: 10.1016/j.cpcardiol.2022.101457. Epub 2022 Oct 21.
Cardiac output (CO) and other hemodynamic parameter measurements play an important role in the management of cardiovascular conditions; however, due to limitations of current day technologies, such measurements are either not routinely performed or incorporated into clinical practice. Moreover, measurement of these hemodynamic parameters in the outpatient setting at different time points to assess interval change is currently not feasible. We attempted to validate total-body impedance cardiography-based Non-Invasive Cardiac System (NICaS) derived stroke volume (SV) with that from cardiac magnetic resonance (CMR), a current day gold standard method of assessment. We compared SV, as it is the primary unit of measurement utilized by both technologies. Forty-one consecutive patients undergoing CMR were also investigated by NICaS following CMR. The consistency of non-invasive technology-derived SV measurement was validated by NICaS measurement in 10 subjects, both before and after CMR. Of the 41 enrolled patients; data from 38 patients was adequate for comparison (motion artifact prevented CMR measures in 3 patients). Fourteen patients (37%) were female; mean age was 55 ± 15 years (28-87 years) and body-mass index was 28.7 ± 5.5 kg/m (20.5-41.9 kg/m). Hypertrophic cardiomyopathy (9/41) was the most common study indication for CMR. NICaS-derived SV strongly correlated with CMR [NICaS 77 ± 20 ml (31-123 ml) and CMR 84 ± 23 ml (47-132 ml); P < 0.001; r = 0.77; ICC = 0.73]. The Bland-Altman limits of agreement between NICaS and CMR were -26.7% and 39.9%. NICaS-derived SV collected before and after MRI did not differ [80 ± 18 ml (51-102 ml) pre and 76 ± 17 ml (50-99 ml) post; P = 0.0007, Kappa = 1]. Agreement between NICaS-derived and CMR-derived SV was within the acceptable range of boundaries set by the US Food and the Drug Administration. Consistency in SV measurement at different time-points may allow use of this technology to identify interval hemodynamic changes noninvasively.
心输出量（CO）及其他血流动力学参数测量在心血管疾病管理中发挥着重要作用；然而，由于当今技术的局限性，此类测量要么未常规进行，要么未纳入临床实践。此外，目前在门诊环境中于不同时间点测量这些血流动力学参数以评估间期变化是不可行的。我们试图将基于全身阻抗心动图的非侵入性心脏系统（NICaS）得出的每搏输出量（SV）与心脏磁共振成像（CMR）得出的结果进行验证对比，CMR是当今评估的金标准方法。我们比较了SV，因为它是两种技术所使用的主要测量单位。41例连续接受CMR检查的患者在CMR检查后也接受了NICaS检查。通过在10名受试者CMR检查前后进行NICaS测量，验证了非侵入性技术得出的SV测量的一致性。在41例入组患者中；38例患者的数据足以进行比较（3例患者因运动伪影导致CMR测量失败）。14例患者（37%）为女性；平均年龄为55±15岁（28 - 87岁），体重指数为28.7±5.5 kg/m²（20.5 - 41.9 kg/m²）。肥厚型心肌病（9/41）是CMR检查最常见的研究适应症。NICaS得出的SV与CMR得出的结果高度相关[NICaS为77±20 ml（31 - 123 ml），CMR为84±23 ml（47 - 132 ml）；P < 0.001；r = 0.77；ICC = 0.73]。NICaS与CMR之间的布兰德 - 奥特曼一致性界限为 - 26.7%和39.9%。MRI前后收集的NICaS得出的SV无差异[术前为80±18 ml（51 - 102 ml），术后为76±17 ml（50 - 99 ml）；P = 0.0007，Kappa = 1]。NICaS得出的SV与CMR得出的SV之间的一致性在美国食品药品监督管理局设定的可接受范围内。不同时间点SV测量的一致性可能允许使用该技术无创地识别间期血流动力学变化。
