Cardiac output measured by use of electrocardiogram-gated 64-slice multidector computed tomography, echocardiography, and thermodilution in healthy dogs

Nicole L. LeBlanc Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331.

Search for other papers by Nicole L. LeBlanc in
Current site
Google Scholar
PubMed
Close
 DVM, MS
,
Katherine F. Scollan Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331.

Search for other papers by Katherine F. Scollan in
Current site
Google Scholar
PubMed
Close
 DVM
, and
Susanne M. Stieger-Vanegas Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331.

Search for other papers by Susanne M. Stieger-Vanegas in
Current site
Google Scholar
PubMed
Close
 DVM, PhD

Abstract

OBJECTIVE To evaluate the accuracy of cardiac output (CO) estimated by use of ECG-gated multidetector CT (MDCT) and 1-, 2-, and 3-D echocardiography and by use of thermodilution.

ANIMALS 6 healthy hound-cross dogs.

PROCEDURES Electrocardiogram-gated contrast-enhanced 64-slice MDCT and 1-, 2-, and 3-D echocardiography were performed on each dog. The CO for ECG-gated MDCT was calculated as volumetric measurements of stroke volume multiplied by mean heart rate. Echocardiographic left ventricle end-diastolic volumes and end-systolic volumes were measured by use of the Teichholz method (1-D echocardiography) and a single-plane method of disks (2-D echocardiography). Real-time 3-D echocardiographic left ventricle volumes were measured with 3-D functional analysis software on right long-axis and left apical views. The CO of each dog was measured in triplicate by use of thermodilution. Mean CO values, correlations, and limits of agreement for MDCT, echocardiographic modalities, and thermodilution were compared.

RESULTS CO measured by use of MDCT, 2-D echocardiography, and 3-D echocardiography had the strongest correlations with CO measured by use of thermodilution. No significant difference in CO was detected between MDCT, any echocardiographic method, and thermodilution. Bland-Altman analysis revealed a systematic underestimation of CO derived by use of MDCT, 2-D echocardiography, and 3-D echocardiography.

CONCLUSIONS AND CLINICAL RELEVANCE Use of MDCT, 2-D echocardiography, and 3-D echocardiography to measure CO in healthy dogs was feasible. Measures of CO determined by use of 3-D echocardiography on the right long-axis view were strongly correlated with CO determined by use of thermodilution, with little variance and slight underestimation.

Abstract

OBJECTIVE To evaluate the accuracy of cardiac output (CO) estimated by use of ECG-gated multidetector CT (MDCT) and 1-, 2-, and 3-D echocardiography and by use of thermodilution.

ANIMALS 6 healthy hound-cross dogs.

PROCEDURES Electrocardiogram-gated contrast-enhanced 64-slice MDCT and 1-, 2-, and 3-D echocardiography were performed on each dog. The CO for ECG-gated MDCT was calculated as volumetric measurements of stroke volume multiplied by mean heart rate. Echocardiographic left ventricle end-diastolic volumes and end-systolic volumes were measured by use of the Teichholz method (1-D echocardiography) and a single-plane method of disks (2-D echocardiography). Real-time 3-D echocardiographic left ventricle volumes were measured with 3-D functional analysis software on right long-axis and left apical views. The CO of each dog was measured in triplicate by use of thermodilution. Mean CO values, correlations, and limits of agreement for MDCT, echocardiographic modalities, and thermodilution were compared.

RESULTS CO measured by use of MDCT, 2-D echocardiography, and 3-D echocardiography had the strongest correlations with CO measured by use of thermodilution. No significant difference in CO was detected between MDCT, any echocardiographic method, and thermodilution. Bland-Altman analysis revealed a systematic underestimation of CO derived by use of MDCT, 2-D echocardiography, and 3-D echocardiography.

CONCLUSIONS AND CLINICAL RELEVANCE Use of MDCT, 2-D echocardiography, and 3-D echocardiography to measure CO in healthy dogs was feasible. Measures of CO determined by use of 3-D echocardiography on the right long-axis view were strongly correlated with CO determined by use of thermodilution, with little variance and slight underestimation.

  • 1. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 13681377.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Butler AL. Goal-directed therapy in small animal critical illness. Vet Clin North Am Small Anim Pract 2011; 41: 817838.

  • 3. Reuter DA, Huang C, Edrich T, et al. Cardiac output monitoring using indicator-dilution techniques: basics, limits, and perspectives. Anesth Analg 2010; 110: 799811.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Bernard GR, Sopko G, Cerra F, et al. Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus statement. JAMA 2000; 283: 25682572.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5. Shih A, Giguere S, Sanchez LC, et al. Determination of cardiac output in neonatal foals by ultrasound velocity dilution and its comparison to the lithium dilution method. J Vet Emerg Crit Care (San Antonio) 2009; 19: 438443.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Pugsley J, Lerner AB. Cardiac output monitoring: is there a gold standard and how do the newer technologies compare? Semin Cardiothorac Vasc Anesth 2010; 14: 274282.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Brown JM. Use of echocardiography for hemodynamic monitoring. Crit Care Med 2002; 30: 13611364.

  • 8. Uehara Y, Koga M, Takahashi M. Determination of cardiac output by echocardiography. J Vet Med Sci 1995; 57: 401407.

  • 9. McConachie E, Barton MH, Rapoport G, et al. Doppler and volumetric echocardiographic methods for cardiac output measurement in standing adult horses. J Vet Intern Med 2013; 27: 324330.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Young LE, Blissitt KJ, Bartram DH, et al. Measurement of cardiac output by transoesophageal Doppler echocardiography in anaesthetized horses: comparison with thermodilution. Br J Anaesth 1996; 77: 773780.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Dorosz JL, Lezotte DC, Weitzenkamp DA, et al. Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis. J Am Coll Cardiol 2012; 59: 17991808.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Jenkins C, Bricknell K, Hanekom L, et al. Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. J Am Coll Cardiol 2004; 44: 878886.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Salm LP, Schuijf JD, de Roos A, et al. Global and regional left ventricular function assessment with 16-detector row CT: comparison with echocardiography and cardiovascular magnetic resonance. Eur J Echocardiogr 2006; 7: 308314.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14. Meyer J, Wefstaedt P, Dziallas P, et al. Assessment of left ventricular volumes by use of one-, two-, and three-dimensional echocardiography versus magnetic resonance imaging in healthy dogs. Am J Vet Res 2013; 74: 12231230.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Eskofier J, Wefstaedt P, Beyerbach M, et al. Quantification of left ventricular volumes and function in anesthetized Beagles using real-time three-dimensional echocardiography: 4D-TomTec analysis versus 4D-AutLVQ analysis in comparison with cardiac magnetic resonance imaging. BMC Vet Res 2015; 11: 260.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Ljungvall I, Hoglund K, Carnabuci C, et al. Assessment of global and regional left ventricular volume and shape by real-time 3-dimensional echocardiography in dogs with myxomatous mitral valve disease. J Vet Intern Med 2011; 25: 10361043.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. Drees R, Johnson RA, Stepien RL, et al. Quantitative planar and volumetric cardiac measurements using 64 MDCT and 3T MRI vs. standard 2D and M-mode echocardiography: does anesthetic protocol matter? Vet Radiol Ultrasound 2015; 56: 638657.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18. Sieslack AK, Dziallas P, Nolte I, et al. Comparative assessment of left ventricular function variables determined via cardiac computed tomography and cardiac magnetic resonance imaging in dogs. Am J Vet Res 2013; 74: 990998.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Teichholz LE, Kreulen T, Herman M V, et al. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol 1976; 37: 711.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 14401463.

    • Search Google Scholar
    • Export Citation
  • 21. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135160.

  • 22. Shih A. Cardiac output monitoring in horses. Vet Clin North Am Equine Pract 2013; 29: 155167.

  • 23. Gueret P, Meerbaum S, Zwehl W, et al. Two-dimensional echocardiographic assessment of left ventricular stroke volume: experimental correlation with thermodilution and cineangiography in normal and ischemic states. Cathet Cardiovasc Diagn 1981; 7: 247258.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Herfkens RJ, Axel L, Lipton MJ, et al. Measurement of cardiac output by computed transmission tomography. Invest Radiol 1982; 17: 550553.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. Garrett JS, Lanzer P, Jaschke W, et al. Measurement of cardiac output by cine computed tomography. Am J Cardiol 1985; 56: 657661.

  • 26. Vieira ML, Nomura CH, Tranchesi B Jr, et al. Real-time three-dimensional echocardiographic left ventricular systolic assessment: side-by-side comparison with 64-slice multi-detector cardiac computed tomography. Eur J Echocardiogr 2010; 11: 257263.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Sugeng L, Mor-Avi V, Weinert L, et al. Quantitative assessment of left ventricular size and function: side-by-side comparison of real-time three-dimensional echocardiography and computed tomography with magnetic resonance reference. Circulation 2006; 114: 654661.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28. Bansal D, Singh RM, Sarkar M, et al. Assessment of left ventricular function: comparison of cardiac multidetector-row computed tomography with two-dimension standard echocardiography for assessment of left ventricular function. Int J Cardiovasc Imaging 2008; 24: 317325.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Stetz CW, Miller RG, Kelly GE, et al. Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 1982; 126: 10011004.

    • Search Google Scholar
    • Export Citation
  • 30. Synder JV, Powner DJ. Effects of mechanical ventilation on the measurement of cardiac output by thermodilution. Crit Care Med 1982; 10: 677682.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31. Stevens JH, Raffin TA, Mihm FG, et al. Thermodilution cardiac output measurement. Effects of the respiratory cycle on its reproducibility. JAMA 1985; 253: 22402242.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32. Mackenzie JD, Haites NE, Rawles JM. Method of assessing the reproducibility of blood flow measurement: factors influencing the performance of thermodilution cardiac output computers. Br Heart J 1986; 55: 1424.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999; 15: 8591.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement