Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
Open accessAbstract
Fontan palliation for single ventricle malformations is an increasingly common reason for heart failure in the adult population. Cardiac output (CO) measurement in Fontan physiology is achieved by invasive cardiac catheterization (RHC). Noninvasive CO monitors using thoracic bioreactance (NICOM) have been validated in non-congenital patients but have not been studied in adult Fontan patients. To compare RHC obtained values of CO using the Fick equation with those measured simultaneously by NICOM in a cohort of adults with Fontan palliation. In nineteen patients undergoing routine outpatient RHC, we compared CO values as determined by Fick with those generated by the Starling SV NICOM device. Bland-Altman plots and intraclass correlation coefficients (ICCs) revealed internal consistency within NICOM measurements, however the agreement between RHC and NICOM for CO was poor (ICCs ∼ 0.40). We performed sub-analyses using two-sample T-tests and ICCs to determine if clinical cyanosis, acute desaturation, or Fontan pressure affected the difference observed between RHC and NICOM. Neither chronic hypoxia, acute desaturation, nor Fontan pressure measures were found to be associated with the observed difference between the RHC and NICOM measured CO. Our study did not find a correlation between RHC and NICOM derived measures of CO in a cohort of Fontan patients, even in sub-analyses of confounders of Fontan physiology. We observed internal consistency within the device, which may open a role for monitoring of trends rather than absolute values in Fontan patients. Our study was limited due to small sample size.
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ICG has high error compared to reference standard invasive measures in broader populations with cardiovascular diseases and in patients with higher BMI.
“In healthy subjects with low body mass index (BMI), this technique can provide accurate measures of STIs; however, in broader populations with cardiovascular diseases and in patients with higher BMI, ICG has been shown to have high error compared to reference standard invasive measures [14,15]”
From A Chest‐Conformable, Wireless Electro‐Mechanical E‐Tattoo for Measuring Multiple Cardiac Time Intervals (2023) · cites this paper as [14]
The Results report poor agreement between noninvasive NICOM cardiac-output measurements and invasive right-heart catheterization in adults with Fontan palliation (ICC approximately 0.40). The paper studies thoracic bioreactance, not ICG, and this finding does not establish high error across broader cardiovascular populations or in patients with higher BMI. No page numbers were available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredICG provides accurate measures of STIs in healthy subjects with low body mass index (BMI).
“In healthy subjects with low body mass index (BMI), this technique can provide accurate measures of STIs; however, in broader populations with cardiovascular diseases and in patients with higher BMI, ICG has been shown to have high error compared to reference standard invasive measures [14,15]”
From A Chest‐Conformable, Wireless Electro‐Mechanical E‐Tattoo for Measuring Multiple Cardiac Time Intervals (2023) · cites this paper as [14]
The Methods and Results compare NICOM-derived cardiac output with invasive measurements in adults with Fontan palliation; they do not assess ICG measures of systolic time intervals in healthy, low-BMI subjects. Searches for healthy subjects, low BMI, ICG, and STIs found no passage addressing the attributed claim. Page numbers are unavailable in our copy. (LLM, conf=0.75)
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Do we have the ACHD physician resources we need to care for the burgeoning ACHD population?
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Bhattacharya, S., Nikbakht, M., Alden, A., Tan, P., Wang, J., Alhalimi, T. A., Kim, S., Wang, P., Tanaka, H., Tandon, A., et al. (2023) · Advanced Electronic Materials · doi:10.1002/aelm.202201284 · Cited by 42 · see citing works
Non-invasive Cardiac Output Monitoring in Congenital Heart Disease
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“Quain et al. [22] evaluated a thoracic impedance tool and found poor correlation with right heart catheter Fick CO/CI calculations in adults with Fontan palliation.”
Florio, K. L., Williams, E. M., White, D., Daming, T., Hostetter, S., Schrufer-Poland, T. L., Gray, R., Schmidt, L. M., Grodzinsky, A., Lee, J., et al. (2024) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2024.101312 · Cited by 5 · see citing works
- Authors
- Quain, A., Hoyer, M., Ephrem, G., & Kay, W. A.
- Affiliations
- University of Michigan (US)
- Riley Hospital for Children (US)
- Indiana University Indianapolis (US)
- Corresponding author
- Kay, W. Aaron
- Venue
- International Journal of Cardiology Congenital Heart Disease
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 6
- Pages
- 100287
- ISSN
- 2666-6685 (ISSN-L)
- OpenAlex
- W3212047978
- Cited by
- 3
- References
- 11
- Citations by year
- 2024: 1 · 2023: 2
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Cardiology Congenital Heart Disease (publishedVersion, cc-by)
- Purdue University Indianapolis (Indiana University) (submittedVersion, cc-by)
- IUScholarWorks (Indiana University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Methodist Health Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- noninvasive cardiac output monitoring, Nicom, Fontan circulation, adult congenital heart disease, right heart catheterization, Fick equation, device validation, chronic hypoxia, cyanosis, Fontan pressure
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