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  • Title: Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured by Three-Dimensional Echocardiography Can Predict Decreases in Brain Natriuretic Peptide.
    Author: Maeda T, Sakurai R, Nakagawa K, Morishima K, Maekawa M, Furumoto K, Kono T, Egawa A, Kubota Y, Kato S, Okamura H, Yoshitani K, Ohnishi Y.
    Journal: J Cardiothorac Vasc Anesth; 2016 Jun; 30(3):599-605. PubMed ID: 26708696.
    Abstract:
    OBJECTIVES: First, to examine the perioperative association between increased cardiac index (CI) measured using three-dimensional echocardiography (CI3D), two-dimensional echocardiography (CI2D), and FloTrac/Vigileo (CIFT) (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 CI2D and CIFT. 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: CIFT and CI2D were determined simultaneously before and after CRT using CI3D 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 CI3D (AUC = 0.735, p = 0.017). Bland-Altman analysis revealed that the percentage error was 58% for CIFT and 28% for CI2D. 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 CIFT and CI2D, respectively. CONCLUSIONS: CI significantly increased after CRT in patients whose BNP level decreased 6 months after CRT. However, only CI3D could predict decreases in BNP 6 months after CRT. Although CI2D was acceptable compared with CI3D, the tracking ability of CI changes was just below acceptable. CIFT has a wide limit of agreement with CI3D, with a poor tracking ability.
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