Cardiac Function Index and Global Ejection Fraction for Assessment of Left Ventricular Systolic Function_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XiaoHuanshun , XuYonghao , LiuXiaoqing , HeWeiqun , XuYuanda , SangLing ,  LiYimin

Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, 510120, China;

Corresponding author：

LiYimin, Email: dryiminli@vip.163.com

Keywords：

Transpulmonary thermodilution technique; Cardiac function index; Global ejection fraction; Left ventricular ejection fraction; Left ventricular systolic function

DOI：

10.7507/1671-6205.2015018

Video：

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Objective To investigate the clinical significance of cardiac function index (CFI) and global ejection fraction (GEF), derived from single-indicator transpulmonary thermodilution technique, in assessment of cardiac function in critically ill patients. Methods A prospective clinical observational study was conducted in the Intensive Care Unit of the First Affiliated Hospital of Guangzhou Medical University. Between January 2012 and December 2012, 39 patients who underwent PiCCO monitoring were recruited, including 18 cases with left ventricular systolic dysfunction and 21 cases without left ventricular systolic dysfunction. Both groups underwent transpulmonary thermodilution measurements and transthoracic cardiac ultrasonography. Pearson correlation analysis was conduced to assess the correlation between left ventricular ejection fraction (LVEF) and CFI and GEF. ROC curve was established to calculate the predicted threshold of CFI and GEF for diagnosing cardiac insufficiency. Results LVEF was significantly correlated with CFI and GEF (r=0.553, P < 0.005; r=0.468, P < 0.005). The area under ROC curve of CFI, GEF and LVEF for diagnosing cardiac insufficiency was 0.885, 0.862 and 0.903, respectively (P > 0.05 for comparison). The cut-off value of CFI for predicting cardiac insufficiency was 4.25/min, with a sensitivity of 77.8% and a specificity of 88.9%. The cut-off value of GEF for predicting cardiac dysfunction was 19.5/min, with a sensitivity of 88.9% and a specificity of 66.7%. Conclusion CFI and GEF measured by transpulmonary thermodilution correlate well with LVEF assessed by transthoracic echocardiography, both can be used for assessment of left ventricular systolic function.

Citation： XiaoHuanshun, XuYonghao, LiuXiaoqing, HeWeiqun, XuYuanda, SangLing, LiYimin. Cardiac Function Index and Global Ejection Fraction for Assessment of Left Ventricular Systolic Function. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(1): 76-80. doi: 10.7507/1671-6205.2015018 Copy

1.	Antonelli M, Levy M, Andrews PJ, et al.Hemodynamic monitoring in shock and implications for management:International Consensus Conference, Paris, France.Intensive Care Med, 2006, 33:575-590.
2.	Poelaert JI, Schupfer G.Hemodynamic monitoring utilizing transesophageal echocardiography:The relationships among pressure, flow, and function.Chest, 2005, 127:379-390.
3.	Sakka SG, Reinhart K, Meier-Hellmann A.Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients.Intensive Care Med, 1999, 25:843-846.
4.	Jabot J, Monnet X, Bouchra L, et al.Cardiac function index provided by transpulmonary thermodilution behaves as an indicator of left ventricular systolic function.Crit Care Med, 2009, 37:2913-2918.
5.	McMurray JJ, Adamopoulos S, Anker SD, et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.Euro J Heart Fail, 2012, 14:803-869.
6.	Ferrada P, Murthi S, Anand RJ, et al.Transthoracic focused rapid echocardiographic examination:real-time evaluation of fluid status in critically ill trauma patients.J Trauma, 2011, 70:56-62.
7.	Gunst M, Sperry J, Ghaemmaghami V, et al.Bedside echocardiographic assessment for trauma/critical care:the BEAT exam.J Am Coll Surg, 2008, 207:e1-e3.
8.	Combes A, Berneau JB, Luyt CE, et al.Estimation of left ventricular systolic function by single transpulmonary thermodilution.Intensive Care Med, 2004, 30:1377-1383.
9.	Friedman Z, Berkenstadt H, Margalit N, et al.Cardiac output assessed by arterial thermodilution during exsanguination and fluid resuscitation:experimental validation against a reference technique.Eur J Anaesthesiol, 2002, 19:337-340.
10.	Goedje O, Hoeke K, Lichtwarck-Aschoff M, et al.Continuous cardiac output by femoral arterial thermodilution-calibrated pulse contour analysis:comparison with pulmonary arterial thermodilution.Crit Care Med, 1999, 27:2407-2412.
11.	Della Rocca G, Costa MG, Pompei L, et al.Continuous and intermittent cardiac output measurement:pulmonary artery catheter versus aortic transpulmonary technique.Br J Anaesth, 2002, 88:350-356.
12.	Reuter DA, Huang C, Edrich T, et al.Cardiac output monitoring using indicator-dilution techniques:basics, limits, and perspectives.Anesth Analg, 2010, 110:799-811.
13.	Huang CC, Chen NH, Li LF, et al.Effects of cardiac output levels on the measurement of transpulmonary thermodilution cardiac output in patients with acute respiratory distress syndrome.J Trauma Acute Care Surg, 2012, 73:1236-1241.
14.	Poelaert J, Schmidt C, Colardyn F.Transoesophageal echocardiography in the critically ill.Anaesthesia, 1998, 53:55-68.
15.	Poelaert J, Schmidt C, Van AH, et al.Transoesophageal echocardiography in critically ill patients.A comprehensive approach.Eur J Anaesthesiol, 1997, 14:350-358.
16.	Shoemaker WC, Wo CC, Lu K, et al.Noninvasive hemodynamic monitoring for combat casualties.Mil Med, 2006, 171:813-820.
17.	Shoemaker WC, Wo CC, Chien LC, et al.Evaluation of invasive and noninvasive hemodynamic monitoring in trauma patients.J Trauma, 2006, 61:844-853.
18.	Gunst M, Sperry J, Ghaemmaghami V, et al. Bedside echocardiographic assessment for trauma/critical care:the BEAT exam. J Am Coll Surg, 2008, 2007:e1-e3.
19.	Poelaert J, Mayo P.Education and evaluation of knowledge and skills in echocardiography:How should we organize? Intensive Care Med, 2007, 33:1684-1686.

1. Antonelli M, Levy M, Andrews PJ, et al.Hemodynamic monitoring in shock and implications for management:International Consensus Conference, Paris, France.Intensive Care Med, 2006, 33:575-590.
2. Poelaert JI, Schupfer G.Hemodynamic monitoring utilizing transesophageal echocardiography:The relationships among pressure, flow, and function.Chest, 2005, 127:379-390.
3. Sakka SG, Reinhart K, Meier-Hellmann A.Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients.Intensive Care Med, 1999, 25:843-846.
4. Jabot J, Monnet X, Bouchra L, et al.Cardiac function index provided by transpulmonary thermodilution behaves as an indicator of left ventricular systolic function.Crit Care Med, 2009, 37:2913-2918.
5. McMurray JJ, Adamopoulos S, Anker SD, et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.Euro J Heart Fail, 2012, 14:803-869.
6. Ferrada P, Murthi S, Anand RJ, et al.Transthoracic focused rapid echocardiographic examination:real-time evaluation of fluid status in critically ill trauma patients.J Trauma, 2011, 70:56-62.
7. Gunst M, Sperry J, Ghaemmaghami V, et al.Bedside echocardiographic assessment for trauma/critical care:the BEAT exam.J Am Coll Surg, 2008, 207:e1-e3.
8. Combes A, Berneau JB, Luyt CE, et al.Estimation of left ventricular systolic function by single transpulmonary thermodilution.Intensive Care Med, 2004, 30:1377-1383.
9. Friedman Z, Berkenstadt H, Margalit N, et al.Cardiac output assessed by arterial thermodilution during exsanguination and fluid resuscitation:experimental validation against a reference technique.Eur J Anaesthesiol, 2002, 19:337-340.
10. Goedje O, Hoeke K, Lichtwarck-Aschoff M, et al.Continuous cardiac output by femoral arterial thermodilution-calibrated pulse contour analysis:comparison with pulmonary arterial thermodilution.Crit Care Med, 1999, 27:2407-2412.
11. Della Rocca G, Costa MG, Pompei L, et al.Continuous and intermittent cardiac output measurement:pulmonary artery catheter versus aortic transpulmonary technique.Br J Anaesth, 2002, 88:350-356.
12. Reuter DA, Huang C, Edrich T, et al.Cardiac output monitoring using indicator-dilution techniques:basics, limits, and perspectives.Anesth Analg, 2010, 110:799-811.
13. Huang CC, Chen NH, Li LF, et al.Effects of cardiac output levels on the measurement of transpulmonary thermodilution cardiac output in patients with acute respiratory distress syndrome.J Trauma Acute Care Surg, 2012, 73:1236-1241.
14. Poelaert J, Schmidt C, Colardyn F.Transoesophageal echocardiography in the critically ill.Anaesthesia, 1998, 53:55-68.
15. Poelaert J, Schmidt C, Van AH, et al.Transoesophageal echocardiography in critically ill patients.A comprehensive approach.Eur J Anaesthesiol, 1997, 14:350-358.
16. Shoemaker WC, Wo CC, Lu K, et al.Noninvasive hemodynamic monitoring for combat casualties.Mil Med, 2006, 171:813-820.
17. Shoemaker WC, Wo CC, Chien LC, et al.Evaluation of invasive and noninvasive hemodynamic monitoring in trauma patients.J Trauma, 2006, 61:844-853.
18. Gunst M, Sperry J, Ghaemmaghami V, et al. Bedside echocardiographic assessment for trauma/critical care:the BEAT exam. J Am Coll Surg, 2008, 2007:e1-e3.
19. Poelaert J, Mayo P.Education and evaluation of knowledge and skills in echocardiography:How should we organize? Intensive Care Med, 2007, 33:1684-1686.

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Cardiac Function Index and Global Ejection Fraction for Assessment of Left Ventricular Systolic Function

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