Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation

Rationale: 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...

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Autores principales:	Angela Quain, Mark Hoyer, Georges Ephrem, W. Aaron Kay
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Fontan Non-invasive NICOM Catheterization Cardiac output Monitoring Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/f9d56bc296ae40149a1980036653a3e0
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spelling	oai:doaj.org-article:f9d56bc296ae40149a1980036653a3e02021-11-20T05:14:49ZNon-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation2666-668510.1016/j.ijcchd.2021.100287https://doaj.org/article/f9d56bc296ae40149a1980036653a3e02021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666668521002111https://doaj.org/toc/2666-6685Rationale: 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. Objective: 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. Methods and results: 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. Discussion and conclusion: 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.Angela QuainMark HoyerGeorges EphremW. Aaron KayElsevierarticleFontanNon-invasiveNICOMCatheterizationCardiac outputMonitoringDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology Congenital Heart Disease, Vol 6, Iss , Pp 100287- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Fontan Non-invasive NICOM Catheterization Cardiac output Monitoring Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Fontan Non-invasive NICOM Catheterization Cardiac output Monitoring Diseases of the circulatory (Cardiovascular) system RC666-701 Angela Quain Mark Hoyer Georges Ephrem W. Aaron Kay Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
description	Rationale: 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. Objective: 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. Methods and results: 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. Discussion and conclusion: 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.
format	article
author	Angela Quain Mark Hoyer Georges Ephrem W. Aaron Kay
author_facet	Angela Quain Mark Hoyer Georges Ephrem W. Aaron Kay
author_sort	Angela Quain
title	Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
title_short	Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
title_full	Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
title_fullStr	Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
title_full_unstemmed	Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation
title_sort	non-invasive cardiac output monitoring (nicom) in adult congenital heart disease patients with fontan palliation
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/f9d56bc296ae40149a1980036653a3e0
work_keys_str_mv	AT angelaquain noninvasivecardiacoutputmonitoringnicominadultcongenitalheartdiseasepatientswithfontanpalliation AT markhoyer noninvasivecardiacoutputmonitoringnicominadultcongenitalheartdiseasepatientswithfontanpalliation AT georgesephrem noninvasivecardiacoutputmonitoringnicominadultcongenitalheartdiseasepatientswithfontanpalliation AT waaronkay noninvasivecardiacoutputmonitoringnicominadultcongenitalheartdiseasepatientswithfontanpalliation
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Non-invasive cardiac output monitoring (NICOM) in adult congenital heart disease patients with Fontan palliation

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