TY - JOUR
T1 - Pulsed Doppler echocardiographic determination of stroke volume and cardiac output
T2 - Clinical validation of two new methods using the apical window
AU - Lewis, J. F.
AU - Kuo, L. C.
AU - Nelson, J. G.
AU - Limacher, M. C.
AU - Quinones, M. A.
PY - 1984
Y1 - 1984
N2 - Two methods of measuring stroke volume and cardiac output with pulsed Doppler two-dimensional echocardiography were developed and validated against the thermodilution technique in 39 patients, 33 of which were in an intensive care unit. With the use of the apical four-chamber view, a mitral inflow method combined the velocity of left ventricular inflow at the mitral anulus with the cross-sectional area of the anulus calculated from its diameter at middiastole (area = π r2). From the apical five-chamber view a left ventricular outflow method combined the velocity of left ventricular outflow with the cross-sectional area of the aortic anulus calculated from its diameter during early systole (parasternal long-axis view). Measurements with the mitral inflow than left ventricular outflow methods were obtained in 35 of 39 (90%) and 39 of 39 (100%) patients, respectively. Validation of the mitral method excluded patients with mitral regurgitation (n = 11) and validation of the left ventricular outflow method excluded those with aortic regurgitation (n = 4). Good correlations were observed between thermodilution and Doppler measurements of stroke volume and cardiac output for both the mitral anulus method (R = .96 and .87, respectively) and the left ventricular outflow method (R = .95 and .91, respectively). The results of the two methods correlated well with each other in patients without regurgitant valve lesions. A greater interobserver variability was observed with the mitral anulus method, which was related solely to greater variability in measuring the annular diameter. In patients with mitral regurgitation, left ventricular inflow volume was always greater and left ventricular outflow stroke volume while the inverse was true in those with aortic regurgitation. Thus, stroke volume and cardiac output can be accurately measured from the cardiac apex with mitral inflow or left ventricular outflow methods when applicable. Comparison of volumes obtained with these two methods may prove valuable in quantitating the severity of mitral or aortic regurgitation.
AB - Two methods of measuring stroke volume and cardiac output with pulsed Doppler two-dimensional echocardiography were developed and validated against the thermodilution technique in 39 patients, 33 of which were in an intensive care unit. With the use of the apical four-chamber view, a mitral inflow method combined the velocity of left ventricular inflow at the mitral anulus with the cross-sectional area of the anulus calculated from its diameter at middiastole (area = π r2). From the apical five-chamber view a left ventricular outflow method combined the velocity of left ventricular outflow with the cross-sectional area of the aortic anulus calculated from its diameter during early systole (parasternal long-axis view). Measurements with the mitral inflow than left ventricular outflow methods were obtained in 35 of 39 (90%) and 39 of 39 (100%) patients, respectively. Validation of the mitral method excluded patients with mitral regurgitation (n = 11) and validation of the left ventricular outflow method excluded those with aortic regurgitation (n = 4). Good correlations were observed between thermodilution and Doppler measurements of stroke volume and cardiac output for both the mitral anulus method (R = .96 and .87, respectively) and the left ventricular outflow method (R = .95 and .91, respectively). The results of the two methods correlated well with each other in patients without regurgitant valve lesions. A greater interobserver variability was observed with the mitral anulus method, which was related solely to greater variability in measuring the annular diameter. In patients with mitral regurgitation, left ventricular inflow volume was always greater and left ventricular outflow stroke volume while the inverse was true in those with aortic regurgitation. Thus, stroke volume and cardiac output can be accurately measured from the cardiac apex with mitral inflow or left ventricular outflow methods when applicable. Comparison of volumes obtained with these two methods may prove valuable in quantitating the severity of mitral or aortic regurgitation.
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U2 - 10.1161/01.CIR.70.3.425
DO - 10.1161/01.CIR.70.3.425
M3 - Article
C2 - 6744546
AN - SCOPUS:0021173362
SN - 0009-7322
VL - 70
SP - 425
EP - 431
JO - Circulation
JF - Circulation
IS - 3 I
ER -