PMID- 27904162
OWN - NLM
STAT- MEDLINE
DCOM- 20190124
LR  - 20190124
IS  - 0011-7781 (Print)
IS  - 0011-7781 (Linking)
VI  - 88
IP  - 7
DP  - 2016 Jul
TI  - Impact of Catheterization Lab Computer Software Settings on Hemodynamic 
      Assessment of Aortic Stenosis.
PG  - 212-217
AB  - BACKGROUND: Accurate assessment of Cardiac Output (CO) is a critical measurement 
      in the calculation of aortic valve area (AVA). Due to the known inaccuracy of 
      estimated Fick calculations, many measure thermodilution (TD) CO as well due to 
      previous studies showing better correlation with the gold standard direct CO. 
      Previous studies showed suboptimal correlation between both methods. Most 
      physicians assume that the TD CO is chosen by catheterization laboratory software 
      for AVA evaluation. Our study was performed to check which CO method is assigned 
      by our popular computer software system [Philips Xper Connect (XIM)] for the AVA 
      calculation and the impact of that on clinical decision. METHODS: We studied one 
      hundred consecutive patients who underwent right and left heart catheterization 
      from 2009 to 2012 for assessment of AVA and who had both estimated Fick and TD CO 
      calculated. Correlation of direct continuous VO2, assumed VO2 and TD based CO 
      measurements were assessed by linear regression analysis and by variance 
      component analysis. RESULTS: We found that whichever CO calculation was entered 
      first to the software system became the determinative output used to calculate 
      the AVA appearing on the final report. This was the estimated Fick method in 32 
      patients and TD in 68 patients. The CO used for the final report depended solely 
      on the timing of the oxygen saturation samples. The Correlation between AVA based 
      on both methods correlated poorly (Pearson R=0.73, Intra-Class Correlation (ICC) 
      =0.72). This discrepancy affects recommendation for surgery (AVA <1.0 cm2) in 18 
      cases (18% of patients). CONCLUSION: Our widely used software has an arbitrary 
      method of selecting the determinative CO to calculate the final AVA. For TD CO to 
      'trump' the Fick CO a complex series of computer commands needs to be performed. 
      None of the physicians or technicians was aware of this software selection 
      process, which affects critical treatment decisions.
FAU - Fanari, Zaher
AU  - Fanari Z
AD  - Division of Cardiology, University of Kansas School of Medicine, Kansas City, KS.
FAU - Rajamanickam, Anitha
AU  - Rajamanickam A
AD  - Division of Cardiology, Mount Sinai Heart, New York, NY.
FAU - Grove, Mathew
AU  - Grove M
AD  - Carolina East Medical Center, New Bern, NC.
FAU - Hammami, Sumaya
AU  - Hammami S
AD  - Section of Cardiology, Christiana Care Health System, Newark, DE.
FAU - Walls, Cassie
AU  - Walls C
AD  - Section of Cardiology, Christiana Care Health System, Newark, DE.
FAU - Kolm, Paul
AU  - Kolm P
AD  - Value Institute, Christiana Care Health System, Newark, DE.
FAU - Weintraub, William
AU  - Weintraub W
AD  - Section of Cardiology, Christiana Care Health System, Newark, DE; Value 
      Institute, Christiana Care Health System, Newark, DE.
FAU - Doorey, Andrew J
AU  - Doorey AJ
AD  - Section of Cardiology, Christiana Care Health System, Newark, DE; Value 
      Institute, Christiana Care Health System, Newark, DE.
LA  - eng
GR  - U54 GM104941/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Del Med J
JT  - Delaware medical journal
JID - 0370077
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aortic Valve Stenosis/*physiopathology
MH  - *Cardiac Catheterization
MH  - *Cardiac Output
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - *Hemodynamics
MH  - Humans
MH  - Male
MH  - *Software
MH  - Young Adult
PMC - PMC5125631
MID - NIHMS811567
OTO - NOTNLM
OT  - Aortic Stenosis
OT  - Cardiac output
OT  - Computer Software
OT  - Hemodynamics
EDAT- 2016/12/03 06:00
MHDA- 2019/01/25 06:00
PMCR- 2016/11/28
CRDT- 2016/12/02 06:00
PHST- 2016/12/02 06:00 [entrez]
PHST- 2016/12/03 06:00 [pubmed]
PHST- 2019/01/25 06:00 [medline]
PHST- 2016/11/28 00:00 [pmc-release]
PST - ppublish
SO  - Del Med J. 2016 Jul;88(7):212-217.