PMID- 28877293
OWN - NLM
STAT- MEDLINE
DCOM- 20190603
LR  - 20190603
IS  - 2380-6591 (Electronic)
IS  - 2380-6583 (Print)
VI  - 2
IP  - 10
DP  - 2017 Oct 1
TI  - Thermodilution vs Estimated Fick Cardiac Output Measurement in Clinical Practice: 
      An Analysis of Mortality From the Veterans Affairs Clinical Assessment, 
      Reporting, and Tracking (VA CART) Program and Vanderbilt University.
PG  - 1090-1099
LID - 10.1001/jamacardio.2017.2945 [doi]
AB  - IMPORTANCE: Thermodilution (Td) and estimated oxygen uptake Fick (eFick) methods 
      are widely used to measure cardiac output (CO). They are often used 
      interchangeably to make critical clinical decisions, yet few studies have 
      compared these approaches as applied in medical practice. OBJECTIVES: To assess 
      agreement between Td and eFick CO and to compare how well these methods predict 
      mortality. DESIGN, SETTING, AND PARTICIPANTS: This investigation was a 
      retrospective cohort study with up to 1 year of follow-up. The study used data 
      from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (VA CART) 
      program. The findings were corroborated in a cohort of patients cared for at 
      Vanderbilt University, an academic referral center. Participants were more than 
      15 000 adults who underwent right heart catheterization, including 12 232 in the 
      Veterans Affairs cohort between October 1, 2007, and September 30, 2013, and 3391 
      in the Vanderbilt cohort between January 1, 1998, and December 31, 2014. 
      EXPOSURES: A single cardiac catheterization was performed on each patient with CO 
      estimated by both Td and eFick methods. Cardiac output was indexed to body 
      surface area (cardiac index [CI]) for all analyses. MAIN OUTCOMES AND MEASURES: 
      All-cause mortality over 90 days and 1 year after catheterization. RESULTS: Among 
      12 232 VA patients (mean [SD] age, 66.4 [9.9] years; 3.3% female) who underwent 
      right heart catheterization in this cohort study, Td and eFick CI estimates 
      correlated modestly (r = 0.65). There was minimal mean difference (eFick minus 
      Td = -0.02 L/min/m2, or -0.4%) but wide 95% limits of agreement between methods 
      (-1.3 to 1.3 L/min/m2, or -50.1% to 49.4%). Estimates differed by greater than 
      20% for 38.1% of patients. Low Td CI (<2.2 L/min/m2 compared with normal CI of 
      2.2-4.0 L/min/m2) more strongly predicted mortality than low eFick CI at 90 days 
      (Td hazard ratio [HR], 1.71; 95% CI, 1.47-1.99; chi2 = 49.5 vs eFick HR, 1.42; 95% 
      CI, 1.22-1.64; chi2 = 20.7) and 1 year (Td HR, 1.53; 95% CI, 1.39-1.69; chi2 = 71.5 
      vs eFick HR, 1.35; 1.22-1.49; chi2 = 35.2). Patients with a normal CI by both 
      methods had 12.3% 1-year mortality. There was no significant additional risk for 
      patients with a normal Td CI but a low eFick CI (12.9%, P = .51), whereas a low 
      Td CI but normal eFick CI was associated with higher mortality (15.4%, P = .001). 
      The results from the Vanderbilt cohort were similar in the context of a more 
      balanced sex distribution (46.6% female). CONCLUSIONS AND RELEVANCE: There is 
      only modest agreement between Td and eFick CI estimates. Thermodilution CI better 
      predicts mortality and should be favored over eFick in clinical practice.
FAU - Opotowsky, Alexander R
AU  - Opotowsky AR
AD  - Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts.
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
FAU - Hess, Edward
AU  - Hess E
AD  - Veterans Affairs Eastern Colorado Health Care System, Denver.
FAU - Maron, Bradley A
AU  - Maron BA
AD  - Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts.
AD  - Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
FAU - Brittain, Evan L
AU  - Brittain EL
AD  - Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt 
      University School of Medicine, Nashville, Tennessee.
AD  - Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt 
      University Medical Center, Nashville, Tennessee.
FAU - Baron, Anna E
AU  - Baron AE
AD  - Veterans Affairs Eastern Colorado Health Care System, Denver.
FAU - Maddox, Thomas M
AU  - Maddox TM
AD  - Veterans Affairs Eastern Colorado Health Care System, Denver.
AD  - University of Colorado School of Medicine, Denver.
FAU - Alshawabkeh, Laith I
AU  - Alshawabkeh LI
AD  - Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts.
AD  - Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
FAU - Wertheim, Bradley M
AU  - Wertheim BM
AD  - Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham 
      and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - Xu, Meng
AU  - Xu M
AD  - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
FAU - Assad, Tufik R
AU  - Assad TR
AD  - Division of Allergy, Pulmonary, and Critical Care Medicine, Department of 
      Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
FAU - Rich, Jonathan D
AU  - Rich JD
AD  - Division of Cardiology, Department of Medicine, Northwestern University, Chicago, 
      Illinois.
FAU - Choudhary, Gaurav
AU  - Choudhary G
AD  - Providence Veterans Affairs Medical Center, Providence, Rhode Island.
AD  - Alpert Medical School of Brown University, Providence, Rhode Island.
FAU - Tedford, Ryan J
AU  - Tedford RJ
AD  - Division of Cardiology, Department of Medicine, Medical University of South 
      Carolina, Charleston.
LA  - eng
GR  - K08 HL111207/HL/NHLBI NIH HHS/United States
GR  - R01 HL139613/HL/NHLBI NIH HHS/United States
GR  - T32 HL007633/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA Cardiol
JT  - JAMA cardiology
JID - 101676033
SB  - IM
MH  - Aged
MH  - Cardiac Catheterization/*mortality
MH  - Cardiac Output/*physiology
MH  - Diabetes Mellitus/mortality/physiopathology
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Diseases/mortality/physiopathology
MH  - Humans
MH  - Hypertension/mortality
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Pulmonary Disease, Chronic Obstructive/mortality/physiopathology
MH  - Renal Insufficiency, Chronic/mortality/physiopathology
MH  - Retrospective Studies
MH  - Tennessee
MH  - Thermodilution/standards
MH  - Treatment Outcome
PMC - PMC5710449
COIS- Conflict of Interest Disclosures: All authors have completed and submitted the 
      ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Opotowsky 
      reported investigator-initiated research supported by Actelion Pharmaceuticals 
      and Roche Diagnostics. Dr Maron reported investigator-initiated research 
      supported by Gilead Sciences Inc. Dr Brittain reported investigator-initiated 
      research supported by Gilead Sciences Inc. Dr Maddox reported being national 
      director of the Veterans Affairs Clinical Assessment, Reporting, and Tracking (VA 
      CART) program. Dr Choudhary reported investigator-initiated research supported by 
      Novartis. No other disclosures were reported.
EDAT- 2017/09/07 06:00
MHDA- 2019/06/04 06:00
PMCR- 2018/10/18
CRDT- 2017/09/07 06:00
PHST- 2017/09/07 06:00 [pubmed]
PHST- 2019/06/04 06:00 [medline]
PHST- 2017/09/07 06:00 [entrez]
PHST- 2018/10/18 00:00 [pmc-release]
AID - 2652883 [pii]
AID - hoi170044 [pii]
AID - 10.1001/jamacardio.2017.2945 [doi]
PST - ppublish
SO  - JAMA Cardiol. 2017 Oct 1;2(10):1090-1099. doi: 10.1001/jamacardio.2017.2945.