Ultrasound Cardiac Output Monitor (USCOM™) Measurements Prove Unreliable Compared to Cardiac Magnetic Resonance Imaging in Adolescents with Cardiac Disease

Pediatr Cardiol. 2021 Mar;42(3):692-699. doi: 10.1007/s00246-020-02531-8. Epub 2021 Jan 4.

Abstract

The purpose of this stuy is to prospectively assess the reliability of the ultrasound cardiac output monitor (USCOM™) for measuring stroke volume index and predicting left ventricular outflow tract diameter in adolescents with heart disease. Sixty consecutive adolescents with heart disease attending a tertiary medical center underwent USCOM™ assessment immediately after cardiac magnetic resonance imaging. USCOM™ measured stroke volume index and predicted left ventricular outflow tract diameter were compared to cardiac magnetic resonance imaging-derived values using Bland-Altman analysis. Ten patients with an abnormal left ventricular outflow tract were excluded from the analysis. An adequate USCOM™ signal was obtained in 49/50 patients. Mean stroke volume index was 46.1 ml/m2 by the USCOM™ (range 22-66.9 ml/m2) and 42.9 ml/m2 by cardiac magnetic resonance imaging (range 24.7-59.9 ml/m2). The bias (mean difference) was 3.2 ml/m2; precision (± 2SD of differences), 17 ml/m2; and mean percentage error, 38%. The mean (± 2SD) left ventricular outflow tract diameter was 0.445 ± 0.536 cm smaller by the USCOM™ algorithm prediction than by cardiac magnetic resonance imaging. Attempted adjustment of USCOM™ stroke volume index using cardiac magnetic resonance imaging left ventricular outflow tract diameter failed to improve agreement between the two modalities (bias 28.4 ml/m2, precision 44.1 ml/m2, percentage error 77.3%). Our study raises concerns regarding the reliability of USCOM™ for stroke volume index measurement in adolescents with cardiac disease, which did not improve even after adjusting for its inaccurate left ventricular outflow tract diameter prediction.

Keywords: Cardiology; Congenital heart disease; Hemodynamic monitoring; Pediatric intensive care; Pediatrics.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Cardiac Output*
  • Child
  • Echocardiography
  • Female
  • Humans
  • Magnetic Resonance Imaging / standards*
  • Male
  • Monitoring, Physiologic / instrumentation*
  • Prospective Studies
  • Reproducibility of Results
  • Stroke Volume
  • Ultrasonography / standards*