Key result
Peak velocity variation within the carotid artery demonstrated strong correlation (ρ = 0.88) and acceptable concordance (93%) with stroke volume variation in cardiac surgery patients.
Why the study?
Peak velocity variation in the carotid artery and LVOT derived from pulsed wave Doppler may predict fluid responsiveness, but required evaluation against calibrated SVV and PVV.
Does peak velocity variation within the carotid artery and left ventricular outflow tract accurately estimate stroke volume variation and pulse pressure variation in cardiac surgery patients?
Observational (n=18)
Does peak velocity variation within the carotid artery and left ventricular outflow tract accurately estimate stroke volume variation and pulse pressure variation in cardiac surgery patients?
Carotid artery peak velocity variation measured by Doppler shows acceptable agreement with stroke volume variation and may serve as a non-invasive tool for assessing fluid responsiveness in cardiac surgery patients.
May support carotid Doppler as non-invasive fluid responsiveness marker in cardiac surgery; leaves open randomized validation before practice change.
The peak velocity variation within the carotid artery (ΔVpeakCCA) and left ventricular outflow tract (ΔVpeakLVOT) is derived from the pulsed wave Doppler waveform and may predict fluid responsiveness. The aim of this study was to evaluate ΔVpeakCCA and ΔVpeakLVOT against calibrated stroke volume variation (SVV) and pulse pressure variation (PVV). Therefore, eighteen cardiac surgery patients were included in this prospective observational study. Doppler measurements were performed after induction of anesthesia, after a passive leg raise, and at the end of surgery. Simultaneously, SVV and PPV were measured by pulse-contour-analysis (PiCCO). The correlation, methodological agreement, concordance, and clinical agreement between Doppler and PiCCO measurements were assessed. The correlation between SVV and ΔVpeakCCA was strong (ρ = 0.88). Bland-Altman analysis demonstrated a bias of 0.01%, and LOA +/− 4.6%, acceptable concordance (93%), and close to acceptable clinical agreement (88%). For PPV and ΔVpeakCCA correlation was also strong (ρ = 0.73), bias was −0.2%, LOA +/− 7.6%, with intermediate acceptable concordance (90%), and low clinical agreement (72%). Analysis of ΔVpeakLVOT measurements demonstrated poor statistical agreement with SVV and PPV. In conclusion, in cardiac surgery patients ΔVpeakCCA, as opposed to ΔVpeakLVOT, has acceptable statistical and clinical agreement with SVV measurements. ΔVpeakCCA may qualify as a potential tool for non-invasive assessment of fluid responsiveness.
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Houte et al. (2023) conducted an observational in Cardiac surgery (n=18). Peak velocity variation (ΔVpeakCCA and ΔVpeakLVOT) vs. Stroke volume variation (SVV) and pulse pressure variation (PPV) by PiCCO was evaluated on Correlation and agreement between Doppler (ΔVpeakCCA) and PiCCO (SVV) measurements (ρ = 0.88). Peak velocity variation within the carotid artery demonstrated strong correlation (ρ = 0.88) and acceptable concordance (93%) with stroke volume variation in cardiac surgery patients.
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