Thermodilution Assessment of Cardiac Index in Patients With Tricuspid Regurgitation.

BACKGROUND: Disparities between thermodilution (TD) and Fick measurements of cardiac index (CI) are common in real-world clinical practice. Published studies about the effect of tricuspid regurgitation (TR) on TD are small and describe conflicting results. We tested the correlation between TD and Fick across a wide range of TR severity, in a larger group of patients undergoing right heart catheterization (RHC). We aimed to determine if TD is an acceptable alternative to Fick in patients with TR in clinical practice. METHODS: We retrospectively evaluated patients undergoing RHC at a single center over a 10-month period, and included those with recent (<90 days) echocardiograms. TD was measured during RHC and Fick was calculated using estimated oxygen consumption. The primary outcome was the correlation between TD and Fick CIs. We performed regression modeling to evaluate predictors of the difference between TD and Fick. RESULTS: A total of 349 patients were included, 40% of whom had at least moderate TR. The correlation between TD and Fick was strong (r=0.765) and did not significantly differ in those with none to mild TR (r=0.73) and those with moderate to severe TR (r=0.80). Atrial fibrillation or atrial flutter was the only variable significantly associated with the difference between CI by Fick and TD (P=.04). CONCLUSION: The correlation between TD and Fick was strong and unaffected by TR severity.

Utility of plasma volume status in ambulatory patients with pulmonary hypertension.

Plasma volume status (PVS) is a noninvasive estimate of intravascular volume status. We studied the utility of PVS to predict short-term outcomes in patients with pulmonary hypertension. Patients with lower PVS had decreased risk of hospitalization and death within 90 days of clinic visit, compared to those with higher PVS.

Focused Cardiac Ultrasound in Dyspnea of Unclear Etiology in the Emergency Department: Utility of the FLUID Score.

OBJECTIVES: We evaluated the utility of focused cardiac ultrasound to predict the length of stay in patients presenting to the emergency department with dyspnea of unclear etiology. METHODS: Patients with focused cardiac ultrasound examinations performed in the emergency department for dyspnea over a 34-month period were retrospectively identified. Patients were excluded if they had a prior diagnosis of heart failure, dialysis requirement, or an etiology of dyspnea unrelated to the volume status. Left ventricular function was categorized as normal or reduced, and the inferior vena cava was categorized as normal or increased volume. A fast limited ultrasound to investigate dyspnea (FLUID) score was calculated by adding 1 point for reduced left ventricular function and 1 point for increased volume, producing a score of 0, 1, or 2. RESULTS: There were 123 patients included. There was a significant correlation between the FLUID score and length of stay, with longer stays for higher scores (FLUID score 0, 7.4 hours median; FLUID score 1, 2.34 days; FLUID score 2, 5.56 days; analysis of variance P < .001). Of the other variables collected, only age, hypertension, diabetes, heart rate, and brain natriuretic peptide were significantly correlated with the length of stay. A multivariate analysis including those variables and the FLUID score showed that the FLUID score was the strongest independent predictor of the length of stay. CONCLUSIONS: Focused cardiac ultrasound and calculation of a FLUID score for patients with undifferentiated dyspnea can be a powerful tool to predict the hospital length of stay.

Ventriculoseptal Rupture Caused by Takotsubo Syndrome.

Ventriculoseptal rupture (VSR) is a rare complication of takotsubo syndrome that often requires immediate treatment. Patients with VSR experience a range of outcomes and should be managed at centers with cardiac and surgical expertise. We present 2 cases of VSR complicating takotsubo syndrome that highlight potential outcomes. (Level of Difficulty: Intermediate.).