Time to Calm the Fick Down? A Systematic Review and Meta-Analysis of Thermodilution Compared to Direct Fick in Tricuspid Regurgitation

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-09-01 DOI:10.1016/j.cjco.2024.05.008
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Abstract

Background

Many clinicians consider thermodilution (TD) as a means to measure cardiac output (CO) to be unreliable in patients with tricuspid regurgitation (TR). No systematic appraisals of this clinical issue have been conducted. We hypothesized that the level of inaccuracy of using TD in patients with TR, compared to the direct Fick (DF) method, to determine CO, is overstated.

Methods

We performed a systematic search of 6 major literature databases for the period from 1946 to July 2023. Studies were included if they included CO measurements determined with both TD and the DF method in patients with vs without TR. Meta-analysis of the correlation between the measurements determined by TD vs the DF method was performed, stratified by the presence of TR.

Results

A total of 1064 studies were identified, of which 8 met the inclusion criteria. Four of the studies were included in the pooled analysis. The presence of TR did not affect the correlation between CO measurements determined by TD vs the DF method (moderate-to-severe TR: r = 0.90, 95% confidence interval 0.76, 0.96; mild or no TR, r = 0.86, 95% confidence interval 0.71, 0.93). Many studies had high levels of heterogeneity and risk of bias.

Conclusions

The accuracy of CO measurements made using TD, compared to the gold-standard DF method, may not be meaningfully affected by the presence of moderate-to-severe TR. Given the high levels of heterogeneity and risk of bias of the included studies, these findings should be replicated in a modern cohort.

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是时候让 Fick 平静下来了吗?三尖瓣反流中热稀释法与直接菲克法相比较的系统回顾和元分析
背景许多临床医生认为热稀释(TD)作为一种测量三尖瓣反流(TR)患者心输出量(CO)的方法并不可靠。目前尚未对这一临床问题进行系统评估。我们假设,与直接菲克(DF)法相比,在 TR 患者中使用 TD 测定 CO 的不准确程度被夸大了。方法我们对 1946 年至 2023 年 7 月期间的 6 个主要文献数据库进行了系统检索。如果研究纳入了同时使用 TD 和 DF 方法测定的 CO 测量值,且研究对象为有 TR 和无 TR 的患者,则纳入研究。根据是否存在 TR,对 TD 与 DF 方法测定值之间的相关性进行了 Meta 分析。结果共发现 1064 项研究,其中 8 项符合纳入标准。其中四项研究被纳入汇总分析。TR的存在并不影响TD法与DF法测定的CO测量值之间的相关性(中度至重度TR:r = 0.90,95%置信区间为0.76,0.96;轻度或无TR,r = 0.86,95%置信区间为0.71,0.93)。结论与黄金标准的 DF 方法相比,使用 TD 测量 CO 的准确性可能不会受到中重度 TR 的影响。考虑到所纳入研究的高度异质性和偏倚风险,这些研究结果应在现代队列中重复。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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