Marian Sidor1, Lalith Premachandra2, Bishoy Hanna3, Nanda Nair4, Amit Misra5. 1. Division of Rheumatology and Connective Tissue Research, Department of Medicine, RWJ-Rutgers University, New Brunswick, NJ, USA. 2. Department of Neurocritical Care, Neurotherapeutics and Neurosurgery, UT Southwestern Medical Center, Dallas, TX, USA. 3. Department of Pulmonary Disease and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA. 4. BayCare Medical Group Cardiology and Heart and Vascular Institute of Florida, Safety Harbor, FL, USA. 5. Urgent Care Medicine, Kaiser Permanente, Bakersfield, CA, USA.
Abstract
OBJECTIVE: Evaluation of common carotid artery (CCA) blood flow can provide valuable information regarding the hemodynamic status of a patient. Utilizing ultrasound, we aimed to evaluate the correlation between cardiac output and different hemodynamic parameters in the CCA, namely systolic carotid flow (SCF), corrected flow time (CFT), and total carotid flow (TCF). METHODS: We studied a pilot sample of 20 healthy volunteers. Hemodynamic parameters were collected in the right CCA and the heart at rest (baseline), 1-leg compression, 2-leg compression, and passive leg raise. Nonparametric Spearman correlation was calculated using STATA 13 software. RESULTS: This study demonstrated the feasibility and safety of the leg compression testing as a hemodynamic maneuver to simulate volume depletion status. We demonstrated a direct correlation between cardiac output and SCF of 0.67 with a P value < 0.001. Interestingly, TCF calculated based on volume-time integral (VTI) in the carotid artery showed positive correlation of only 0.41, with P < 0.06, and it did not reach statistical significance. We also found a positive correlation between CFT and cardiac output at baseline 0.57, with P < 0.001. CONCLUSION: Variations in cardiac preload and the subsequent alterations in cardiac output were directly translatable into variations in the carotid blood flow. This supports the potential for using carotid flow as a surrogate for cardiac output. The most promising parameters were SCF, CFT, and carotid systolic VTI. Further work is needed to validate these correlations and utilize these acquired carotid parameters to guide fluid management and predict fluid responsiveness.
OBJECTIVE: Evaluation of common carotid artery (CCA) blood flow can provide valuable information regarding the hemodynamic status of a patient. Utilizing ultrasound, we aimed to evaluate the correlation between cardiac output and different hemodynamic parameters in the CCA, namely systolic carotid flow (SCF), corrected flow time (CFT), and total carotid flow (TCF). METHODS: We studied a pilot sample of 20 healthy volunteers. Hemodynamic parameters were collected in the right CCA and the heart at rest (baseline), 1-leg compression, 2-leg compression, and passive leg raise. Nonparametric Spearman correlation was calculated using STATA 13 software. RESULTS: This study demonstrated the feasibility and safety of the leg compression testing as a hemodynamic maneuver to simulate volume depletion status. We demonstrated a direct correlation between cardiac output and SCF of 0.67 with a P value < 0.001. Interestingly, TCF calculated based on volume-time integral (VTI) in the carotid artery showed positive correlation of only 0.41, with P < 0.06, and it did not reach statistical significance. We also found a positive correlation between CFT and cardiac output at baseline 0.57, with P < 0.001. CONCLUSION: Variations in cardiac preload and the subsequent alterations in cardiac output were directly translatable into variations in the carotid blood flow. This supports the potential for using carotid flow as a surrogate for cardiac output. The most promising parameters were SCF, CFT, and carotid systolic VTI. Further work is needed to validate these correlations and utilize these acquired carotid parameters to guide fluid management and predict fluid responsiveness.
Entities:
Keywords:
cardiac output; carotid flow; leg compression test; systolic carotid flow; velocity time integral; volume responsiveness
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