Continuous Arterial Pressure Waveform Analysis Accurately Detects Cardiac Output in Cardiac Surgery: A Prospective Comparison with Thermodilution, Echocardiography, and Magnetic Resonance Techniques


  • Sahin Senay
  • Fevzi Toraman
  • Serkan Gelmez
  • Sinan Da?delen
  • Hasan Karabulut
  • Cem Alhan



Objective: The aim of this study was to compare the accuracy of cardiac output (CO) measurements of noninvasive continuous arterial pressure waveform analysis, thermodilution technique and echocardiography with magnetic resonance (MRI) imaging.

Methods: Eleven patients who underwent coronary bypass surgery under cardiopulmonary bypass were prospectively enrolled in this study in 2008. Repeated arterial pressure based, thermodilution, echocardiography, and MRI cardiac output measurements were performed at the postoperative 24th hour.

Results: Mean CO values were 5.58 ± 0.98, 5.97 ± 0.8, 5.31 ± 0.52, and 5.32 ± 0.92 measured with MRI, echocardiography, arterial pressure waveform analysis, and thermodilution techniques, respectively. Bland-Altman analysis showed good overall agreement between the MRI vs arterial waveform analysis and MRI vs thermodilution; values for bias ± SD were -0.27 ± 1.06 (95% confidence interval [CI] [-2.3 to 1.8]; P = .42) and -0.26 ± 0.89 (95% CI [-2.0 to 1.5]; P = .34), respectively. Poor agreement was defined between MRI and echocardiography: bias ± SD, 0.39 ± 1.28 (95% CI [-2.1 to 2.9]; P = .34).

Conclusions: Arterial pressure-based and thermodilution CO measurement systems yielded results comparable to those obtained with cardiac MRI assessment after cardiac surgery. Arterial pressure wave-form analysis systems for CO measurement may be feasible, noninvasive methods for use in cardiac surgery.


Bein B, Worthmann F, Tonner PH, et al. 2004. Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output. J Cardiothorac Vasc Anesth 18:185-9.nBettex DA, Hinselmann V, Hellermann JP, et al. 2004. Transesophageal echocardiography is unreliable for cardiac output assessment after cardiac surgery compared with thermodilution. Anaesthesia 59:1184-92.nBottini PB, Carr AA, Prisant M, et al. 1995. Magnetic resonance imaging compared to echocardiography to assess left ventricular mass in the hypertensive patient. Am J Hypertens 8:221-8.nBreukers RM, Sepehrkhouy S, Spiegelenberg SR, et al. 2007. Cardiac output measured by a new arterial pressure waveform analysis method without calibration compared with thermodilution after cardiac surgery. J Cardiothorac Vasc Anesth 21:632-5.nButton D, Weibel L, Reuthebuch O, et al. 2007. Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth 99:329-36.nCastillo E, Lima JA, Bluemke DA. 2003. Regional myocardial function: advances in MR imaging and analysis. Radiographics 23 Spec No:S127-40. Available from:'> FD, Zukunft B, Hoffmann C, Zidek W, Schaefer JH. 2008. Performance of a minimally invasive uncalibrated cardiac output monitoring system (FlotracTM/VigileoTM) in hemodynamically unstable patients. Br J Anaesth 100:451-6.nGiomarelli P, Biagioli B, Scolletta S. 2004. Cardiac output monitoring by pressure recording analytical method in cardiac surgery. Eur J Cardiothorac Surg 26:515-20.nIshihara H, Okawa H, Tanabe B, et al. 2004. A new noninvasive continuous cardiac output trend solely utilizing routine cardiovascular monitors. J Clin Monit Comput 18:313-20.nLorsomradee S, Lorsomradee S, Cromheecke S, et al. 2007. Uncalibrated arterial pulse contour analysis versus continuous thermodilution technique: effects of alterations in arterial waveform. J Cardiothorac Vasc Anesth 21:636-43.nLorsomradee S, Lorsomradee SR, Cromheecke S, et al. 2007. Continuous cardiac output measurement: arterial pressure analysis versus thermodilution technique during cardiac surgery with cardiopulmonary bypass. Anaesthesia 62:979-83.nMayer J, Boldt J, Wolf MW, et al. 2008. Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device. Anesth Analg 106:867-72.nMorris AH, Chapman RH, Gardner RM. 1984. Frequency of technical problems encountered in the measurement of pulmonary artery wedge pressure. Crit Care Med 12:164-70.nPattynama PMT, Lamb HJ, Van der Velde EA, et al. 1993. Left ventricular measurements with cine and spin-echo imaging: a study of reproducibility with variance component analysis. Radiology 187:261-8.nPluim BP, Beyerbacht HP, Chin JC, et al. 1997. Comparison of echocardiography with magnetic resonance in the assessment of the athlete's heart. Eur Heart J 18:1505-13.nRoyse CF, Royse AG, Blake DW, et al. 1999. Measurement of cardiac output by transoesophageal echocardiography: a comparison of two Doppler methods with thermodilution. Anaesth Intensive Care 27:586-90.nYamamuro M, Tadamura E, Kubo S, et al. 2005. Cardiac functional analysis with multi-detector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging. Radiology 234:381-90.n



How to Cite

Senay, S., Toraman, F., Gelmez, S., Da?delen, S., Karabulut, H., & Alhan, C. (2009). Continuous Arterial Pressure Waveform Analysis Accurately Detects Cardiac Output in Cardiac Surgery: A Prospective Comparison with Thermodilution, Echocardiography, and Magnetic Resonance Techniques. The Heart Surgery Forum, 12(2), E75-E78.