Cardiac power output accurately reflects external cardiac work over a wide range of inotropic states in pigs

Abstract

Background: Cardiac power output (CPO), derived from the product of cardiac output and mean aortic pressure, is an important yet underexploited parameter for hemodynamic monitoring of critically ill patients in the intensive-care unit (ICU). The conductance catheter-derived pressure-volume loop area reflects left ventricular stroke work (LV SW). Dividing LV SW by time, a measure of LV SW min-1 is obtained sharing the same unit as CPO (W). We aimed to validate CPO as a marker of LV SW min-1 under various inotropic states. Methods: We retrospectively analysed data obtained from experimental studies of the hemodynamic impact of mild hypothermia and hyperthermia on acute heart failure. Fifty-nine anaesthetized and mechanically ventilated closed-chest Landrace pigs (68 ± 1 kg) were instrumented with Swan-Ganz and LV pressure-volume catheters. Data were obtained at body temperatures of 33.0 °C, 38.0 °C and 40.5 °C; before and after: Resuscitation, myocardial infarction, endotoxemia, sevoflurane-induced myocardial depression and beta-adrenergic stimulation. We plotted LVSW min-1 against CPO by linear regression analysis, as well as against the following classical indices of LV function and work: LV ejection fraction (LV EF), rate-pressure product (RPP), triple product (TP), LV maximum pressure (LVPmax) and maximal rate of rise of LVP (LV dP/dtmax). Results: CPO showed the best correlation with LV SW min-1 (r 2 = 0.89; p < 0.05) while LV EF did not correlate at all (r 2 = 0.01; p = 0.259). Further parameters correlated moderately with LV SW min-1 (LVPmax r 2 = 0.47, RPP r 2 = 0.67; and TP r 2 = 0.54). LV dP/dtmax correlated worst with LV SW min-1 (r 2 = 0.28). Conclusion: CPO reflects external cardiac work over a wide range of inotropic states. These data further support the use of CPO to monitor inotropic interventions in the ICU.