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ABSTRACT Incremental Doppler stress echocardiographic evaluation of cardiovascular reserve in heart failure: A case comparison of 2D independent CW Doppler and thermodilution. R.A.Phillips, M.J.West, D.J.Burstow, J.Wright, L.H.Naylor, D.J.Green, G.O’Driscoll The University of Queensland, Brisbane, Australia, the Royal Perth Hospital and the University of Western Australia, Perth, Australia Background: Heart failure is a common and serious condition characterised by impaired cardiac output (CO), and increased morbidity and mortality. Doppler ultrasound is a reliable and reproducible method of measuring CO, and is routinely used to determine the severity of cardiac failure. Intractable cardiac failure may require cardiac transplantation for the prolongation of life. While pharmacotherapy may maintain reasonable health, ventricular assist devices (VAD), which by-pass blood from the ventricle or atrium to the aorta on the left, or the atrium to the pulmonary artery on the right, reducing ventricular pressures, volumes and wall stress, can be used for haemodynamic support prior to transplantation. Assessment of cardiovascular reserve, the ability to upregulate CO on demand, may be influential in determining appropriate short and long term management. One method currently used to evaluate cardiovascular reserve is thermodilution CO measurements during incremental exercise testing. CW Doppler ultrasound may provide such measurements non-invasively. This presentation compares serial CO measurements in a subject in cardiac failure at rest, during exercise, and post biVAD implantation, using invasive thermodilution and a dedicated 2D independent CW Doppler ultrasound device. Method: Serial simultaneous haemodynamic measurements were made using both methods with the subject supine at rest, erect at rest, and during incremental bicycle exercise testing and post biVAD implantation. Five consecutive CW Doppler outputs were averaged for comparison with each invasive measure to minimise the effects of beat to beat physiologic variability. Continuous and injectate derived outputs were compared to the CW results using mean values and Bland-Altman bias analysis. Results: The mean cardiac output at rest and during exercise by thermodilution was 3.51±0.66l/min, and 3.42±0.51l/min for CW Doppler (n=16). There was a mean difference between methods of 0.09±0.58l/m. Using the Critchley criteria (precision of new method/mean value of the reference method x 100), and despite the small sample numbers, the CW method compared well with thermodilution (16.8%), with the resolution required for validation of a new CO measurement method being <30% (J Clin Monit. 1999). Conclusion: This case demonstrates favourable comparison of CO measurements at rest and during exercise, using CW Doppler and thermodilution. This 2D independent CW Doppler device may be a cost effective, non-invasive alternative for evaluation of subjects with cardiac failure. July 22, 2003 International Society of Cardiovascular Ultrasound, Buenos Aires, 2003