The Compensatory Reserve Index Responds to Acute Hemodynamic Changes in Patients with Congenital Heart Disease: A Proof of Concept Study

Patients with congenital heart disease (CHD) who undergo cardiac procedures may become hemodynamically unstable. Predictive algorithms that utilize dense physiologic data may be useful. The compensatory reserve index (CRI) trends beat-to-beat progression from normovolemia (CRI = 1) to decompensation...

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Published in:Pediatric cardiology Vol. 41; no. 6; pp. 1190 - 1198
Main Authors: Ehrmann, Daniel E., Leopold, David K., Phillips, Ryan, Shahi, Niti, Campbell, Kristen, Ross, Michael, Zablah, Jenny E., Moulton, Steven L., Morgan, Gareth, Kim, John S.
Format: Journal Article
Language:English
Published: New York Springer US 01.08.2020
Springer
Subjects:
Adolescent
Adult
Algorithms
Cardiac Catheterization
Cardiac Surgery
Cardiology
Care and treatment
Congenital heart disease
Female
Genetic disorders
Heart Defects, Congenital - surgery
Heart Valve Prosthesis Implantation - methods
Hemodynamics
Humans
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Original Article
Photoplethysmography
Proof of Concept Study
Prospective Studies
Pulmonary Valve - surgery
Stroke Volume
Treatment Outcome
Valves
Vascular Surgery
Vital Signs - physiology
Young Adult
Colorado
Transcatheter pulmonary valve replacement
Compensatory reserve index
Congenital heart disease
Predictive algorithm
ISSN:0172-0643, 1432-1971, 1432-1971
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Summary:Patients with congenital heart disease (CHD) who undergo cardiac procedures may become hemodynamically unstable. Predictive algorithms that utilize dense physiologic data may be useful. The compensatory reserve index (CRI) trends beat-to-beat progression from normovolemia (CRI = 1) to decompensation (CRI = 0) in hemorrhagic shock by continuously analyzing unique sets of features in the changing pulse photoplethysmogram (PPG) waveform. We sought to understand if the CRI accurately reflects changing hemodynamics during and after a cardiac procedure for patients with CHD. A transcatheter pulmonary valve replacement (TcPVR) model was used because left ventricular stroke volume decreases upon sizing balloon occlusion of the right ventricular outflow tract (RVOT) and increases after successful valve placement. A single-center, prospective cohort study was performed. The CRI was continuously measured to determine the change in CRI before and after RVOT occlusion and successful TcPVR. Twenty-six subjects were enrolled with a median age of 19 (interquartile range (IQR) 13–29) years. The mean (± standard deviation) CRI decreased from 0.66 ± 0.15 1-min before balloon inflation to 0.53 ± 0.16 ( p  = 0.03) 1-min after balloon deflation. The mean CRI increased from a pre-valve mean CRI of 0.63 [95% confidence interval (CI) 0.56–0.70] to 0.77 (95% CI 0.71–0.83) after successful TcPVR. In this study, the CRI accurately reflected acute hemodynamic changes associated with TcPVR. Further research is justified to determine if the CRI can be useful as an early warning tool in patients with CHD at risk for decompensation during and after cardiac procedures.
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ISSN:0172-0643
1432-1971
1432-1971
DOI:10.1007/s00246-020-02374-3