Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Jun;26(2):429-434.
doi: 10.1007/s40477-022-00671-6. Epub 2022 Apr 21.

A modified subcostal view: a novel method for measuring the LVOT VTI

Issac Cheong  1   2 , Victoria Otero Castro  3 , Raúl Alejandro Gómez  3 , Pablo Martín Merlo  4 , Francisco Marcelo Tamagnone  4
Affiliations
Observational Study

A modified subcostal view: a novel method for measuring the LVOT VTI

Issac Cheong et al. J Ultrasound. 2023 Jun.

Abstract

Purpose: The velocity time integral (VTI) of the left ventricular outflow tract (LVOT) obtained in the apical view by echocardiography can be regarded as a surrogate for the stroke volume. In critically ill patients it is often difficult to obtain an appropriate apical view to assess the VTI. The subcostal view is more accessible, but while it allows a qualitative assessment of the heart, is not adequate for estimating a reliable LVOT VTI, given the inappropriate angle between the Doppler signal and the flow through the LVOT. We present a new modified subcostal view that allows a proper LVOT VTI measurement.

Methods: This is a single-centre experimental, retrospective, and observational study using data from patients in a tertiary-care centre. We included adult patients admitted to the intensive care unit in the period from June 2020 to January 2022, who were evaluated by echocardiography and whose LVOT VTI was measured aligned with the Doppler signal in both the apical five-chamber view and the modified subcostal view.

Results: A total of 30 patients were evaluated in the study period by ultrasonography. The Bland-Altman method analysis of the LVOT VTI measured in the apical view compared with that obtained in the subcostal view showed a bias of 0.8 (95% CI 0.39-1.21) with a 95% limit of agreement between - 1.35 (95% CI - 2.06 to - 0.64) and 2.96 (95% CI 2.25-3.67). The percentage error was calculated to be 23%. The Pearson correlation coefficient for the two forms of measurements showed an R value of 0.98 (95% CI 0.96-0.99).

Conclusion: The LVOT VTI measured in a modified subcostal view is useful for estimating the value of the LVOT VTI obtained in an apical view.

Keywords: Cardiac output; Critical care; Echocardiography; POCUS; Subcostal view.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Transducer position for the modified subcostal windows to visualize LVOT
Fig. 2
Fig. 2
B mode of the modified subcostal view that allows the visualization of the LVOT (yellow arrow) which is aligned with the dotted line representing the incidence of the Doppler signal (AO aorta, PA pulmonary artery)
Fig. 3
Fig. 3
Pulsed wave Doppler mode at the LVOT above the aortic valve in the modified subcostal view with its VTI measurement
Fig. 4
Fig. 4
Bland–Altman plot between LVOT VTI in apical and the modified subxiphoid views
Fig. 5
Fig. 5
Correlation between LVOT VTI in apical and the modified subxiphoid views
See this image and copyright information in PMC

References

    1. Blanco P. Rationale for using the velocity-time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings. Ultrasound J. 2020;12(1):21. doi: 10.1186/s13089-020-00170-x. - DOI - PMC - PubMed
    1. Mercado P, Maizel J, Beyls C, Titeca-Beauport D, Joris M, Kontar L, Riviere A, Bonef O, Soupison T, Tribouilloy C, de Cagny B, Slama M. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Crit Care. 2017;21(1):136. doi: 10.1186/s13054-017-1737-7. - DOI - PMC - PubMed
    1. Wang J, Zhou D, Gao Y, Wu Z, Wang X, Lv C. Effect of VTILVOT variation rate on the assessment of fluid responsiveness in septic shock patients. Medicine (Baltimore) 2020;99(47):e22702. doi: 10.1097/MD.0000000000022702. - DOI - PMC - PubMed
    1. Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest. 2001;119(3):867–873. doi: 10.1378/chest.119.3.867. - DOI - PubMed
    1. Biais M, Vidil L, Sarrabay P, Cottenceau V, Revel P, Sztark F. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients: comparison between echocardiography and Vigileo/FloTrac device. Crit Care. 2009;13(6):R195. doi: 10.1186/cc8195. - DOI - PMC - PubMed

Publication types

LinkOut - more resources