Diagnostic Value of Electrical Cardiometry for Detecting Left Ventricular Systolic Dysfunction in Critically Ill Neonates

Background: Hemodynamics and cardiac function monitoring are crucial for management of the critically ill neonates. Conventional transthoracic echocardiography (TTE) remains the gold standard for assessing cardiovascular hemodynamics, but is limited by being intermittent and operator-dependent. Aim of the work: to identify the ability of electric cardiometry-derived contractility indices to detect left ventricle (LV) systolic dysfunction in clinically unstable newborns. Subjects and Methods: This cross-sectional study included 120 neonates, divided into two groups; 75(62.5%) hemodynamically stable, and 45 (37.5%) unstable. Demographic and clinical data were recorded. Both groups were assessed by electrical cardiometry (EC) and conventional m-mode and pulsed Doppler TTE simultaneously. Results: The study included 120 newborns, comprising 63 (52.5%) males and 57 (47.5%) females, with a mean postnatal age of 9.89 ± 8.24 days; of these, 83 (70%) were preterm and 37 (30%) were full-term. Using EC, hemodynamically unstable neonates demonstrated significantly lower stroke volume (SV) (3.26 ± 1.13 ml), stroke index (SI) (21.35 ± 5.87 ml/m²), cardiac output (CO) (0.49 ± 0.16 L/min), cardiac index (CI) (3.24 ± 0.85 L/min/m²), index of contractility (ICON) (73.02 ± 24.96), and left ventricular ejection time (LVET) (149.2 ± 49.36 ms) compared with the stable group values of SV (4.27 ± 1.18 ml), SI (27.73 ± 5.98 ml/m²), CO(0.62 ± 0.18 L/min), CI (3.92 ± 0.89 L/min/m²), ICON (103.22 ± 35.61), and LVET (172.04 ± 27.97 ms) (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.006, respectively). The SV, CO, CI, and SI measurements between TTE and EC showed a strong significant correlation (r 0.993, p <0.001; r 0.990, p<0.001; r 0.969, p<0.001; r 0.973, p<0.001, respectively). Additionally, EC-derived ICON showed a strong positive correlation with echocardiographic fractional shortening (FS%) (r = 0.770, p < 0.001) and ejection fraction (EF%) (r 0.721 and p < 0.001). An ICON value below 65.9 predicted reduced contractility (FS <28% and ejection fraction <50%) with high sensitivity (96%) and good specificity (83%). None of the demographic or clinical variables had a significant effect on ICON values. Conclusion: EC provides a reliable, non-invasive, operator-independent tool for continuous cardiac monitoring in sick neonates. EC-derived ICON value below 65.9 is diagnostic for LV systolic dysfunction in critically sick newborns.