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Mattavelli I, Vignati C, Farina S, Apostolo A, Cattadori G, De Martino F, Pezzuto B, Zaffalon D, Agostoni P. Beyond VO2: the complex cardiopulmonary exercise test. Eur J Prev Cardiol 2023; 30:ii34-ii39. [PMID: 37819225 DOI: 10.1093/eurjpc/zwad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023]
Abstract
Cardiopulmonary exercise test (CPET) is a valuable diagnostic tool with a specific application in heart failure (HF) thanks to the strong prognostic value of its parameters. The most important value provided by CPET is the peak oxygen uptake (peak VO2), the maximum rate of oxygen consumption attainable during physical exertion. According to the Fick principle, VO2 equals cardiac output (Qc) times the arteriovenous content difference [C(a-v)O2], where Ca is the arterial oxygen and Cv is the mixed venous oxygen content, respectively; therefore, VO2 can be reduced both by impaired O2 delivery (reduced Qc) or extraction (reduced arteriovenous O2 content). However, standard CPET is not capable of discriminating between these different impairments, leading to the need for 'complex' CPET technologies. Among non-invasive methods for Qc measurement during CPET, inert gas rebreathing and thoracic impedance cardiography are the most used techniques, both validated in healthy subjects and patients with HF, at rest and during exercise. On the other hand, the non-invasive assessment of peripheral muscle perfusion is possible with the application of near-infrared spectroscopy, capable of measuring tissue oxygenation. Measuring Qc allows, by having haemoglobin values available, to discriminate how much any VO2 deficit depends on the muscle, anaemia or heart.
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Affiliation(s)
- Irene Mattavelli
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Stefania Farina
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
- Cytogenetics and Medical Genetics, University of Milano-Bicocca, Milan, Italy
| | - Anna Apostolo
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
| | - Gaia Cattadori
- Multimedica IRCCS, Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milan, Italy
| | - Fabiana De Martino
- Casa di Cura Tortorella, Dipartimento Medico, Unità funzionale di Cardiologia, Casa di Cura Tortorella, Salerno, Italy
| | - Beatrice Pezzuto
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
| | - Denise Zaffalon
- Cardiovascular Department, 'Azienda Sanitaria Universitaria Giuliano-Isontina', Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Robertson L, Bunclark K, Ross RM, Cannon J, Sheares K, Taboada D, Pepke-Zaba J, Toshner M. The prognostic ability of cardiac output determined by inert gas rebreathing technique in pulmonary hypertension. Chron Respir Dis 2022; 19:14799731221078473. [PMID: 35184583 PMCID: PMC8864257 DOI: 10.1177/14799731221078473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This investigation validated the inert gas rebreathing (IGR) technique and
determined IGR prognostic ability compared to invasive cardiac output
measurements in patients with pulmonary hypertension. IGR compared with
thermodilution cardiac output demonstrated a moderate bias. IGR technique
demonstrated long-term prognostic value comparable to invasive cardiac output in
pulmonary hypertension patients
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Affiliation(s)
- Lucy Robertson
- Department of Medicine, University
of Cambridge, Cambridge, UK
- Lucy Robertson, Pulmonary Vascular Disease
Unit, Royal Papworth Hospital, Papworth Road, Cambridge CB2 0AY, UK.
| | | | | | - John Cannon
- Department of Medicine, University
of Cambridge, Cambridge, UK
| | - Karen Sheares
- Department of Medicine, University
of Cambridge, Cambridge, UK
| | - Dolores Taboada
- Department of Medicine, University
of Cambridge, Cambridge, UK
| | | | - Mark Toshner
- Department of Medicine, University
of Cambridge, Cambridge, UK
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Stach K, Michels J, Doesch C, Brade J, Papavassiliu T, Borggrefe M, Akin I, Saur J, Trinkmann F. Non‑invasive measurement of hemodynamic response to postural stress using inert gas rebreathing. Biomed Rep 2019; 11:98-102. [DOI: 10.3892/br.2019.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/09/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ksenija Stach
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Julia Michels
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Christina Doesch
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Joachim Brade
- Department of Medical Statistics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, D‑68167 Mannheim, Germany
| | - Theano Papavassiliu
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Joachim Saur
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
| | - Frederik Trinkmann
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany
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Smith JR, Johnson BD, Olson TP. Impaired central hemodynamics in chronic obstructive pulmonary disease during submaximal exercise. J Appl Physiol (1985) 2019; 127:691-697. [PMID: 31295068 DOI: 10.1152/japplphysiol.00877.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is unknown whether central hemodynamics are impaired during exercise in chronic obstructive pulmonary disease (COPD) patients. We hypothesized that, at a similar absolute V̇o2 during exercise, COPD patients would have a lower stroke volume and cardiac output compared with healthy controls. Furthermore, we hypothesized that greater static hyperinflation [ratio of inspiratory capacity to total lung capacity (IC/TLC)] and expiratory intrathoracic pressure would be significantly related to the lower cardiac output and stroke volume responses in COPD patients. Clinically stable COPD (n = 13; FEV1/FVC: 52 ± 13%) and controls (n = 10) performed constant workload submaximal exercise at an absolute V̇o2 of ~1.3 L/min. During exercise, inspiratory capacity maneuvers were performed to determine operating lung volumes and cardiac output (via open-circuit acetylene rebreathe technique) and esophageal pressure were measured. At similar absolute V̇o2 during exercise (P = 0.81), COPD had lower cardiac output than controls (COPD: 11.0 ± 1.6 vs. control: 12.2 ± 1.2 L/min, P = 0.03) due to a lower stroke volume (COPD: 107 ± 13 vs. control: 119 ± 19 mL, P = 0.04). The heart rate response during exercise was not different between groups (P = 0.66). FEV1 (%predicted) and IC/TLC were positively related to stroke volume (r = 0.68, P = 0.01 and r = 0.77, P < 0.01). Last, esophageal pressure-time integral during inspiration was positively related to cardiac output (r = 0.56, P = 0.047). These data demonstrate that COPD patients have attenuated cardiac output and stroke volume responses during exercise compared with control. Furthermore, these data suggest that the COPD patients with the most severe hyperinflation and more negative inspiratory intrathoracic pressures have the most impaired central hemodynamic responses.NEW & NOTEWORTHY Chronic obstructive pulmonary disease leads to cardiac structural changes and pulmonary derangements that impact the integrative response to exercise. However, it is unknown whether these pathophysiological alterations influence the cardiac response during exercise. Herein, we demonstrate that COPD patients exhibit impaired central hemodynamics during exercise that are worsened with greater hyperinflation.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Vignati C, Morosin M, Fusini L, Pezzuto B, Spadafora E, De Martino F, Salvioni E, Rovai S, Filardi PP, Sinagra G, Agostoni P. Do rebreathing manoeuvres for non-invasive measurement of cardiac output during maximum exercise test alter the main cardiopulmonary parameters? Eur J Prev Cardiol 2019; 26:1616-1622. [DOI: 10.1177/2047487319845967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inert gas rebreathing has been recently described as an emergent reliable non-invasive method for cardiac output determination during exercise, allowing a relevant improvement of cardiopulmonary exercise test clinical relevance. For cardiac output measurements by inert gas rebreathing, specific respiratory manoeuvres are needed which might affect pivotal cardiopulmonary exercise test parameters, such as exercise tolerance, oxygen uptake and ventilation vs carbon dioxide output (VE/VCO2) relationship slope. Method We retrospectively analysed cardiopulmonary exercise testing of 181 heart failure patients who underwent both cardiopulmonary exercise testing and cardiopulmonary exercise test+cardiac output within two months (average 16 ± 15 days). All patients were in stable clinical conditions (New York Heart Association I–III) and on optimal medical therapy. Results The majority of patients were in New York Heart Association Class I and II (78.8%), with a mean left ventricular ejection fraction of 31 ± 10%. No difference was found between the two tests in oxygen uptake at peak exercise (1101 (interquartile range 870–1418) ml/min at cardiopulmonary exercise test vs 1103 (844–1389) at cardiopulmonary exercise test-cardiac output) and at anaerobic threshold. However, anaerobic threshold and peak heart rate, peak workload (75 (58–101) watts and 64 (42–90), p < 0.01) and carbon dioxide output were significantly higher at cardiopulmonary exercise testing than at cardiopulmonary exercise test+cardiac output, whereas VE/VCO2 slope was higher at cardiopulmonary exercise test+cardiac output (30 (27–35) vs 33 (28–37), p < 0.01). Conclusion The similar anaerobic threshold and peak oxygen uptake in the two tests with a lower peak workload and higher VE/VCO2 slope at cardiopulmonary exercise test+cardiac output suggest a higher respiratory work and consequent demand for respiratory muscle blood flow secondary to the ventilatory manoeuvres. Accordingly, VE/VCO2 slope and peak workload must be evaluated with caution during cardiopulmonary exercise test+cardiac output.
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Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Marco Morosin
- Centro Cardiologico Monzino, IRCCS, Italy
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste, Italy
| | | | | | | | | | | | - Sara Rovai
- Centro Cardiologico Monzino, IRCCS, Italy
- Università degli Studi di Padova, Italy
| | - Pasquale P Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
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Evaluation of inert gas rebreathing for determination of cardiac output: influence of age, gender and body size. Hypertens Res 2018; 42:834-844. [PMID: 30560890 PMCID: PMC8076049 DOI: 10.1038/s41440-018-0179-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/28/2018] [Accepted: 11/04/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study was to evaluate an inert gas rebreathing method (Innocor) for measurement of cardiac output and related haemodynamic variables and to provide robust normative data describing the influence of age, gender and body size on these variables. Four separate studies were conducted: measurement repeatability (study 1, n = 45); postural change (study 2, n = 40); response to submaximal cycling exercise (study 3, n = 20); and the influence of age, gender and body size (study 4, n = 1400). Repeated measurements of cardiac output, stroke volume and heart rate were similar, with low mean (±SD) differences (0.26 ± 0.53 L/min, 0 ± 11 mL and 2 ± 6beats/min, respectively). In addition, cardiac output and stroke volume both declined progressively from supine to seated and standing positions (P < 0.001 for both) and there was a stepwise increase in both parameters moving from rest to submaximal exercise (P < 0.001 for both). In study 4, there was a significant age-related decline in cardiac output and stroke volume in males and females, which remained significant after adjusting for body surface area (BSA, P < 0.001 for all comparisons). Both parameters were also significantly higher in those with high body mass index (BMI; P < 0.01 versus those with normal BMI for all comparisons), although indexing cardiac output and stroke volume to BSA reversed these trends. Inert gas rebreathing using the Innocor device provides repeatable measurements of cardiac output and related indices, which are sensitive to the effects of acute physiological manoeuvres. Moreover, inert gas rebreathing is a suitable technique for examining chronic influences such as age, gender and body size on key haemodynamic components of the arterial blood pressure.
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7
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Masini G, Foo LF, Cornette J, Tay J, Rizopoulos D, McEniery CM, Wilkinson IB, Lees CC. Cardiac output changes from prior to pregnancy to post partum using two non-invasive techniques. Heart 2018; 105:715-720. [PMID: 30377262 DOI: 10.1136/heartjnl-2018-313682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES We aimed to describe cardiac output (CO) trend from prepregnancy to post partum using an inert gas rebreathing (IGR) device and compare these measurements with those obtained by a pulse waveform analysis (PWA) technique, both cross-sectionally and longitudinally. METHODS Non-smoking healthy women, aged 18-44 years, with body mass index <35 were included in this prospective observational study. CO measurements were collected at different time points (prepregnancy, at four different gestational epochs and post partum) using IGR and PWA. A linear mixed model analysis tested whether the longitudinal change in CO differed between the techniques. Bland-Altman analysis and intraclass correlation coefficient (ICC) were used for cross-sectional and a four-quadrant plot for longitudinal comparisons. RESULTS Of the 413 participants, 69 had a complete longitudinal assessment throughout pregnancy. In this latter cohort, the maximum CO rise was seen at 15.2 weeks with IGR (+17.5% from prepregnancy) and at 10.4 weeks with PWA (+7.7% from prepregnancy). Trends differed significantly (p=0.0093). Cross-sectional analysis was performed in the whole population of 413 women: the mean CO was 6.14 L/min and 6.38 L/min for PWA and IGR, respectively, the percentage of error was 46% and the ICC was 0.348, with similar results at all separate time points. Longitudinal concordance was 64%. CONCLUSIONS Despite differences between devices, the maximum CO rise in healthy pregnancies is more modest and earlier than previously reported. The two methods of CO measurement do not agree closely and cannot be used interchangeably. Technique-specific reference ranges are needed before they can be applied in research and clinical settings.
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Affiliation(s)
- Giulia Masini
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lin F Foo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jérôme Cornette
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Jasmine Tay
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Carmel M McEniery
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, Cambridge, UK
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, Cambridge, UK
| | - Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Van Iterson EH, Baker SE, Wheatley CM, Morgan WJ, Olson TP, Snyder EM. Exercise Stroke Volume in Adult Cystic Fibrosis: A Comparison of Acetylene Pulmonary Uptake and Oxygen Pulse. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2018; 12:1179548418790564. [PMID: 30083061 PMCID: PMC6073827 DOI: 10.1177/1179548418790564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/28/2018] [Indexed: 12/19/2022]
Abstract
Cardiac hemodynamic assessment during cardiopulmonary exercise testing (CPET) is proposed to play an important role in the clinical evaluation of individuals with cystic fibrosis (CF). Cardiac catheterization is not practical for routine clinical CPET. Use of oxygen pulse (O2pulse) as a noninvasive estimate of stroke volume (SV) has not been validated in CF. This study tested the hypothesis that peak exercise O2pulse is a valid estimate of SV in CF. Measurements of SV via the acetylene rebreathe technique were acquired at baseline and peak exercise in 17 mild-to-moderate severity adult CF and 25 age-matched healthy adults. We calculated O2pulse=V.O2HR. Baseline relationships between SV and O2pulse were significant in CF (r = .80) and controls (r = .40), persisting to peak exercise in CF (r = .63) and controls (r = .73). The standard error of estimate for O2pulse-predicted SV with respect to measured SV was similar at baseline (14.1 vs 20.1 mL) and peak exercise (18.2 vs 13.9 mL) for CF and controls, respectively. These data suggest that peak exercise O2pulse is a valid estimate of SV in CF. The ability to noninvasively estimate SV via O2pulse during routine clinical CPET can be used to improve test interpretation and advance our understanding of the impact cardiac dysfunction has on exercise intolerance in CF.
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Affiliation(s)
| | - Sarah E Baker
- College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Courtney M Wheatley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Wayne J Morgan
- Department of Pediatrics, The University of Arizona, Tucson, AZ, USA
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric M Snyder
- College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
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Kuhn M, Hornung A, Ulmer H, Schlensak C, Hofbeck M, Wiegand G. Comparative Noninvasive Measurement of Cardiac Output Based on the Inert Gas Rebreathing Method (Innocor®) and MRI in Patients with Univentricular Hearts. Pediatr Cardiol 2018; 39:810-817. [PMID: 29396582 DOI: 10.1007/s00246-018-1824-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/20/2018] [Indexed: 11/28/2022]
Abstract
There are many complex cardiac malformations that are characterized by a functionally univentricular physiology. Staged surgical repair according to the Fontan principle separates the systemic and pulmonary circulations by connecting the systemic venous return to the pulmonary arteries. However, long-term follow-up studies demonstrate a gradual deterioration of cardiac function, particularly from the second or third decade. Noninvasive evaluation of the cardiac function is, therefore, important in the follow-up of these patients. The cardiac index (CI) is a reliable hemodynamic parameter and represents an important marker of cardiac function. We compared CI values determined by cardiac MRI (CMRI) with values obtained by noninvasive inert gas rebreathing (IGR; Innocor® system). Sixteen patients (age range: 7.2-32.7 years) with functionally univentricular hearts (UVH) following total cavopulmonary connection (TCPC) were compared with 12 healthy subjects (age range: 8.5-18.6 years). The standard treadmill protocol of the German Society of Pediatric Cardiology was used for exercise testing. CI was determined at rest and at two standardized submaximal exercise levels. In all subjects, CI increased under exercise conditions, but the values were significantly lower in patients with UVH. There was no significant difference between patients with UVH and predominantly right- or left-ventricular morphology. In comparison with CMRI measurements, the CI values obtained by the IGR method tended to be lower, with a mean difference of 1.02 l/min/m2. Noninvasive measurement of CI with the IGR method is feasible at rest and during exercise, and appears to be suited for routine determination of CI in patients with UVH following TCPC.
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Affiliation(s)
- Miriam Kuhn
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Andreas Hornung
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Heidi Ulmer
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Gesa Wiegand
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
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Van Iterson EH, Olson TP, Borlaug BA, Johnson BD, Snyder EM. Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction. Med Sci Sports Exerc 2018; 49:1758-1768. [PMID: 28471812 DOI: 10.1249/mss.0000000000001308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. METHODS Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=V˙O2/HR). RESULTS Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R = 0.30, 0.36, 0.67), but not controls (R = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R = 0.70, 0.53, 0.70) and controls (R = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. CONCLUSIONS Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.
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Affiliation(s)
- Erik H Van Iterson
- 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; and 2Department of Kinesiology, University of Minnesota, Minneapolis, MN
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11
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Perioperative Cardiac Output Monitoring Utilizing Non-pulse Contour Methods. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Sayyid ZN, Sellers ZM. Technological advances shed light on left ventricular cardiac disturbances in cystic fibrosis. J Cyst Fibros 2017; 16:454-464. [PMID: 28314540 DOI: 10.1016/j.jcf.2017.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 01/08/2023]
Abstract
Cystic fibrosis (CF), the most common autosomal recessive lethal disease in Caucasians, causes chronic pulmonary disease and can lead to cor pulmonale with right ventricular dysfunction. The presence of the cystic fibrosis transmembrane conductance regulator (CFTR) in cardiac myocardia has prompted debate regarding possible defective ion channel-induced cardiomyopathy. Clinical heart disease in CF is considered rare and is restricted to case reports. It has been unclear if this is due to the lack of physiological importance of CFTR in the heart, the relatively short lifespan of those with CF, or a technical inability to detect subclinical disease. Extensive echocardiographic investigations have yielded contradictory results, leading to the dogma that left ventricular defects in CF occur secondary to lung disease. In this review, we consider why studies examining heart function in CF have not provided clarity on this topic. We then focus on data from new echocardiographic and magnetic resonance imaging technology, which are providing greater insight into cardiac function in CF and demonstrating that, in addition to secondary effects from pulmonary disease, there may be an intrinsic primary defect in the CF heart. With advancing lifespans and activity levels, understanding the risk of cardiac disease is vital to minimizing morbidity in adults with CF.
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Affiliation(s)
- Zahra N Sayyid
- Stanford University, School of Medicine, Palo Alto, CA, United States
| | - Zachary M Sellers
- Stanford University, School of Medicine, Palo Alto, CA, United States.
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Jones JH, Zelt JT, Hirai DM, Diniz CV, Zaza A, O'Donnell DE, Neder JA. Emphysema on Thoracic CT and Exercise Ventilatory Inefficiency in Mild-to-Moderate COPD. COPD 2016; 14:210-218. [PMID: 27997255 DOI: 10.1080/15412555.2016.1253670] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is growing evidence that emphysema on thoracic computed tomography (CT) is associated with poor exercise tolerance in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that an excessive ventilatory response to exercise (ventilatory inefficiency) would underlie these abnormalities. In a prospective study, 19 patients (FEV1 = 82 ± 13%, 12 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1) and 26 controls underwent an incremental exercise test. Ventilatory inefficiency was assessed by the ventilation ([Formula: see text]E)/CO2 output ([Formula: see text]CO2) nadir. Pulmonary blood flow (PBF) in a submaximal test was calculated by inert gas rebreathing. Emphysema was quantified as % of attenuation areas below 950 HU. Patients typically presented with centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/total lung ratio = 0.82 ± 0.04). They had lower peak oxygen uptake ([Formula: see text]O2), higher [Formula: see text]E/[Formula: see text]CO2 nadir, and greater dyspnea scores than controls (p < 0.05). Lower peak [Formula: see text]O2 and worse dyspnea were found in patients with higher [Formula: see text]E/[Formula: see text]CO2 nadirs (≥30). Patients had blunted increases in PBF from rest to iso-[Formula: see text]O2 exercise (p < 0.05). Higher [Formula: see text]E/[Formula: see text]CO2 nadir in COPD was associated with emphysema severity (r = 0.63) which, in turn, was related to reduced lung diffusing capacity (r = -0.72) and blunted changes in PBF from rest to exercise (r = -0.69) (p < 0.01). Ventilation "wasted" in emphysematous areas is associated with impaired exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (DLCO) to a key clinical outcome (poor exercise tolerance) in COPD patients with only modest spirometric abnormalities.
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Affiliation(s)
- Joshua H Jones
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Joel T Zelt
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Daniel M Hirai
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Camilla V Diniz
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Aida Zaza
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - Denis E O'Donnell
- b Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
| | - J Alberto Neder
- a Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University , Kingston , ON , Canada
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Perak AM, Opotowsky AR, Walsh BK, Esch JJ, DiNardo JA, Kussman BD, Porras D, Rhodes J. Noninvasive Cardiac Output Estimation by Inert Gas Rebreathing in Mechanically Ventilated Pediatric Patients. J Pediatr 2016; 177:184-190.e3. [PMID: 27499214 DOI: 10.1016/j.jpeds.2016.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/13/2016] [Accepted: 07/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility and accuracy of inert gas rebreathing (IGR) pulmonary blood flow (Qp) estimation in mechanically ventilated pediatric patients, potentially providing real-time noninvasive estimates of cardiac output. STUDY DESIGN In mechanically ventilated patients in the pediatric catheterization laboratory, we compared IGR Qp with Qp estimates based upon the Fick equation using measured oxygen consumption (VO2) (FickTrue); for context, we compared FickTrue with a standard clinical short-cut, replacing measured with assumed VO2 in the Fick equation (FickLaFarge, FickLundell, FickSeckeler). IGR Qp and breath-by-breath VO2 were measured using the Innocor device. Sampled pulmonary arterial and venous saturations and hemoglobin concentration were used for Fick calculations. Qp estimates were compared using Bland-Altman agreement and Spearman correlation. RESULTS The final analysis included 18 patients aged 4-23 years with weight >15 kg. Compared with the reference FickTrue, IGR Qp estimates correlated best and had the least systematic bias and narrowest 95% limits of agreement (results presented as mean bias ±95% limits of agreement): IGR -0.2 ± 1.1 L/min, r = 0.90; FickLaFarge +0.7 ± 2.2 L/min, r = 0.80; FickLundell +1.6 ± 2.9 L/min, r = 0.83; FickSeckeler +0.8 ± 2.5 L/min, r = 0.83. CONCLUSIONS IGR estimation of Qp is feasible in mechanically ventilated patients weighing >15 kg, and agreement with FickTrue Qp estimates is better for IGR than for other Fick Qp estimates commonly used in pediatric catheterization. IGR is an attractive option for bedside monitoring of Qp in mechanically ventilated children.
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Affiliation(s)
- Amanda M Perak
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Alexander R Opotowsky
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Brian K Walsh
- Division of Critical Care, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Jesse J Esch
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - James A DiNardo
- Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Barry D Kussman
- Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jonathan Rhodes
- Department of Cardiology, Boston Children's Hospital, Boston, MA.
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15
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Van Iterson EH, Wheatley CM, Baker SE, Morgan WJ, Snyder EM. The relationship between cardiac hemodynamics and exercise tolerance in cystic fibrosis. Heart Lung 2016; 45:283-90. [PMID: 27045901 PMCID: PMC4860124 DOI: 10.1016/j.hrtlng.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) have reduced pulmonary function and exercise tolerance. Additionally, these individuals may develop abnormal cardiac function. The implications of abnormal cardiac function on exercise tolerance are unclear in CF. OBJECTIVE Study relationships between exercise cardiac hemodynamics and exercise tolerance in CF. METHODS 17 CF and 25 controls participated in cardiopulmonary exercise testing to measure exercise duration and peak workload (PW). Cardiac index (QI) was measured using acetylene rebreathe and oxygen uptake (VO2) breath-by-breath. Forced expiratory volume in 1-second (FEV1) was performed at rest. RESULTS Peak QI was 6.7 ± 0.5 vs. 9.1 ± 0.3 mL/min/m(2), CF vs. controls, respectively (P < 0.05). Linear regressions between QI (R(2) = 0.63 and 0.51) and exercise duration or PW were stronger than VO2 (R(2) = 0.35 and 0.37) or FEV1 (R(2) = 0.34 and 0.36) in CF, respectively (P < 0.05). CONCLUSION These data are clinically relevant suggesting attenuated cardiac function in addition to low airway function relate to exercise tolerance in CF.
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Affiliation(s)
- Erik H. Van Iterson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN 55455
| | - Courtney M. Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
| | - Sarah E. Baker
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Wayne J. Morgan
- Department of Pediatrics, University of Arizona, 1501 N. Campbell Avenue, Room 3301, Tucson, AZ 85724
| | - Eric M. Snyder
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN 55455
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
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16
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Noninvasive cardiac output estimation by inert gas rebreathing in pediatric and congenital heart disease. Am Heart J 2016; 174:80-8. [PMID: 26995373 DOI: 10.1016/j.ahj.2016.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inert gas rebreathing (IGR) techniques provide rapid, reliable estimates of cardiac output in adults with structurally normal hearts. Data on IGR reliability in pediatric and congenital heart disease populations are lacking. Our objective was to validate pulmonary blood flow (Qp) measurement by IGR compared with clinical reference tests, cardiovascular magnetic resonance (CMR), and indirect Fick. METHODS Pulmonary blood flow was measured by IGR and CMR or indirect Fick in 80 patients grouped by presence and type of shunt lesion. Inert gas rebreathing precision was assessed using Bland-Altman analysis, repeatability coefficient, intraclass correlation, and coefficient of error. Agreement with the reference tests was assessed with Bland-Altman plots. For comparison, agreement between the 2 reference tests, CMR and indirect Fick, was assessed in 34 contemporary patients. RESULTS Subjects were aged 7-78 years and had a wide range of cardiac diagnoses. Inert gas rebreathing Qp showed good repeatability (95% limits of agreement for 2 trials = ±22%, repeatability coefficient = 1.2 L/min, intraclass correlation = 0.92, and coefficient of error = 5%). In the absence of left-to-right shunting (n = 67), IGR Qp estimates agreed with CMR and indirect Fick Qp estimates, and the reference tests agreed with each other, with mean bias ≤10% (≤0.5 L/min) and 95% limits of agreement ±33%-38%. Conversely, IGR was unreliable in patients with left-to-right shunt (n = 14), with large bias (-58%, -4.0 L/min) and wide limits of agreement (±76%). CONCLUSIONS Inert gas rebreathing reliably estimates Qp in children and adults with congenital heart disease in the absence of left-to-right shunting, with agreement comparable to that seen between CMR and indirect Fick estimates.
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17
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Perrault H, Richard R, Kapchinsky S, Baril J, Bourbeau J, Taivassalo T. Addressing Assumptions for the Use of Non-invasive Cardiac Output Measurement Techniques During Exercise in COPD. COPD 2015; 13:75-81. [DOI: 10.3109/15412555.2015.1043985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hélène Perrault
- Faculty of Health Sciences, University of Ottawa, Ottawa Ontario, Canada
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute—McGill University Health Center, Montreal, Quebec, Canada
| | - Ruddy Richard
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute—McGill University Health Center, Montreal, Quebec, Canada
- Department of Sport Medicine and Functional Explorations, CHU, Clermont-Ferrand and INRA UMR 1019, Clermont-Ferrand, France
| | - Sophia Kapchinsky
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute—McGill University Health Center, Montreal, Quebec, Canada
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Jacinthe Baril
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute—McGill University Health Center, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute—McGill University Health Center, Montreal, Quebec, Canada
| | - Tanja Taivassalo
- Respiratory and Epidemiology Clinical Research Unit, Montreal Chest Institute—McGill University Health Center, Montreal, Quebec, Canada
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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18
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Wheatley CM, Baker SE, Morgan MA, Martinez MG, Morgan WJ, Wong EC, Karpen SR, Snyder EM. Effects of exercise intensity compared to albuterol in individuals with cystic fibrosis. Respir Med 2014; 109:463-74. [PMID: 25749641 DOI: 10.1016/j.rmed.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although exercise is a vital component of the therapy prescribed to individuals with cystic fibrosis (CF), it is not a priority due to a finite amount of treatment time and the view that exercise is not as beneficial as pharmacological treatments by many individuals with CF. We sought to compare the therapeutic benefits of exercise and their prescribed bronchodilator albuterol. METHODS CF (n = 14) and healthy (n = 16) subjects completed three visits, a baseline screening with VO2 max test and two treatment visits. On the two treatment visits, subjects completed spirometry and diffusing capacity of the lungs for nitric oxide (DLNO) maneuvers either at baseline, 60, and 110 min post-albuterol administration, or at baseline and the midway point of three separate 15 min exercise bouts at low, moderate and vigorous intensity (25, 50 and 65% of the maximum workload, respectively). RESULTS With moderate exercise the increase in DLNO was double (39 ± 8 vs 15 ± 6% change) and the level of bronchodilation similar (23% change) when compared to 110 min post-albuterol in individuals with CF. During exercise FVC became reduced (-309 ± 66 mL with moderate exercise) and the increase in FEV1 was attenuated (103 ± 39 vs 236 ± 58 mL, exercise vs. albuterol) when compared with the response to albuterol in individuals with CF. Epinephrine (EPI) release increased 39, 72 and 144% change with low, moderate and vigorous intensity exercise respectively for individuals with CF, but this increase was blunted when compared to healthy subjects. CONCLUSION Our results suggest that moderate intensity exercise is the optimal intensity for individuals with CF, as low intensity exercise increases EPI less than 50% and vigorous intensity exercise is over taxing, such that airflow can be restricted. Although the duration of the beneficial effect is uncertain, exercise can promote greater improvements in gas diffusion and comparable bronchodilation when compared to albuterol.
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Affiliation(s)
- Courtney M Wheatley
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | - Sarah E Baker
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
| | - Mary A Morgan
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Marina G Martinez
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Wayne J Morgan
- Department of Pediatrics- Pulmonology, Allergy and Immunology, University of Arizona, Tucson, AZ, USA.
| | - Eric C Wong
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Stephen R Karpen
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA.
| | - Eric M Snyder
- Department of Pharmacy Practice & Science, University of Arizona, Tucson, AZ, USA; Department of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
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19
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Farina S, Teruzzi G, Cattadori G, Ferrari C, De Martini S, Bussotti M, Calligaris G, Bartorelli A, Agostoni P. Noninvasive cardiac output measurement by inert gas rebreathing in suspected pulmonary hypertension. Am J Cardiol 2014; 113:546-51. [PMID: 24315114 DOI: 10.1016/j.amjcard.2013.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/05/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
The objective of this study was to evaluate inert gas rebreathing (IGR) reliability in cardiac output (CO) measurement compared with Fick method and thermodilution. IGR is a noninvasive method for CO measurement; CO by IGR is calculated as pulmonary blood flow plus intrapulmonary shunt. IGR may be ideal for follow-up of patients with pulmonary hypertension (PH), sparing the need of repeated invasive right-sided cardiac catheterization. Right-sided cardiac catheterization with CO measurement by thermodilution, Fick method, and IGR was performed in 125 patients with possible PH by echocardiography. Patients were grouped according to right-sided cardiac catheterization-measured mean pulmonary and wedge pressures: normal pulmonary arterial pressure (n = 20, mean pulmonary arterial pressure = 18 ± 3 mm Hg, pulmonary capillary wedge pressure = 11 ± 5 mm Hg), PH and normal pulmonary capillary wedge pressure (PH-NW, n = 37 mean pulmonary arterial pressure = 42 ± 13 mm Hg, pulmonary capillary wedge pressure = 11 ± 6 mm Hg), and PH and high pulmonary capillary wedge pressure (PH-HW, n = 68, mean pulmonary arterial pressure = 37 ± 9 mm Hg, pulmonary capillary wedge pressure = 24 ± 6 mm Hg). Thermodilution and Fick measurements were comparable. Fick and IGR agreement was observed in normal pulmonary arterial pressure (CO = 4.10 ± 1.14 and 4.08 ± 0.97 L/min, respectively), whereas IGR overestimated Fick in patients with PH-NW and those with PH-HW because of intrapulmonary shunting overestimation in hypoxemic patients. When patients with arterial oxygen saturation (SO2) ≤90% were excluded, IGR and Fick agreement improved in PH-NW (CO = 4.90 ± 1.70 and 4.76 ± 1.35 L/min, respectively) and PH-HW (CO = 4.05 ± 1.04 and 4.10 ± 1.17 L/min, respectively). In hypoxemic patients, we estimated pulmonary shunt as Fick - pulmonary blood flow and calculated shunt as: -0.2423 × arterial SO2 + 21.373 L/min. In conclusion, IGR is reliable for CO measurement in patients with PH with arterial SO2 >90%. For patients with arterial SO2 ≤90%, a new formula for shunt calculation is proposed.
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20
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Influence of Bag Volume on Reproducibility of Inert Gas Rebreathing Pulmonary Blood Flow Measurements in Patients with Pulmonary Diseases. Lung 2013; 191:467-73. [DOI: 10.1007/s00408-013-9494-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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21
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Trinkmann F, Berger M, Hoffmann U, Borggrefe M, Kaden JJ, Saur J. A comparative evaluation of electrical velocimetry and inert gas rebreathing for the non-invasive assessment of cardiac output. Clin Res Cardiol 2011; 100:935-43. [PMID: 21720853 DOI: 10.1007/s00392-011-0329-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND When assessing the function of the cardiovascular system, cardiac output (CO) is a substantial parameter. For its determination, numerous non-invasive techniques have been proposed in the recent years including inert gas rebreathing (IGR) and impedance cardiography (ICG). The aim of our study was to evaluate whether a novel ICG algorithm (electrical velocimetry) and IGR can be used interchangeably in the clinical setting. METHODS A total of 120 consecutive stable patients were included resulting in two pairs of repeated non-invasive cardiac output measurements. RESULTS The mean CO was 5.0 ± 1.2 l/min (range 2.6-8.6 l/min) using IGR and 4.4 ± 1.1 l/min (1.7-7.4 l/min) using ICG, respectively. Bland-Altman analysis revealed an acceptable agreement with a mean bias of 0.6 ± 1.2 l/min. We found a high reproducibility with a mean bias of 0.2 ± 0.7 l/min for IGR and 0.0 ± 0.3 l/min for ICG (p < 0.001), respectively. There was a statistically significant difference for unphysiological circulatory conditions represented by values of 2.6-4.1 l/min and 5.6-8.6 l/min. CONCLUSIONS Both non-invasive techniques are associated with low operating costs and require only a few expendable items for the rapid determination of cardiac function. We found an acceptable agreement between IGR and ICG as well as a high reproducibility, which was statistically significant higher for ICG. For cardiac output states exceeding the physiological range, we found a statistically significant difference. Consequently, values of cardiac function determined by either method should not be used interchangeably in the clinical setting.
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Affiliation(s)
- Frederik Trinkmann
- First Department of Medicine (Cardiology, Angiology, Pneumology, Intensive Care), Universitätsmedizin Mannheim, University of Heidelberg, Germany
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