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Chwiedź A, Minarowski Ł, Mróz RM, Razak Hady H. Non-Invasive Cardiac Output Measurement Using Inert Gas Rebreathing Method during Cardiopulmonary Exercise Testing-A Systematic Review. J Clin Med 2023; 12:7154. [PMID: 38002766 PMCID: PMC10671909 DOI: 10.3390/jcm12227154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The use of inert gas rebreathing for the non-invasive cardiac output measurement has produced measurements comparable to those obtained by various other methods. However, there are no guidelines for the inert gas rebreathing method during a cardiopulmonary exercise test (CPET). In addition, there is also a lack of specific standards for assessing the non-invasive measurement of cardiac output during CPET, both for healthy patients and those suffering from diseases and conditions. AIM This systematic review aims to describe the use of IGR for a non-invasive assessment of cardiac output during cardiopulmonary exercise testing and, based on the information extracted, to identify a proposed CPET report that includes an assessment of the cardiac output using the IGR method. METHODS This systematic review was conducted by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) guidelines. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from inception until 29 December 2022. The primary search returned 261 articles, of which 47 studies met the inclusion criteria for this review. RESULTS AND CONCLUSIONS This systematic review provides a comprehensive description of protocols, indications, technical details, and proposed reporting standards for a non-invasive cardiac output assessment using IGR during CPET. It highlights the need for standardized approaches to CPET and identifies gaps in the literature. The review critically analyzes the strengths and limitations of the studies included and offers recommendations for future research by proposing a combined report from CPET-IGR along with its clinical application.
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Affiliation(s)
- Agnieszka Chwiedź
- I Department of General and Endocrine Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland
- II Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, 15-540 Bialystok, Poland
| | - Łukasz Minarowski
- II Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, 15-540 Bialystok, Poland
| | - Robert M Mróz
- II Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, 15-540 Bialystok, Poland
| | - Hady Razak Hady
- I Department of General and Endocrine Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland
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2
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Fröhlich H, Frey N, Estler B, Mäck M, Schlegel P, Beckendorf J, Frankenstein L, Täger T. Haemodynamic Effects of Sacubitril/Valsartan Initiation in Outpatients with Chronic Heart Failure. Am J Cardiovasc Drugs 2022; 22:695-704. [PMID: 36136241 PMCID: PMC9493168 DOI: 10.1007/s40256-022-00549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
Background Sacubitril/valsartan (S/V) improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Data about the immediate, short-, and intermediate-term hemodynamic effects of S/V are limited. Methods In this prospective observational study, 37 outpatients with chronic HFrEF were treated with S/V according to current guideline recommendations. Next to clinical, laboratory and echocardiographic parameters, haemodynamic variables were assessed non-invasively by use of inert gas rebreathing and bioimpedance cardiography at baseline and at 2-week, 3-month and 6-month follow-up. The course of variables throughout the study and the relationship between variables were analysed using fractional polynomials. Results S/V treatment resulted in short- and intermediate-term improvements in NYHA functional class (2.3 ± 0.6 at baseline vs. 1.9 ± 0.5 at 6-month follow-up, p = 0.14), 6-min walk test (453 ± 110 vs. 528 ± 98 m, p = 0.02), ejection fraction (31 ± 9 vs. 36 ± 12%, p = 0.13), pulmonary artery pressure (39 ± 10 vs. 31 ± 10 mmHg, p = 0.02), and NT-proBNP values (1702 (782–2897 vs. 1004 (599–1627) ng/L, p = 0.03). In addition, S/V caused immediate decreases in systemic vascular resistance index (SVRI) and systolic blood pressure (SBP), which were associated with a simultaneous drop in stroke volume (SV) and cardiac index (CI). However, while SVRI and SBP remained at low levels during further treatment, SV and CI restored rapidly and increased to slightly higher levels thereafter. Conclusion The vasodilative effects of S/V result in immediate reductions in SVRI, SBP, SV and CI. However, S/V induces reverse cardiac remodelling, which is apparent shortly after treatment initiation and leads to improvements of clinical, functional, echocardiographic, laboratory and haemodynamic variables. Supplementary Information The online version contains supplementary material available at 10.1007/s40256-022-00549-2.
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Affiliation(s)
- Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Bent Estler
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Mirjam Mäck
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philipp Schlegel
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jan Beckendorf
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Tobias Täger
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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3
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Whittle RS, Stapleton LM, Petersen LG, Diaz-Artiles A. Indirect measurement of absolute cardiac output during exercise in simulated altered gravity is highly dependent on the method. J Clin Monit Comput 2021; 36:1355-1366. [PMID: 34677821 DOI: 10.1007/s10877-021-00769-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Altered gravity environments introduce cardiovascular changes that may require continuous hemodynamic monitoring in both spaceflight and terrestrial analogs. Conditions in such environments are often prohibitive to direct/invasive methods and therefore, indirect measurement techniques must be used. This study compares two common cardiac measurement techniques used in the human spaceflight domain, pulse contour analysis (PCA-Nexfin) and inert gas rebreathing (IGR-Innocor), in subjects completing ergometer exercise under altered gravity conditions simulated using a tilt paradigm. METHODS Seven subjects were tilted to three different angles representing Martian, Lunar, and microgravity conditions in the rostrocaudal direction. They completed a 36-min submaximal cardiovascular exercise protocol in each condition. Hemodynamics were continuously monitored using Nexfin and Innocor. RESULTS Linear mixed-effects models revealed a significant bias of [Formula: see text] ml ([Formula: see text]) in stroke volume and [Formula: see text] l/min ([Formula: see text]) in cardiac output, with Nexfin measuring greater than Innocor in both variables. These values are in agreement with a Bland-Altman analysis. The correlation of stroke volume and cardiac output measurements between Nexfin and Innocor were [Formula: see text] ([Formula: see text]) and [Formula: see text] ([Formula: see text]) respectively. CONCLUSION There is a poor agreement in absolute stroke volume and cardiac output values between measurement via PCA (Nexfin) and IGR (Innocor) in subjects who are exercising in simulated altered gravity environments. These results suggest that the chosen measurement method and device greatly impacts absolute measurements of cardiac output. However, there is a good level of agreement between the two devices when measuring relative changes. Either of these devices seem adequate to capture cardiac changes, but should not be solely relied upon for accurate measurement of absolute cardiac output.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843, USA
| | - Lindsay M Stapleton
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843, USA
| | - Lonnie G Petersen
- Department of Radiology, University of California San Diego, 8929 University Center Lane, La Jolla, CA, 92122, USA
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843, USA. .,Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77843, USA.
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4
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Trinkmann F, Maros M, Roth K, Hermanns A, Schäfer J, Gawlitza J, Saur J, Akin I, Borggrefe M, Herth FJF, Ganslandt T. Multiple breath washout (MBW) testing using sulfur hexafluoride: reference values and influence of anthropometric parameters. Thorax 2021; 76:380-386. [PMID: 33593931 DOI: 10.1136/thoraxjnl-2020-214717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple breath washout (MBW) using sulfur hexafluoride (SF6) has the potential to reveal ventilation heterogeneity which is frequent in patients with obstructive lung disease and associated small airway dysfunction. However, reference data are scarce for this technique and mostly restricted to younger cohorts. We therefore set out to evaluate the influence of anthropometric parameters on SF6-MBW reference values in pulmonary healthy adults. METHODS We evaluated cross-sectional data from 100 pulmonary healthy never-smokers and smokers (mean 51 (SD 20), range 20-88 years). Lung clearance index (LCI), acinar (Sacin) and conductive (Scond) ventilation heterogeneity were derived from triplicate SF6-MBW measurements. Global ventilation heterogeneity was calculated for the 2.5% (LCI2.5) and 5% (LCI5) stopping points. Upper limit of normal (ULN) was defined as the 95th percentile. RESULTS Age was the only meaningful parameter influencing SF6-MBW parameters, explaining 47% (CI 33% to 59%) of the variance in LCI, 32% (CI 18% to 47%) in Sacin and 10% (CI 2% to 22%) in Scond. Mean LCI increases from 6.3 (ULN 7.4) to 8.8 (ULN 9.9) in subjects between 20 and 90 years. Smoking accounted for 2% (CI 0% to 8%) of the variability in LCI, 4% (CI 0% to 13%) in Sacin and 3% (CI 0% to 13%) in Scond. CONCLUSION SF6-MBW outcome parameters showed an age-dependent increase from early adulthood to old age. The effect was most pronounced for global and acinar ventilation heterogeneity and smaller for conductive ventilation heterogeneity. No influence of height, weight and sex was seen. Reference values can now be provided for all important SF6-MBW outcome parameters over the whole age range. TRIAL REGISTRATION NUMBER NCT04099225.
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Affiliation(s)
- Frederik Trinkmann
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany .,Department of Pneumology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of German Centre for Lung Research (DZL), Heidelberg, Baden-Württemberg, Germany.,Department of Biomedical Informatics, Centre for Preventive Medicine & Digital Health Baden-Württemberg, University Medical Centre Mannheim, Mannheim, Germany
| | - Máté Maros
- Department of Biomedical Informatics, Centre for Preventive Medicine & Digital Health Baden-Württemberg, University Medical Centre Mannheim, Mannheim, Germany.,Department of Neuroradiology, University Medical Centre Mannheim, Mannheim, Germany
| | - Katharina Roth
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany
| | - Arne Hermanns
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany
| | - Julia Schäfer
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany
| | - Joshua Gawlitza
- Institute for Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Joachim Saur
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany
| | - Ibrahim Akin
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany.,DZHK (German Centre for Cardiovascular Research), Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, University Medical Centre Mannheim, Mannheim, Baden-Württemberg, Germany.,DZHK (German Centre for Cardiovascular Research), Mannheim, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of German Centre for Lung Research (DZL), Heidelberg, Baden-Württemberg, Germany
| | - Thomas Ganslandt
- Department of Biomedical Informatics, Centre for Preventive Medicine & Digital Health Baden-Württemberg, University Medical Centre Mannheim, Mannheim, Germany
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Okwose NC, Bouzas-Cruz N, Fernandez OG, Koshy A, Green T, Woods A, Robinson-Smith N, Tovey S, Mcdiarmid A, Parry G, Schueler S, Macgowan GA, Jakovljevic DG. Validity of Hemodynamic Monitoring Using Inert Gas Rebreathing Method in Patients With Chronic Heart Failure and Those Implanted With a Left Ventricular Assist Device. J Card Fail 2020; 27:414-418. [PMID: 33035686 DOI: 10.1016/j.cardfail.2020.09.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present study assessed agreement between resting cardiac output estimated by inert gas rebreathing (IGR) and thermodilution methods in patients with heart failure and those implanted with a left ventricular assist device (LVAD). METHODS AND RESULTS Hemodynamic measurements were obtained in 42 patients, 22 with chronic heart failure and 20 with implanted continuous flow LVAD (34 males, aged 50 ± 11 years). Measurements were performed at rest using thermodilution and IGR methods. Cardiac output derived by thermodilution and IGR were not significantly different in LVAD (4.4 ± 0.9 L/min vs 4.7 ± 0.8 L/min, P = .27) or patients with heart failure (4.4 ± 1.4 L/min vs 4.5 ± 1.3 L/min, P = .75). There was a strong relationship between thermodilution and IGR cardiac index (r = 0.81, P = .001) and stroke volume index (r = 0.75, P = .001). Bland-Altman analysis showed acceptable limits of agreement for cardiac index derived by thermodilution and IGR, namely, the mean difference (lower and upper limits of agreement) for patients with heart failure -0.002 L/min/m2 (-0.65 to 0.66 L/min/m2), and -0.14 L/min/m2 (-0.78 to 0.49 L/min/m2) for patients with LVAD. CONCLUSIONS IGR is a valid method for estimating cardiac output and should be used in clinical practice to complement the evaluation and management of chronic heart failure and patients with an LVAD.
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Affiliation(s)
- Nduka C Okwose
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Noelia Bouzas-Cruz
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Oscar Gonzalez Fernandez
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aaron Koshy
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Green
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sian Tovey
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Adam Mcdiarmid
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth Parry
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy A Macgowan
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Cardiovascular Research Division, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
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6
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Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes. J Clin Med 2020; 9:jcm9092891. [PMID: 32906735 PMCID: PMC7565559 DOI: 10.3390/jcm9092891] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022] Open
Abstract
We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed as z-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97, p = 0.02) and PVR higher (z-score 2.88, p = 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention.
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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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8
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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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9
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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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10
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Koschate J, Thieschäfer L, Drescher U, Hoffmann U. Impact of 60 days of 6° head down tilt bed rest on muscular oxygen uptake and heart rate kinetics: efficacy of a reactive sledge jump countermeasure. Eur J Appl Physiol 2018; 118:1885-1901. [PMID: 29946969 DOI: 10.1007/s00421-018-3915-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/08/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE The effects of 60 days of head down tilt bed rest (HDBR) with and without the application of a reactive jump countermeasure were investigated, using a method which enables to discriminate between pulmonary ([Formula: see text]O2pulm) and muscular ([Formula: see text]O2musc) oxygen uptake kinetics to control for hemodynamic influences. METHODS 22 subjects were randomly allocated to either a group performing a reactive jumps countermeasure (JUMP; n = 11, male, 29 ± 7 years, 23.9 ± 1.3 kg m- 2) or a control group (CTRL; n = 11, male, 29 ± 6 years, 23.3 ± 2.0 kg m- 2). Heart rate (HR) and [Formula: see text]O2pulm were measured in response to repeated changes in work rate between 30 and 80 W before (BDC-9) and two times after HDBR (R+ 2, R+ 13). Kinetic responses of HR, [Formula: see text]O2pulm, and [Formula: see text]O2musc were assessed applying time series analysis. Higher maxima in cross-correlation functions (CCFmax(x)) between work rate and the respective parameter indicate faster kinetics responses. Statistical analysis was performed applying multifactorial analysis of variance. RESULTS CCFmax([Formula: see text]O2musc) and CCFmax([Formula: see text]O2pulm) were not significantly different before and after HDBR (P > 0.05). CCFmax(HR) decreased following bed rest (JUMP: BDC-9: 0.30 ± 0.09 vs. R+ 2: 0.28 ± 0.06 vs. R+13: 0.28 ± 0.07; CTRL: 0.35 ± 0.09 vs. 0.27 ± 0.06 vs. 0.33 ± 0.07 P = 0.025). No significant differences between the groups were observed (P > 0.05). Significant alterations were found for CCFmax of mean arterial blood pressure (mBP) after HDBR (JUMP: BDC-9: 0.21 ± 0.07 vs. R+ 2: 0.30 ± 0.13 vs. R+ 13: 0.28 ± 0.08; CTRL: 0.25 ± 0.07 vs. 0.38 ± 0.13 vs. 0.28 ± 0.08; P = 0.008). CONCLUSIONS Despite hemodynamic changes, [Formula: see text]O2 kinetics seem to be preserved for a longer period of HDBR, even without the application of a countermeasure.
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Affiliation(s)
- J Koschate
- Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Cologne, Germany.
| | - L Thieschäfer
- Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Cologne, Germany
| | - U Drescher
- Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Cologne, Germany
| | - U Hoffmann
- Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Cologne, Germany
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11
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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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12
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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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13
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Täger T, Wiebalck C, Fröhlich H, Corletto A, Katus HA, Frankenstein L. Biological variation of extracellular matrix biomarkers in patients with stable chronic heart failure. Clin Res Cardiol 2017; 106:974-985. [PMID: 28779229 DOI: 10.1007/s00392-017-1147-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/31/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Extracellular matrix (ECM) biomarkers such as matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) are pathophysiological key, prognostic marker and therapeutic target in chronic heart failure (HF). Serial measurements of MMPs and TIMPs may be useful for guidance of these applications. However, interpretation of time-dependent changes requires knowledge about the biological variation of ECM biomarkers. METHODS We performed measurements of MMP-2, MMP-9, TIMP-1, and TIMP-4 in 50 patients with chronic HF who met rigid criteria for clinical stability at 3-h, 6-h, 1-week and 2-week time intervals. In addition, clinical and haemodynamic assessment was performed at baseline, at 1- and 2-week intervals. Haemodynamic variables were measured using inert gas rebreathing and impedance cardiography. Heart rhythm was monitored with external ECG event recorders throughout the complete study. Reference change values (RCVs) and minimal important differences (MIDs) were determined for MMP-2, MMP-9, TIMP-1, and TIMP-4. RESULTS Clinical and haemodynamic variables were stable over time. Depending on the time-interval, RCVs ranged between 4.9 and 11.7% for MMP-2, 26.4 and 56.7% for MMP-9, 10.8 and 30.7% for TIMP-1, and 16.0 and 47.4% for TIMP-4, respectively. The MIDs varied between 43.38 and 65.22 ng/ml for MMP-2, 28.71 and 40.96 ng/ml for MMP-9, 52.32 and 156.07 ng/ml for TIMP-1, and 293.92 and 798.04 pg/ml for TIMP-4, respectively. CONCLUSION The biological variation of ECM biomarkers differs with respect to individual biomarkers and time intervals. MMP-2 may be most suitable for serial biomarker measurements, as the biological variation is low irrespective of the time interval between measurements.
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Affiliation(s)
- Tobias Täger
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Clara Wiebalck
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anna Corletto
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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14
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Täger T, Wiedergruen AK, Fröhlich H, Cebola R, Corletto A, Horsch A, Hess G, Slottje K, Zdunek D, Katus HA, Wians FH, Frankenstein L. Hemodynamic Determinants of the Biologic Variation of N-Terminal Pro-B-Type Natriuretic Peptide in Patients With Stable Systolic Chronic Heart Failure. J Card Fail 2017; 23:835-842. [PMID: 28757153 DOI: 10.1016/j.cardfail.2017.07.404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 06/23/2017] [Accepted: 07/25/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND CONTEXT Biologic variation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in chronic heart failure (CHF) may affect blood levels and risk stratification. The sources of NT-proBNP variation are unknown. METHODS AND RESULTS We performed NT-proBNP measurements and clinical and hemodynamic assessments in 50 patients with heart failure with reduced ejection fraction (HFrEF) who met criteria for clinical stability over 2 time intervals. Hemodynamic variables were measured with the use of inert gas rebreathing and impedance cardiography. Heart rhythm was monitored with the use of external electrocardiographic event recorders throughout the study. Determinants of NT-proBNP-levels and both absolute (ΔNT-proBNPabs) and relative (ΔNT-proBNP%) changes at 1-week and 2-week intervals were identified with the use of univariable and multivariable linear mixed-effects models and linear regression analyses, respectively. Clinical and hemodynamic variables did not significantly change between study visits. The individual variation of NT-proBNP at 2 weeks was 9.2% (range 3.9%-18.6%). Weight and glomerular filtration rate were independently associated with baseline NT-proBNP concentrations (P = .01 and P = .005, respectively). There was no relationship between absolute and relative changes of NT-proBNP at 1-week intervals and changes in clinical and hemodynamic variables. Absolute change of NT-proBNP at 2-week intervals was associated with absolute change in left cardiac work index (P = .008), and relative change in NT-proBNP at 2-week intervals was determined by relative change of thoracic fluid content index (P = .008) and diastolic blood pressure (P = .01). The coefficients of determination (R2) for the multivariable models with Δ1wkNT-proBNPabs, Δ2-weeksNT-proBNPabs, Δ1wkNT-proBNP%, and Δ2wksNT-proBNP% as dependent variables were 0.21, 0.19, 0.10, and 0.32, respectively. CONCLUSIONS In patients with stable HFrEF, changes in clinical and hemodynamic variables only marginally contribute to the variation of NT-proBNP.
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Affiliation(s)
| | | | | | - Rita Cebola
- University of Heidelberg, Heidelberg, Germany
| | | | | | - Georg Hess
- Roche Diagnostics International, Switzerland
| | | | | | | | - Frank H Wians
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas 79905
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15
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Hassan M, Wagdy K, Kharabish A, Selwanos PP, Nabil A, Elguindy A, ElFaramawy A, Elmahdy MF, Mahmoud H, Yacoub MH. Validation of Noninvasive Measurement of Cardiac Output Using Inert Gas Rebreathing in a Cohort of Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003592. [PMID: 28283502 DOI: 10.1161/circheartfailure.116.003592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cardiac output (CO) is a key indicator of cardiac function in patients with heart failure. No completely accurate method is available for measuring CO in all patients. The objective of this study was to validate CO measurement using the inert gas rebreathing (IGR) method against other noninvasive and invasive methods of CO quantification in a cohort of patients with heart failure and reduced ejection fraction. METHODS AND RESULTS The study included 97 patients with heart failure and reduced ejection fraction (age 42±15.5 years; 64 patients (65.9%) had idiopathic dilated cardiomyopathy and 21 patients (21.6%) had ischemic heart disease). Median left ventricle ejection fraction was 24% (10%-36%). Patients with atrial fibrillation were excluded. CO was measured using 4 methods (IGR, cardiac magnetic resonance imaging, cardiac catheterization, and echocardiography) and indexed to body surface area (cardiac index [CI]). All studies were performed within 48 hours. Median CI measured by IGR was 1.75, by cardiac magnetic resonance imaging was 1.82, by cardiac catheterization was 1.65, and by echo was 1.7 L·min-1·m-2. There were significant modest linear correlations between IGR-derived CI and cardiac magnetic resonance imaging-derived CI (r=0.7; P<0.001), as well as cardiac catheterization-derived CI (r=0.6; P<0.001). Using Bland-Altman analysis, the agreement between the IGR method and the other methods was as good as the agreement between any 2 other methods with each other. CONCLUSIONS The IGR method is a simple, accurate, and reproducible noninvasive method for quantification of CO in patients with advanced heart failure. The prognostic value of this simple measurement needs to be studied prospectively.
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Affiliation(s)
- Mohamed Hassan
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Kerolos Wagdy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Ahmed Kharabish
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Peter Philip Selwanos
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Ahmed Nabil
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Ahmed Elguindy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Amr ElFaramawy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Mahmoud F Elmahdy
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Hani Mahmoud
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.)
| | - Magdi H Yacoub
- From the Cardiology Department (M.H., A.E., M.F.E.) and Radiology Department (A.K.), Cairo University, Egypt; Cardiology Department (M.H., K.W., P.P.S., A.E., H.M.), Radiology Department (A.K.), Biomedical Engineering Department (A.N.), and Cardiothoracic Department (M.H.Y.), Aswan Heart Centre, Egypt; and Imperial College, London, United Kingdom (M.H.Y.).
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16
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Trinkmann F, Schneider C, Michels JD, Stach K, Doesch C, Schoenberg SO, Borggrefe M, Saur J, Papavassiliu T. Comparison of bioreactance non-invasive cardiac output measurements with cardiac magnetic resonance imaging. Anaesth Intensive Care 2017; 44:769-776. [PMID: 27832567 DOI: 10.1177/0310057x1604400609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Impedance cardiography measurement of cardiac output gained wide interest due to its ease of use and non-invasiveness. However, validation studies of different algorithms yielded diverging results. Bioreactance (BR) as a recent adaption differs fundamentally as the flow signal is derived from phase shifts. Our aim was to assess the accuracy and reproducibility of BR, as compared to the non-invasive gold standard--cardiac magnetic resonance imaging (CMR). We prospectively included 32 stable patients. BR was performed twice in the supine position and averaged over 30 seconds. Mean bias was 0.2 ± 1.8 l/minute (1 ± 28%, percentage error 55%) with limits of agreement ranging from -3.4 to 3.7 l/minute. Reproducibility was acceptable with a mean bias of 0.1 ± 0.9 l/minute (1 ± 14%, 27%). Low cardiac output was significantly overestimated (-1.1 ± 1.5 l/minute), while high cardiac output was underestimated (1.5 ± 1.7 l/minute), (P=0.001), although reproducibility was unaffected. Bias and weight were moderately correlated in men (r = 0.50, P=0.02). No differences for accuracy were found in nine patients who had an arrhythmia (0.3 ± 1.4 versus 0.1 ± 2.0 l/minute, P=0.76), while clinically relevant differences were found in patients with mild aortic valve disease (1.9 ± 2.2 versus -0.3 ± 1.7 l/minute, P=0.02). Overall, BR showed insufficient agreement with CMR, overestimating low and underestimating high cardiac output states. Reproducibility was acceptable and not negatively affected by the circulatory condition. Consequently, absolute values acquired with BR should be interpreted with caution and must not be used interchangeably in clinical practice.
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Affiliation(s)
- F Trinkmann
- Internist, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
| | - C Schneider
- Medical student, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
| | - J D Michels
- Head of Pulmonology Section, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
| | - K Stach
- Internist, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
| | - C Doesch
- Internist, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
| | - S O Schoenberg
- Head of Department, Institute of Clinical Radiology and Nuclear Medicine,University Medical Centre Mannheim, Mannheim, Germany
| | - M Borggrefe
- Head of Department, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - J Saur
- Professor, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
| | - T Papavassiliu
- Head of Cardiovascular Magnetic Resonance Section, First Department of Medicine, University Medical Centre Mannheim, Mannheim, Heidelberg University, Germany
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Okwose NC, Chowdhury S, Houghton D, Trenell MI, Eggett C, Bates M, MacGowan GA, Jakovljevic DG. Comparison of cardiac output estimates by bioreactance and inert gas rebreathing methods during cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2017; 38:483-490. [DOI: 10.1111/cpf.12442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nduka C. Okwose
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
| | - Shakir Chowdhury
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
| | - David Houghton
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
| | - Michael I. Trenell
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
- RCUK Centre for Ageing and Vitality; Newcastle University; Newcastle Upon Tyne UK
| | - Christopher Eggett
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
| | - Matthew Bates
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
| | - Guy A. MacGowan
- Cardiology Department; Freeman Hospital and Institute of Genetic Medicine; Newcastle University; Newcastle upon Tyne UK
| | - Djordje G. Jakovljevic
- Institute of Cellular Medicine; Medical School; Newcastle University; Newcastle Upon Tyne UK
- RCUK Centre for Ageing and Vitality; Newcastle University; Newcastle Upon Tyne UK
- Clinical Research Facility; Royal Victoria Infirmary; Newcastle Upon Tyne UK
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18
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Ebrahim M, Hegde S, Printz B, Abcede M, Proudfoot JA, Davis C. Evaluation of Impedance Cardiography for Measurement of Stroke Volume in Congenital Heart Disease. Pediatr Cardiol 2016; 37:1453-1457. [PMID: 27562130 DOI: 10.1007/s00246-016-1456-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
Noninvasive measurement of cardiac output (CO) and particularly stroke volume (SV) remain difficult but potentially valuable. These variables can be particularly challenging to measure in children with congenital heart disease (CHD). Impedance cardiography (IC) is a technique shown to be accurate in measuring SV in adults and in children with structurally normal hearts. The ease of use and rapidity of SV measurement using IC makes it potentially attractive for young patients with CHD. Advances in IC technology have led to more sophisticated signal-morphology IC (SMIC) devices that may further improve accuracy. We tested the accuracy of SMIC to measure SV in 21 subjects with CHD by comparing measurements with those from cardiac magnetic resonance (CMR) imaging. There was good agreement between SMIC and CMR in measurement of SV: mean difference = 1.7 ml (p = 0.47); r = 0.89. The agreement and correlation persisted when controlling for the differences in blood pressure and heart rate during the two testing methods. We conclude that SMIC is accurate at measuring SV and thus CO when compared to CMR in a variety of forms of CHD.
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Affiliation(s)
- Mohammed Ebrahim
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Sanjeet Hegde
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Beth Printz
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Mark Abcede
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - James A Proudfoot
- Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, US
| | - Christopher Davis
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US.
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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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Physical Capacity in LVAD Patients: Hemodynamic Principles, Diagnostic Tools and Training Control. Int J Artif Organs 2016; 39:451-459. [DOI: 10.5301/ijao.5000529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/20/2022]
Abstract
Over time left ventricular assist devices (LVAD) have become an alternative to heart transplantation because of enormous technical development and miniaturization. Most patients present a significant improvement in clinical conditions and exercise capacity. Nevertheless, exercise tolerance remains markedly limited even after LVAD implantation compared to a control group. The complex physiological and hemodynamic changes in LVAD patients, both at rest and during exercise, are not yet understood, or at least not completely. It is the aim of the present paper to describe the current state of scientific knowledge. Furthermore, the spectrum of diagnostic tools, including the noninvasive inert gas rebreathing method for measurement of cardiac output and associate parameters, are discussed. Options for training control in this special patient group are presented.
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Trinkmann F, Berger M, Michels JD, Doesch C, Weiss C, Schoenberg SO, Akin I, Borggrefe M, Papavassiliu T, Saur J. Influence of electrode positioning on accuracy and reproducibility of electrical velocimetry cardiac output measurements. Physiol Meas 2016; 37:1422-35. [PMID: 27480359 DOI: 10.1088/0967-3334/37/9/1422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Electrical velocimetry (EV) is one of the most recent adaptions of impedance cardiography. Previous studies yielded diverging results identifying several factors negatively influencing accuracy. Although electrode arrangement is suspected to be an influencing factor for impedance cardiography in general, no data for EV is available. We aimed to prospectively assess the influence of electrode position on the accuracy and reproducibility of cardiac output (CO) measurements obtained by EV. Two pairs of standard electrocardiographic electrodes were placed at predefined positions of the thorax in 81 patients. The inter-electrode gap was varied between either 5 or 15 cm by caudal movement of the lowest electrode. Measurements were averaged over 20 s and performed twice at each electrode position. Reference values were determined using cardiac magnetic resonance imaging (CMR). Mean bias was 1.2 ± 1.6 l min(-1) (percentage error 22 ± 28%) between COCMR and COEV at the 5 cm gap significantly improving to 0.5 ± 1.6 l min(-1) (8 ± 28%) when increasing the gap (p < 0.0001). The mean difference between repeated measurements was 0.0 ± 0.3 l min(-1) for the 5 cm and 0.1 ± 0.3 l min(-1) for the 15 cm gap, respectively (p = 0.3). The accuracy of EV can be significantly improved when increasing the lower inter-electrode gap still exceeding the Critchley and Critchley recommendations. Therefore, absolute values should not be used interchangeably in clinical routine. As the reproducibility was not negatively affected, serial hemodynamic measurements can be reliably acquired in stable patients when the electrode position remains unchanged.
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Affiliation(s)
- Frederik Trinkmann
- 1st Department of Medicine (Cardiology, Angiology, Pulmonology, Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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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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Hämodynamik und körperliche Belastbarkeit bei Patienten mit Linksherzunterstützungssystem. Herz 2016; 41:507-13. [DOI: 10.1007/s00059-015-4396-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022]
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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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Comparison of electrical velocimetry and cardiac magnetic resonance imaging for the non-invasive determination of cardiac output. J Clin Monit Comput 2015; 30:399-408. [DOI: 10.1007/s10877-015-9731-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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Täger T, Fröhlich H, Franke J, Slottje K, Horsch A, Zdunek D, Hess G, Dösch A, Katus HA, Wians FH, Frankenstein L. Biological variation of the cardiac index in patients with stable chronic heart failure: inert gas rebreathing compared with impedance cardiography. ESC Heart Fail 2015; 2:112-120. [PMID: 27708853 PMCID: PMC5032993 DOI: 10.1002/ehf2.12040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/30/2015] [Accepted: 04/26/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS In chronic heart failure (CHF), changes in cardiac function define the course of the disease. The cardiac index (CI) is the most adequate indicator of cardiac function. Interpretation of serial CI measurements, however, requires knowledge of the biological variation of CI. Because measurements of CI can be confounded by the clinical situation or the method applied, biological variation might be subject to the same confounders. METHODS AND RESULTS We prospectively included 50 CHF patients who met rigid criteria for clinical stability. CI was measured by both inert gas rebreathing (IGR) and impedance cardiography (ICG) in weekly intervals over 3 weeks-each measurement performed at rest (IGRrest/ICGrest) and during low-exercise 10 Watt pedalling (IGR10W/ICG10W). Intra-class correlation coefficients (ICCs), reference change values, and minimal important differences of CI were determined for IGRrest, ICGrest, IGR10W, and ICG10W. Impedance cardiography and IGR showed moderate agreement at rest (20% (6-36)) and good agreement at 10 Watt (-4% (-23-16)). Depending on time interval, measurement modality for CI, and mode, ICC ranged between 0.42 and 0.78, ICC values for IGR were lower than those for ICG. Reference change value ranged between 3 and 15%, and minimal important difference ranged between 0.2 and 0.5 L/min/m2. Values for IGR were lower at rest and higher at 10 Watt than those for ICG. CONCLUSION Non-invasive measurements of CI are stable over time. Measurement modalities for CI, however, are not interchangeable. Biological variation is less pronounced when obtained by ICG. The influence of low-level exercise on stability of CI depends on the measurement modality.
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Affiliation(s)
- Tobias Täger
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
| | - Jennifer Franke
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
| | - Karen Slottje
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
| | - Andrea Horsch
- Roche Diagnostics International AG Risch-Rotkreuz Switzerland
| | - Dietmar Zdunek
- Roche Diagnostics International AG Risch-Rotkreuz Switzerland
| | - Georg Hess
- Roche Diagnostics International AG Risch-Rotkreuz Switzerland
| | - Andreas Dösch
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
| | | | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmology University of Heidelberg Heidelberg Germany
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Ståhlberg M, Sander M, Mortensen L, Linde C, Braunschweig F. Increase in paced heart rate reduces muscle sympathetic nerve activity in heart failure patients treated with cardiac resynchronization therapy. Europace 2014; 17:439-46. [PMID: 25355780 DOI: 10.1093/europace/euu289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS To test the hypothesis that acute increased biventricularly (BiV) paced heart rate (pHR) results in decreased muscle sympathetic nerve activity (MSNA), and that dyssynchronous pacing (AAI) attenuates this effect, in heart failure patients receiving cardiac resynchronization therapy (CRT). METHODS AND RESULTS Fourteen CRT patients (NYHA II-III, 12 males, mean EF 28 ± 14%) were recruited. Three different pHRs (50-90 b.p.m.) were randomly programmed in BiV- and AAI-pacing modes. Muscle sympathetic nerve activity (total sympathetic nerve activity/min (units) and number of bursts/100 RR) were recorded from the peroneal nerve using a microelectrode. In addition, cardiac output (CO) and mean blood pressure (mBP) were measured. With BiV pacing, the total MSNA/min was lower at 70 b.p.m. (-7 ± 21%, P = 0.18) and 90 b.p.m. (-29 ± 18%, P = 0.01) compared with at 50 b.p.m. (280 ± 180 U). Similarly, bursts/100RR decreased with increased BiV pHR. Cardiac output (3.7 L/min at 50 b.p.m., +12 ± 12% at 70 b.p.m., and +18 ± 19% at 90 b.p.m.) and mBP (78 ± 11 mmHg at 50 b.p.m., +6 ± 6% at 70 b.p.m. and +11 ± 8% at 90 b.p.m.) increased significantly at elevated pHRs in BiV-pacing mode. The effect on MSNA, CO, and mBP was less pronounced in AAImode but we found no significant differences between the pacing modes. CONCLUSION Increased pHR acutely reduces MSNA and improves haemodynamics in HF patients treated with CRT with no evident differences between BiV- and AAI-pacing modes. Further studies are warranted to guide the programming of basic pHR in CRT patients.
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Affiliation(s)
- Marcus Ståhlberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Mikael Sander
- Department of Cardiology, Copenhagen University Hospital at Hvidovre, Copenhagen, Denmark
| | - Lars Mortensen
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Cecilia Linde
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, S-17176 Stockholm, Sweden
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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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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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Sheth SS, Maxey DM, Drain AE, Feinstein JA. Validation of the Innocor device for noninvasive measurement of oxygen consumption in children and adults. Pediatr Cardiol 2013; 34:847-52. [PMID: 23108483 DOI: 10.1007/s00246-012-0555-6] [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: 07/13/2012] [Accepted: 10/04/2012] [Indexed: 11/29/2022]
Abstract
Outpatient measurements of oxygen consumption (VO2) and cardiac output (CO) are valuable in the management of pediatric cardiac disease. Current methods are inaccurate and cumbersome or require invasive procedures. New devices to measure these variables in adults have not been rigorously tested for children. The Innocor system uses a photoacoustic analyzer to measure gas content for noninvasive measurement of VO2 and CO. This study sought to validate Innocor-derived VO2 measurements in children and adults by comparing them against the gold standard Douglas bag method. Subjects were tested in an outpatient setting. Adaptations were made for pediatric patients based on weight. Resting VO2 measurements were obtained simultaneously by the Innocor system and Douglas bag during 3 min. The study enrolled 31 children (mean age, 12.2 years; range, 7-17 years, 17 girls) and 29 adults (mean age, 36.7 years; range, 19-57 years; 17 women). Strong correlation between the two techniques was seen for both the adults (R (2) = 0.88) and the children (R (2) = 0.82). The average discrepancy between the Innocor and Douglas bag measurements was 1.7 % (range, 0.6-19.1 %) for the adults, and 5.4 % (range, 0.1-32.2 %) for the children. The discrepancy was more than 15 % for 17 % of the adults and 22 % of the children, with the Innocor device tending to overestimate VO2 in children compared with the Douglas bag. This trend was not seen in adults. The Innocor system has excellent correlation with the Douglas bag and shows promise for noninvasive measurement of VO2 and CO in the school-age pediatric population.
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Affiliation(s)
- Shreya S Sheth
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, CA, USA.
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Trinkmann F, Sampels M, Doesch C, Papavassiliu T, Brade J, Schmid-Bindert G, Hoffmann U, Borggrefe M, Kaden JJ, Saur J. Is Arterial Pulse Contour Analysis Using Nexfin a New Option in the Noninvasive Measurement of Cardiac Output?—A Pilot Study. J Cardiothorac Vasc Anesth 2013; 27:283-7. [DOI: 10.1053/j.jvca.2012.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Indexed: 11/11/2022]
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Hemodynamic Effects of Exercise Training in Heart Failure. J Card Fail 2011; 17:916-22. [DOI: 10.1016/j.cardfail.2011.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 07/28/2011] [Indexed: 01/11/2023]
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Bartels SA, Stok WJ, Bezemer R, Boksem RJ, van Goudoever J, Cherpanath TGV, van Lieshout JJ, Westerhof BE, Karemaker JM, Ince C. Noninvasive cardiac output monitoring during exercise testing: Nexfin pulse contour analysis compared to an inert gas rebreathing method and respired gas analysis. J Clin Monit Comput 2011; 25:315-21. [PMID: 22002638 DOI: 10.1007/s10877-011-9310-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 09/29/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise testing is often used to assess cardiac function during physical exertion to obtain diagnostic information. However, this procedure is limited to measuring the electrical activity of the heart using electrocardiography and intermittent blood pressure (BP) measurements and does not involve the continuous assessment of heart functioning. In this study, we compared continuous beat-to-beat pulse contour analysis to monitor noninvasive cardiac output (CO) during exercise with inert gas rebreathing and respired gas analysis. METHODS Nineteen healthy male volunteers were subjected to bicycle ergometry testing with increasing workloads. Cardiac output was deter- mined noninvasively by continuous beat-to-beat pulse contour analysis (Nexfin) and by inert gas rebreathing, and estimated using the respired gas analysis method. The effects of the rebreathing maneuver on heart rate (HR), stroke volume (SV), and CO were evaluated. RESULTS The CO values derived from the Nexfin- and inert gas rebreathing methods were well correlated (r = 0.88, P < 0.01) and the limits of agreement were 30.3% with a measurement bias of 0.4 ± 1.8 L/min. Nexfin- and respired gas analysis-derived CO values correlated even better (r = 0.94, P < 0.01) and the limits of agreement were 21.5% with a measurement bias of -0.70 ± 1.6 L/min. At rest, the rebreathing maneuver increased HR by 13 beats/min (P < 0.01), SV remained unaffected (P = 0.7), while CO increased by 1.0 L/min (P < 0.01). Rebreathing did not affect these parameters during exercise. CONCLUSIONS Nexfin continuous beat-to-beat pulse contour analysis is an appropriate method for noninvasive assessment of CO during exercise.
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Affiliation(s)
- Sebastiaan A Bartels
- Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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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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Hauser J, Michel-Behnke I, Zervan K, Pees C. Noninvasive measurement of atrial contribution to the cardiac output in children and adolescents with congenital complete atrioventricular block treated with dual-chamber pacemakers. Am J Cardiol 2011; 107:92-5. [PMID: 21146693 DOI: 10.1016/j.amjcard.2010.08.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/11/2010] [Accepted: 08/11/2010] [Indexed: 10/18/2022]
Abstract
The contribution of atrial contraction to cardiac output (CO) has been the subject of extensive research but has yet to be quantified adequately in children and adolescents. Patients with third-degree atrioventricular (AV) block treated with pacemakers (PMs) are ideal candidates to assess the atrial contribution to CO by repeated measurements in single-chamber pacing mode (VVIR) and dual-chamber pacing mode (DDD/VDD). Hemodynamic measurements in children are often complicated by technical restrictions, but more recently a noninvasive method involving inert gas rebreathing has become available, which is an excellent tool for this age group. We examined 10 patients (6 female patients, mean age 14.5 ± 2.5 years, range 11 to 18) with congenital complete AV block treated with dual-chamber PM. Using an inert gas rebreathing device (Innocor) we measured CO in DDD/VDD with optimized AV delays. Devices were subsequently set to VVIR with matched heart rates and after 20 minutes the CO measurement was repeated. Mean CO of 6.4 ± 1.8 L/min was significantly higher in DDD/VDD than in VVIR, where it averaged 5.2 ± 1.4 L/min (p <0.001). Fractional increase of CO gained through sequential ventricular contraction was 18% (p <0.001). In VVIR, 8 patients reported PM-related symptoms. In conclusion, our data strongly suggest that pediatric patients with congenital complete AV block may benefit from AV synchrony with respect to hemodynamics and tolerability. Therefore, preferred use of DDD/VDD with optimized AV conduction delays should be considered.
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Nickl W, Bugaj T, Mondritzki T, Kuhlebrock K, Dinh W, Krahn T, Sohler F, Truebel H. Non-invasive assessment of cardiac output during mechanical ventilation – a novel approach using an inert gas rebreathing method. BIOMED ENG-BIOMED TE 2011; 56:147-51. [DOI: 10.1515/bmt.2011.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wiegand G, Kerst G, Baden W, Hofbeck M. Noninvasive cardiac output determination for children by the inert gas-rebreathing method. Pediatr Cardiol 2010; 31:1214-8. [PMID: 20941596 DOI: 10.1007/s00246-010-9806-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Accepted: 09/18/2010] [Indexed: 11/29/2022]
Abstract
Standard methods for determination of cardiac output (CO) are either invasive or technically demanding. Measurement of CO by the inert gas-rebreathing (IGR) method, applied successfully in adults, uses a low-concentration mixture of an inert and a blood-soluble gas, respectively. This study tested the feasibility of this method for determining CO during exercise for pediatric patients with complete congenital atrioventricular block (CCAVB) stimulated with a VVI pacemaker. In this study, 5 CCAVB patients (age 9.2-17.4 years) were compared with 10 healthy age-matched boys and girls. Testing was performed with the Innocor system. The patients were instructed to breathe the test gas from a closed system. Pulmonary blood flow was calculated according to the washout of the soluble gas component. During standardized treadmill testing, CO was determined at three defined levels. The CO measurements were successful for all the study participants. The patients reached a lower peak CO than the control subjects (5.9 l/min/m(2) vs 7.3 [boys] and 7.2 [girls]). The stroke volume increase under exercise also was reduced in the patients compared with the control subjects. The feasibility of the IGR method for exercise CO testing in children was documented. Application of the IGR method for children requires careful instruction of the patients and appears restricted to subjects older than 8 years. The method offers new insights into mechanisms of cardiovascular adaptation in children with congenital heart disease.
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Affiliation(s)
- Gesa Wiegand
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
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Saur J, Trinkmann F, Doesch C, Scherhag A, Brade J, Schoenberg SO, Borggrefe M, Kaden JJ, Papavassiliu T. The impact of pulmonary disease on noninvasive measurement of cardiac output by the inert gas rebreathing method. Lung 2010; 188:433-40. [PMID: 20676666 DOI: 10.1007/s00408-010-9257-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
Cardiac output (CO) is an important parameter for diagnosis and therapy of heart diseases, but it is still difficult to determine. Innocor, a novel noninvasive inert gas rebreathing (IGR) system, has shown promising results. However, the impact of pulmonary diseases on IGR remains unclear. The aim of the study therefore was to assess the accuracy and reliability of IGR in patients with distinct chronic lung disease. A total of 96 patients were enrolled, including 48 consecutive patients with variant lung diseases (group A) and 48 pair-matched pulmonary healthy patients (group B). CO was measured with cardiac magnetic resonance imaging (CMR) and IGR. Lung function testing was done by spirometry [FEV(1)/FVC (forced expiratory volume in one second/forced vital capacity), VC (vital capacity)] and determination of the diffusing capacity of the lung for carbon monoxide divided by alveolar volume (DLCO/VA). In group A we found a mean CO of 4.7 ± 1.3 L/min by IGR and 4.9 ± 1.2 L/min by CMR. Group B showed a mean CO of 4.8 ± 1.4 L/min by IGR and 5.0 ± 1.3 L/min by CMR. Bland-Altman analysis revealed good correspondence between CMR and IGR, with an average deviation of 0.1 ± 1.0 L/min in group A and 0.1 ± 1.0 L/min in group B (p = 0.99). Multiple regression analysis for the pulmonary parameters did not show a statistically significant impact on the mean bias of CO measurements (FEV(1)/FVC: r = 0.01, p = 0.91; VC: r = -0.2, p = 0.13; and DLCO/VA: r = 0.04, p = 0.82). IGR allows a feasible determination of CO even in patients with lung diseases. The accuracy of the IGR method is not influenced by either pulmonary obstructive and restrictive diseases or a reduced DLCO.
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Affiliation(s)
- Joachim Saur
- 1st Department of Medicine (Cardiology, Angiology, Pneumology, Intensive Care), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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