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Klavebäck S, Skúladóttir H, Olbers J, Östergren J, Braunschweig F. Changes in cardiac output, rhythm regularity, and symptom severity after electrical cardioversion of atrial fibrillation. SCAND CARDIOVASC J 2023; 57:2236341. [PMID: 37452449 DOI: 10.1080/14017431.2023.2236341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/14/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Symptoms in atrial fibrillation (AF) range from none to disabling. The physiological correlates of AF symptoms are not well characterized. This study investigated the association between physiological parameters and symptom severity before and after electrical cardioversion (EC) of AF. DESIGN We studied 44 patients with persistent AF (age 66.2 ± 7.9 years, 16% females) 4 ± 2 days before and 5 ± 2 days after EC. Physiological parameters included cardiac output (CO; non-invasive inert gas rebreathing), heart rate (HR), RR variability and resting and ambulatory blood pressure (BP). Symptoms and quality of life (QoL) were assessed by the modified European Heart Rhythm Association score (mEHRA), the Atrial Fibrillation Effect on Quality of Life (AFEQT) and the Symptom Checklist for frequency and severity of symptoms (SCL). RESULTS 28 of 44 patients were still in sinus rhythm (SR) at post EC evaluation. Those in SR had a decreased HR (-15.4 ± 13.1 bpm, p < 0.001), and an increased CO (+0.8 ± 0.7 L/min, p < 0.001) as compared to those with recurrent AF. Changes in CO after EC correlated with symptom improvement as scored by AFEQT (r = 0.36; p < 0.05), AFEQT symptoms subscore (r = 0.46; p < 0.01), SCL for frequency (r = 0.62; p < 0.01) and severity (r = 0.33; p < 0.05) of symptoms, and the mEHRA score (r = 0.50; p < 0.01). A decrease in RR variability showed similar correlations with these measures of symptom improvement. CONCLUSIONS Improvements in symptoms and quality of life experienced by patients after electrical conversion of atrial fibrillation are correlated with an increase in CO and a decreased RR variability.
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Affiliation(s)
- Sofia Klavebäck
- Department of Medicine Solna, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Helga Skúladóttir
- Department of Medicine Solna, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Joakim Olbers
- Department of Clinical Science and Education, Cardiology Unit, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Jan Östergren
- Department of Medicine Solna, Unit of Clinical Medicine, Karolinska Institute, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Medicine Solna, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
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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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3
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Correlation of Impedance Cardiography-Derived and Cardiac Magnetic Resonance-Derived Stroke Volumes. Curr Probl Cardiol 2023; 48:101457. [PMID: 36273652 DOI: 10.1016/j.cpcardiol.2022.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Cardiac output (CO) and other hemodynamic parameter measurements play an important role in the management of cardiovascular conditions; however, due to limitations of current day technologies, such measurements are either not routinely performed or incorporated into clinical practice. Moreover, measurement of these hemodynamic parameters in the outpatient setting at different time points to assess interval change is currently not feasible. We attempted to validate total-body impedance cardiography-based Non-Invasive Cardiac System (NICaS) derived stroke volume (SV) with that from cardiac magnetic resonance (CMR), a current day gold standard method of assessment. We compared SV, as it is the primary unit of measurement utilized by both technologies. Forty-one consecutive patients undergoing CMR were also investigated by NICaS following CMR. The consistency of non-invasive technology-derived SV measurement was validated by NICaS measurement in 10 subjects, both before and after CMR. Of the 41 enrolled patients; data from 38 patients was adequate for comparison (motion artifact prevented CMR measures in 3 patients). Fourteen patients (37%) were female; mean age was 55 ± 15 years (28-87 years) and body-mass index was 28.7 ± 5.5 kg/m2 (20.5-41.9 kg/m2). Hypertrophic cardiomyopathy (9/41) was the most common study indication for CMR. NICaS-derived SV strongly correlated with CMR [NICaS 77 ± 20 ml (31-123 ml) and CMR 84 ± 23 ml (47-132 ml); P < 0.001; r = 0.77; ICC = 0.73]. The Bland-Altman limits of agreement between NICaS and CMR were -26.7% and 39.9%. NICaS-derived SV collected before and after MRI did not differ [80 ± 18 ml (51-102 ml) pre and 76 ± 17 ml (50-99 ml) post; P = 0.0007, Kappa = 1]. Agreement between NICaS-derived and CMR-derived SV was within the acceptable range of boundaries set by the US Food and the Drug Administration. Consistency in SV measurement at different time-points may allow use of this technology to identify interval hemodynamic changes noninvasively.
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4
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MacNamara JP, Dias KA, Hearon CM, Hieda M, Turer AT, Link MS, Sarma S, Levine BD. Limits to Submaximal and Maximal Exercise in Patients with Hypertrophic Cardiomyopathy. J Appl Physiol (1985) 2022; 133:787-797. [PMID: 35952351 DOI: 10.1152/japplphysiol.00566.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) often have reduced exercise capacity, and it is unclear whether cardiovascular regulation during exercise is intact in these patients. We aimed to determine the relationship between cardiac output (Q̇c) and oxygen uptake (V̇O2), and stroke volume (SV) reserve in HCMcompared to healthy participants and participants with left ventricular hypertrophy (LVH) but not HCM. METHODS Sixteen patients with HCM (48±7 years, 44% female), 16 participants with LVH (49±5 years, 44% female), and 61 healthy controls (CON: 52±5 years, 52% female) completed submaximal steady-state treadmill exercise followed by a maximal exercise test. V̇O2, Q̇c,SV and arterio-venous oxygen difference were measured during rest and exercise, and Q̇c/V̇O2 slopes were constructed. RESULTS The Q̇c/V̇O2 slopewas blunted in HCM compared to CON and LVH (HCM 4.9±0.7 vs. CON 5.5± 1.0 [P = 0.027], vs LVH 6.0±1.0AU [P = 0.002]) and participants with HCM had a lower SV reserve (HCM 53±33%, controls 83±33%, LVH 82±22%; HCM vs. controls P = 0.002; HCM vs. LVH P = 0.015). Despite a blunted Q̇c/V̇O2 slope, 75% of patients with HCM achieved ≥80% predicted V̇O2max by augmenting a-vO2 difference at maximal exercise (16.0±0.8 mL/100mL vs 13.8±2.7 mL/100mL, P = 0.021). CONCLUSIONS Patients with HCM do not appropriately match Q̇c to metabolic demand, primarily due to inadequate stroke volume augmentation. Despite this central limitation, many patients achieve normal exercise capacities by significantly increasing peripheral oxygen extraction.
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Affiliation(s)
- James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States.,Kyushu University, School of Medicine, Department of Medicine and Biosystemic Science, Fukuoka, Japan
| | - Aslan T Turer
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
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5
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Tobushi T, Kasai T, Hirose M, Sakai K, Akamatsu M, Ohsawa C, Yoshioka Y, Suda S, Shiroshita N, Nakamura R, Kadokami T, Tohyama T, Funakoshi K, Hosokawa K, Ando SI. Lung-to-finger circulation time can be measured stably with high reproducibility by simple breath holding method in cardiac patients. Sci Rep 2021; 11:15913. [PMID: 34354137 PMCID: PMC8342428 DOI: 10.1038/s41598-021-95192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
Lung to finger circulation time (LFCT) has been used to estimate cardiac function. We developed a new LFCT measurement device using a laser sensor at fingertip. We measured LFCT by measuring time from re-breathing after 20 s of breath hold to the nadir of the difference of transmitted red light and infrared light, which corresponds to percutaneous oxygen saturation. Fifty patients with heart failure were enrolled. The intrasubject stability of the measurement was assessed by the intraclass correlation coefficient (ICC). The ICC calculated from 44 cases was 0.85 (95% confidence interval: 0.77–0.91), which means to have “Excellent reliability.” By measuring twice, at least one clear LFCT value was obtained in 89.1% of patients and the overall measurability was 95.7%. We conducted all LFCT measurements safely. High ICCs were obtained even after dividing patients according to age, cardiac index (CI); 0.85 and 0.84 (≥ 75 or < 75 years group, respectively), 0.81 and 0.84 (N = 26, ≥ or < 2.2 L/min/M2). These results show that our new method to measure LFCT is highly stable and feasible for any type of heart failure patients.
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Affiliation(s)
- Tomoyuki Tobushi
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Hirose
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuhiro Sakai
- Imaging Device Development, Fuji Xerox Co., Ltd., Kanagawa, Japan
| | - Manabu Akamatsu
- Imaging Device Development, Fuji Xerox Co., Ltd., Kanagawa, Japan
| | - Chizuru Ohsawa
- Imaging Device Development, Fuji Xerox Co., Ltd., Kanagawa, Japan
| | - Yasuko Yoshioka
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nanako Shiroshita
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Nakamura
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Toshiaki Kadokami
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Takeshi Tohyama
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Stocker TJ, Hertell H, Orban M, Braun D, Rommel KP, Ruf T, Ong G, Nabauer M, Deseive S, Fam N, von Bardeleben RS, Thiele H, Massberg S, Lurz P, Hausleiter J. Cardiopulmonary Hemodynamic Profile Predicts Mortality After Transcatheter Tricuspid Valve Repair in Chronic Heart Failure. JACC Cardiovasc Interv 2020; 14:29-38. [PMID: 33309317 DOI: 10.1016/j.jcin.2020.09.033] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was designed to assess hemodynamic changes in response to transcatheter tricuspid valve edge-to-edge repair (TTVR) and to identify hemodynamic predictors associated with mortality. BACKGROUND Severe tricuspid regurgitation (TR) is associated with high mortality. TTVR effectively alleviates heart failure symptoms, but comprehensive hemodynamic characterization of patients undergoing TTVR is currently lacking. METHODS This international, multicenter study included 236 patients undergoing TTVR. Data from clinical assessment, echocardiography, intraprocedural right heart catheterization, and noninvasive cardiac output measurement were analyzed. Hemodynamic predictors for mortality were identified using linear Cox regression analysis and were used for stratification of patients with subsequent analysis of survival time. RESULTS Patients (median age 78 years, 53% women) were symptomatic (89% in New York Heart Association functional class III or IV) because of severe TR (grade ≥3+ in 100%). TTVR significantly reduced TR at discharge (grade ≥3+ in 16%; p < 0.001), with a corresponding 19% reduction of the right atrial v wave (21 mm Hg vs. 16 mm Hg; p < 0.001) and an improvement in cardiac output (from 3.5 to 4.0 l/min; p < 0.01). Invasive mean pulmonary artery pressure, transpulmonary gradient, pulmonary vascular resistance, and right ventricular stroke work were significant predictors of 1-year mortality (p < 0.05 for all). Hemodynamic stratification by mean pulmonary artery pressure and transpulmonary gradient best predicted 1-year survival (p < 0.001). Although patients with pre-capillary dominant pulmonary hypertension showed an unfavorable prognosis (1-year survival 38%), patients without or with post-capillary pulmonary hypertension had favorable outcome (1-year survival 92% or 78%, respectively). CONCLUSIONS Invasive assessment of cardiopulmonary hemodynamic status predicts survival after TTVR. Invasive hemodynamic characterization may help identify patients profiting most from TTVR.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Helene Hertell
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg University, Mainz, Germany
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Holger Thiele
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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7
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Corrieri N, Del Torto A, Vignati C, Maragna R, De Martino F, Cellamare M, Farina S, Salvioni E, Bonomi A, Agostoni P. Cardiac output changes during exercise in heart failure patients: focus on mid-exercise. ESC Heart Fail 2020; 8:55-62. [PMID: 33201613 PMCID: PMC7835620 DOI: 10.1002/ehf2.13005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/12/2022] Open
Abstract
Aims Peak exercise oxygen uptake (VO2) and cardiac output (CO) are strong prognostic indexes in heart failure (HF) but unrelated to real‐life physical activity, which is associated to submaximal effort. Methods and results We analysed maximal cardiopulmonary exercise test with rest, mid‐exercise, and peak exercise non‐invasive CO measurements (inert gas rebreathing) of 231 HF patients and 265 healthy volunteers. HF patients were grouped according to exercise capacity (peak VO2 < 50% and ≥50% pred, Groups 1 and 2). To account for observed differences, data regarding VO2, CO, stroke volume (SV), and artero‐venous O2 content difference [ΔC(a‐v)O2] were adjusted by age, gender, and body mass index. A multiple regression analysis was performed to predict peak VO2 from mid‐exercise cardiopulmonary exercise test and CO parameters among HF patients. Rest VO2 was lower in HF compared with healthy subjects; meanwhile, Group 1 patients had the lowest CO and highest ΔC(a‐v)O2. At mid‐exercise, Group 1 patients achieved a lower VO2, CO, and SV [0.69 (interquartile range 0.57–0.80) L/min; 5.59 (4.83–6.67) L/min; 62 (51–73) mL] than Group 2 [0.94 (0.83–1.1) L/min; 7.6 (6.56–9.01) L/min; 77 (66–92) mL] and healthy subjects [1.15 (0.93–1.30) L/min; 9.33 (8.07–10.81) L/min; 87 (77–102) mL]. Rest to mid‐exercise SV increase was lower in Group 1 than Group 2 (P = 0.001) and healthy subjects (P < 0.001). At mid‐exercise, ΔC(a‐v)O2 was higher in Group 2 [13.6 (11.8–15.4) mL/100 mL] vs. healthy patients [11.6 (10.4–13.2) mL/100 mL] (P = 0.002) but not different from Group 1 [13.6 (12.0–14.9) mL/100 mL]. At peak exercise, Group 1 patients achieved a lower VO2, CO, and SV than Group 2 and healthy subjects. ΔC(a‐v)O2 was the highest in Group 2. At multivariate analysis, a model comprising mid‐exercise VO2, carbon dioxide production (VCO2), CO, haemoglobin, and weight predicted peak VO2, P < 0.001. Mid‐exercise VO2 and CO, haemoglobin, and weight added statistically significantly to the prediction, P < 0.050. Conclusions Mid‐exercise VO2 and CO portend peak exercise values and identify severe HF patients. Their evaluation could be clinically useful.
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Affiliation(s)
| | | | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Cardiovascular Medicine Fellowship Program, University of Milan, Milan, Italy
| | | | - Martina Cellamare
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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8
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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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9
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Hardin EA, Stoller D, Lawley J, Howden EJ, Hieda M, Pawelczyk J, Jarvis S, Prisk K, Sarma S, Levine BD. Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed-Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement. J Am Heart Assoc 2020; 9:e015794. [PMID: 32851906 PMCID: PMC7660774 DOI: 10.1161/jaha.120.015794] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C2H2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [r=0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [r=0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C2H2 correlated well with thermodilution (supine: r=0.84, TE=1.02; exercise: r=0.82, TE=2.36). In patients with clinical disease during supine rest, C2H2 correlated with thermodilution (r=0.85, TE=1.43). C2H2 was similar to thermodilution and nitrous oxide (N2O) rebreathing technique compared with Fick in healthy adults (C2H2 rest: r=0.85, TE=0.84; C2H2 exercise: r=0.87, TE=2.39; thermodilution rest: r=0.72, TE=1.11; thermodilution exercise: r=0.73, TE=2.87; N2O rest: r=0.82, TE=0.94; N2O exercise: r=0.84, TE=2.18). The accuracy of the C2H2 and N2O methods was excellent (r=0.99, TE=0.58). Conclusions The C2H2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N2O rebreathing method approved by the US Food and Drug Administration.
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Affiliation(s)
- E Ashley Hardin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Douglas Stoller
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Justin Lawley
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Erin J Howden
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Michinari Hieda
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - James Pawelczyk
- Department of Physiology Pennsylvania State University University Park and Hershey PA
| | - Sara Jarvis
- Department of Biological Sciences Northern Arizona University Flagstaff AZ
| | - Kim Prisk
- Department of Medicine University of California at San Diego La Jolla CA
| | - Satyam Sarma
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Benjamin D Levine
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
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Agostoni P, Dumitrescu D. How to perform and report a cardiopulmonary exercise test in patients with chronic heart failure. Int J Cardiol 2019; 288:107-113. [DOI: 10.1016/j.ijcard.2019.04.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/04/2019] [Accepted: 04/16/2019] [Indexed: 01/01/2023]
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11
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Vignati C, Morosin M, Fusini L, Pezzuto B, Spadafora E, De Martino F, Salvioni E, Rovai S, Filardi PP, Sinagra G, Agostoni P. Do rebreathing manoeuvres for non-invasive measurement of cardiac output during maximum exercise test alter the main cardiopulmonary parameters? Eur J Prev Cardiol 2019; 26:1616-1622. [DOI: 10.1177/2047487319845967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inert gas rebreathing has been recently described as an emergent reliable non-invasive method for cardiac output determination during exercise, allowing a relevant improvement of cardiopulmonary exercise test clinical relevance. For cardiac output measurements by inert gas rebreathing, specific respiratory manoeuvres are needed which might affect pivotal cardiopulmonary exercise test parameters, such as exercise tolerance, oxygen uptake and ventilation vs carbon dioxide output (VE/VCO2) relationship slope. Method We retrospectively analysed cardiopulmonary exercise testing of 181 heart failure patients who underwent both cardiopulmonary exercise testing and cardiopulmonary exercise test+cardiac output within two months (average 16 ± 15 days). All patients were in stable clinical conditions (New York Heart Association I–III) and on optimal medical therapy. Results The majority of patients were in New York Heart Association Class I and II (78.8%), with a mean left ventricular ejection fraction of 31 ± 10%. No difference was found between the two tests in oxygen uptake at peak exercise (1101 (interquartile range 870–1418) ml/min at cardiopulmonary exercise test vs 1103 (844–1389) at cardiopulmonary exercise test-cardiac output) and at anaerobic threshold. However, anaerobic threshold and peak heart rate, peak workload (75 (58–101) watts and 64 (42–90), p < 0.01) and carbon dioxide output were significantly higher at cardiopulmonary exercise testing than at cardiopulmonary exercise test+cardiac output, whereas VE/VCO2 slope was higher at cardiopulmonary exercise test+cardiac output (30 (27–35) vs 33 (28–37), p < 0.01). Conclusion The similar anaerobic threshold and peak oxygen uptake in the two tests with a lower peak workload and higher VE/VCO2 slope at cardiopulmonary exercise test+cardiac output suggest a higher respiratory work and consequent demand for respiratory muscle blood flow secondary to the ventilatory manoeuvres. Accordingly, VE/VCO2 slope and peak workload must be evaluated with caution during cardiopulmonary exercise test+cardiac output.
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Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Marco Morosin
- Centro Cardiologico Monzino, IRCCS, Italy
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste, Italy
| | | | | | | | | | | | - Sara Rovai
- Centro Cardiologico Monzino, IRCCS, Italy
- Università degli Studi di Padova, Italy
| | - Pasquale P Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata of Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
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12
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Epidermal growth factor and its influencing variables in healthy children and adults. PLoS One 2019; 14:e0211212. [PMID: 30677083 PMCID: PMC6345470 DOI: 10.1371/journal.pone.0211212] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background & objective Epidermal growth factor (EGF) stimulates cell proliferation and differentiation after binding to its receptor. Next to its role in magnesium homeostasis, EGF disturbances have been described in oncology, diabetes and autism spectrum disorders. The aim of this study was to determine EGF serum and urine values for both healthy children and adults. Next, we investigated the relation between several variables and urinary and serum EGF concentrations. Methods Both healthy adults (n = 50) and children (n = 78) were included. Serum and urinary EGF concentrations were measured with ELISA technology. Results Serum EGF was inversely correlated with age (r = —0.873; p<0.001) and positively correlated with serum magnesium (r = 0.597; p<0.001). The urinary EGF was also inversely correlated with age (r = -0.855; p<0.001). In adults and children older than 13 years of age, the urinary EGF significantly differed between sexes (p = 0.001). Urinary EGF was positively correlated with serum magnesium (r = 0.583; p<0.001) and creatinine clearance (r = 0.524; p<0.001) and negatively correlated with the fractional excretion of magnesium (r = 0.248; p = 0.014). In a multivariate model, age and serum magnesium remained independently related to serum EGF while age, serum EGF and serum magnesium remained independently related to urinary EGF. Conclusions This study provides valuable insights in urinary and serum EGF patterns in healthy subjects. By systematically correcting EGF for body surface, significant correlations with age, gender and magnesium were observed.
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13
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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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Stocker TJ, Orban M, Braun D, Scheck F, Weckbach LT, Orban M, Deseive S, Nabauer M, Massberg S, Hausleiter J. Physical Activity and Noninvasive Cardiac Output as Novel Clinical Endpoints After Transcatheter Valve Repair for Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2018; 11:2127-2129. [DOI: 10.1016/j.jcin.2018.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
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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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Staer-Jensen H, Sunde K, Nakstad ER, Eritsland J, Andersen GØ. Comparison of three haemodynamic monitoring methods in comatose post cardiac arrest patients. SCAND CARDIOVASC J 2018; 52:141-148. [PMID: 29544369 DOI: 10.1080/14017431.2018.1450992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Haemodynamic monitoring during post arrest care is important to optimise treatment. We compared stroke volume measured by minimally-invasive monitoring devices with or without thermodilution calibration, and transthoracic echocardiography (TTE), and hypothesised that thermodilution calibration would give stroke volume index (SVI) more in agreement with TTE during targeted temperature management (TTM). DESIGN Comatose out-of-hospital cardiac arrest survivors receiving TTM (33 °C for 24 hrs) underwent haemodynamic monitoring with arterial pulse contour analyses with (PiCCO2®) and without (FloTrac®/Vigileo® monitor®) transpulmonary thermodilution calibration. Haemodynamic parameters were collected simultaneously every fourth hour during TTM (hypothermia) and (normothermia). SVI was measured with TTE during hypothermia and normothermia. Bland-Altman analyses were used for determination of SVI bias (±1SD). RESULTS Twenty-six patients were included, of whom 77% had initial shockable rhythm and 52% discharged with good outcome. SVI (bias ±2SD) between PiCCO (after thermodilution calibration) vs FloTrac/Vigileo, TTE vs FloTrac/Vigileo and TTE vs PiCCO were 1.4 (±25.8), -1.9 (±19.8), 0.06 (±18.5) ml/m2 during hypothermia and 9.7 (±23.9), 1.0 (±17.4), -7.2 (±12.8) ml/m2 during normothermia. Continuous SVI measurements between PiCCO and FloTrac/Vigileo during hypothermia at reduced SVI (<35 ml/m2) revealed low bias and relatively narrow limits of agreement (0.5 ± 10.2 ml/m2). CONCLUSION We found low bias, but relatively wide limits of agreement in SV with PiCCO, FloTrac/Vigileo and TTE during TTM treatment. The methods are not interchangeable. Precision was not improved by transpulmonary thermodilution calibration during hypothermia.
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Affiliation(s)
- Henrik Staer-Jensen
- a Department of Anaesthesiology, Division of Emergencies and Critical Care , Oslo University Hospital , Oslo , Norway
| | - Kjetil Sunde
- a Department of Anaesthesiology, Division of Emergencies and Critical Care , Oslo University Hospital , Oslo , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Espen Rostrup Nakstad
- c Norwegian National Unit for CBRNE Medicine, Division of Medicine , Oslo University Hospital , Oslo , Norway
| | - Jan Eritsland
- d Department of Cardiology, Division of Medicine , Oslo University Hospital , Oslo , Norway.,e Center for Heart Failure Research , University of Oslo , Oslo , Norway
| | - Geir Øystein Andersen
- d Department of Cardiology, Division of Medicine , Oslo University Hospital , Oslo , Norway.,e Center for Heart Failure Research , University of Oslo , Oslo , Norway
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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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