Measurement of cardiac output by CO2 rebreathing in unsteady state exercise

Is peak oxygen uptake a determinant of moderate-duration self-paced exercise performance in the heat?

This study aimed to identify whether reductions in peak oxygen uptake (VO2peak) dictate performance outcomes during 30 min of self-paced exercise in the heat, which is expected to induce minimal hyperthermia. On 4 occasions, 11 male subjects completed peak and self-paced exercise in both hot (HOT, 40.2 ± 0.3 °C) and moderate (MOD; 20.4 ± 0.7 °C) conditions. During peak exercise, submaximal oxygen uptake (VO2) was ∼8% higher in HOT, but VO2peak (MOD, 4.64 ± 0.83 L·min–1; HOT, 4.54 ± 0.77 L·min–1) and peak cardiac output (Qpeak) were similar. Self-paced exercise performance was reduced by ∼21% in HOT. VO2 was similar through 15 min, but lower in HOT thereafter. Relative to MOD, this represented a higher and lower %VO2peak during the initial and latter stages. Cardiac output was similar in both trials (MOD, 31.6 ± 6.6 L·min–1; HOT, 30.1 ± 6.0 L·min–1), representing a similar percentage of Qpeak throughout. Rectal temperature was similar in both conditions until 30 min (MOD, 38.5 ± 0.3 °C; HOT, 38.7 ± 0.3 °C), while skin temperature was higher throughout in HOT (mean: MOD, 32.4 ± 1.1 °C; HOT, 37.3 ± 0.4 °C). Perceived exertion rose similarly in both conditions, while thermal discomfort was higher in HOT. These data indicate that when only skin temperature is elevated, reductions in exercise performance during moderate-duration self-paced exercise are not associated with changes in VO2peak. Rather, increases in VO2 at a given submaximal external workload and (or) thermal discomfort appear to play a larger role.

Cardiac output and oxygen uptake relationship during physical effort in men and women over 60 years old

This study investigated the relationship between oxygen uptake (VO(2)), cardiac output (Q), stroke volume (SV), and heart rate (HR) in 54 men and 77 women (age = 69 +/- 5 years) during incremental effort. Subjects performed a maximal cycle-ergometer test and VO(2) was directly measured. HR and SV were assessed by ECG and cardiograph impedance. Regression equations were calculated for Q-VO(2), HR-VO(2), and Q-HR relationships. The equations obtained for women were (a) Q (l min(-1)) = 2.61 + 4.67 VO(2) (l min(-1))(r(2) = 0.84); (b) HR (bpm) = 62.03 + 46.55 VO(2) (l min(-1)) (r (2) = 0.72); (c) SV (ml) 100:6[1 - e(-2.6 VO2 (1 min-1))] (r (2) = 0.41); (d) HR (bpm) = 41.48 + 9.24 Q (l min(-1)) (r (2) = 0.73). Equations for men were (a) Q (l min(-1)) = 2.52 + 5.70 VO(2) (l min(-1)) (r (2) = 0.89); (b) HR (bpm) = 66.31 + 32.35 VO(2) (l min(-1)) (r (2) = 0.72); (c) [1 - e(-1.7 VO2 (1 min-1))] (r (2) = 0.47); (d) HR (bpm) = 56.33 + 5.25 Q (l min(-1)) (r (2) = 0.69). The intercepts for Q-VO(2) and HR-VO(2) equations were similar for both genders, but the slopes were different (P < 0.05). The SV increased from baseline to 50-60% of VO(2) peak in both groups. No gender effect was found in SV increasing pattern, but the absolute values were in general higher for men (P > 0.05). A significant difference between men and women was observed for both slopes and intercepts in the Q-HR relationship (P < 0.05). In conclusion, (a) Q-VO(2) relation was linear during progressive effort; (b) regression intercepts were similar, but the slopes were higher for men compared to women; (c) SV-VO(2) relationship was nonlinear and maximum SV was reached at very submaximal workload; (d) older men exhibited higher Q upward potential as well higher SV but lower HR for a given submaximal workload than women of similar age.

Physiological range of peak cardiac power output in healthy adults

AIMS

The purpose of this study was to indicate the normal range for peak cardiac power output (CPO(peak)) in healthy adults and to explore age- and sex-related variations of this parameter.

METHODS AND RESULTS

Using the non-invasive exponential CO(2) rebreathing technique [J.G. Defares, J Appl Physiol13 (1958) 159], cardiac output was measured at an exercise intensity determined to coincide with > or =95% of peak oxygen consumption in 102 healthy adults (mean +/- SD, age 43 +/- 13 years, body mass 74 +/- 13 kg). Peak cardiac power was then computed from measurements of peak cardiac output (Q(Tpeak)) and peak mean arterial pressure (MAP(peak)) using the equation described by Cooke et al. [Heart79 (1998) 289]. Peak oxygen consumption in the study population was 2.42 (+/-0.74) l min(-1) and subjects achieved 101 +/- 7% of this value during the measurement of . was 17.3 (+/-4) l min(-1), and CPO(peak) was computed as 4.5 (+/-1.2) W. CPO(peak) ranged from 3.11 to 7.94 W in men and 2.53 to 5.57 W in women. Additionally, ageing appears to be associated with a significant loss of peak cardiac power in men that is not apparent in women.

CONCLUSION

Although the sample size remains moderate, the CPO values attained were normally distributed and these values provide a useful indication of the normal range for CPO(peak) in healthy adults.

Resting and exercise cardiorespiratory function in survivors of congenital diaphragmatic hernia

Our objective was to study exercise capacity and cardiorespiratory response to exertion in survivors of congenital diaphragmatic hernia (CDH). This was a cross-sectional cohort study of 23 CDH survivors, aged 10-16 years, and 23 gender- and age-matched controls. Exercise testing was performed on a cycle ergometer, with cardiac output measurements made using exponential CO2 rebreathing. Pretest cardiorespiratory assessment was done by echocardiography and pulmonary function testing. Statistical analysis was performed using Student's t-test, regression analysis, and longitudinal model computing with spatial covariance structure. No echocardiographic evidence for pulmonary hypertension was found at rest (right ventricular systolic pressures, 27 +/- 6 mmHg). Mean pulmonary artery diameter on the side of the CDH was significantly smaller than contralaterally, but was within normal range (z-score, 0 +/- 1.1 vs. 1.2 +/- 1.6, P < 0.01). Exercise capacity was mildly reduced in CDH compared to controls and predictive data (maximum workload, 77% +/- 12% vs. 91% +/- 16% of predicted, P < 0.01). Cardiorespiratory response to exertion was not significantly different between groups. In conclusion, most adolescent CDH survivors have nearly normal exercise capacity and cardiorespiratory response to exertion. This study may prove useful in comparisons with future cohorts comprising more severely affected individuals now surviving due to improved neonatal care.

Decreased peak arteriovenous oxygen difference during treadmill exercise testing in individuals infected with the human immunodeficiency virus

OBJECTIVE

To determine if arteriovenous oxygen difference was lower in asymptomatic individuals with human immunodeficiency virus (HIV) infection than in sedentary but otherwise healthy controls.

DESIGN

Quasi-experimental cross-sectional.

SETTING

Clinical exercise laboratory.

PARTICIPANTS

Fifteen subjects (10 men, 5 women) with HIV and 15 healthy gender- and activity level-matched controls (total N=30).

INTERVENTION

Participants performed an incremental maximal exercise treadmill test to exhaustion. Electrocardiogram, metabolic, and noninvasive cardiac output measurements were evaluated at rest and throughout the tests. Data were analyzed by using analysis of covariance.

MAIN OUTCOME MEASURES

Peak oxygen consumption (Vo(2)), cardiac output, stroke volume, and arteriovenous oxygen difference. The arteriovenous oxygen difference was determined indirectly using the Fick equation.

RESULTS

Peak VO(2) was significantly lower (P<.0005) in participants with HIV (24.6+/-1.2mL.kg(-1).min(-1)) compared with controls (32.0+/-1.2mL.kg(-1).min(-1)). There were no significant intergroup differences in cardiac output or stroke volume at peak exercise. Peak arteriovenous oxygen difference was significantly lower (P<.04) in those infected with HIV (10.8+/-0.5 volume %) than in controls (12.4+/-0.5 volume %).

CONCLUSION

The observed deficit in aerobic capacity in the participants with HIV appeared to be the result of a peripheral tissue oxygen extraction or utilization limitation. In addition to deconditioning, potential mechanisms for this significant attenuation may include HIV infection and inflammation, highly active antiretroviral therapy medication regimens, or a combination of these factors.

Comparison of cardiac output measured by two automated methods of CO2 rebreathing

PURPOSE

The aim of the present study was to investigate the reproducibility of the exponential method of CO2 rebreathing with the use of automated curve fitting and to determine whether this method is superior to the equilibrium method in terms of reproducibility and clinical practicability.

METHODS

Repeated measurements of cardiac output were performed using the automated equilibrium and exponential methods. These measurements were compared in 12 healthy male subjects at rest and during incremental exercise tests.

RESULTS

Estimated cardiac output was not significantly different between duplicate measurements at rest nor at any level of exercise with either method. At rest the exponential method showed a tendency toward larger variability than the equilibrium method. The exponential method produced significantly higher (P < or = 0.001) estimates at rest (averaging up to 9.8 L x min(-1)) compared with the equilibrium method (averaging up to 6.5 L x min(-1)). Reproducibility improved for both methods with increasing workloads, and a second measurement at rest also seemed more reproducible and valid than the first. During exercise, both methods produced comparable values for cardiac output, and highly significant relations between cardiac output and oxygen uptake were observed for both methods (ranging from r2 = 0.79 to r2 = 0.88, P < or = 0.001). The equilibrium method produced unpleasant side effects more frequently (75% vs 21%, P < or = 0.001) compared with the exponential method and lead more subjects to premature interruption of the exercise test because of the rebreathing maneuver (42% vs 17%, P = 0.058).

CONCLUSIONS

Automated curve fitting for the exponential method gave reproducible and valid results during submaximal and maximal exercise but not at rest. The equilibrium method on the other hand interfered with exercise. Therefore, the equilibrium method is recommended at rest and at lower levels of exercise and the exponential method at higher intensities.

Estimation of mixed venous PCO2 for determination of cardiac output in children

STUDY OBJECTIVES

Cardiac output (Q) can be estimated noninvasively during exercise by employing CO2-rebreathing techniques (equilibrium and exponential) to estimate the oxygenated mixed venous PCO2 (PvCO2). It has been found in adults and children that the equilibrium method underestimates Q as a result of overestimation of PvCO2, unless PvCO2 is "downstream corrected." In adults, it has been found that the exponential method does not require downstream correction and yields values similar to those obtained by the equilibrium method with downstream correction. The objectives of this study were as follows: to test whether the exponential method gives similar results to the equilibrium method with downstream correction in children; to verify that downstream correction is required in children; and to test whether a single equation could be used in adults and children to predict Q from oxygen consumption (VO2).

DESIGN

Descriptive.

SETTING

Exercise laboratory of a university hospital.

PARTICIPANTS

23 children (16 boys, 7 girls) with a mean age of 11.0 +/- 1.9 years (7.1 to 13.9 years), and 12 adults (7 men, 5 women) with a mean age of 33.6 +/- 7.2 years (24 to 48 years).

INTERVENTIONS

While performing steady-state exercise on an ergometer, PvCO2 was determined in 14 children using both the equilibrium and exponential methods, and in all other subjects using the equilibrium method alone.

MEASUREMENTS AND RESULTS

For the 14 children who underwent testing by both the equilibrium and exponential methods, the uncorrected equilibrium PvCO2 was significantly different from both the corrected PvCO2 and the exponential PvCO2. We found a strong relationship between Q (L/min), calculated using the downstream corrected values of PvCO2, and VO2 (L/min) (r2 = 0.95), and this relationship was similar to that obtained by dye dilution in other studies. When weight was included, it was determined that one equation could be used for children and adults: Q (L/min) = 1.42 + 5.80.VO2 (L/min) + 0.06.wt (kg), r2 = 0.97, SEY = 0.67.

CONCLUSIONS

CO2-rebreathing techniques can be used to determine Q in children; the exponential method gives values that are similar to the equilibrium method with the downstream correction; and one prediction can be used for Q in adults and children.

Cardiac output determined by the CO2 rebreathing method during arm exercise

Since arm exercise affects the respiratory muscles the CO2 rebreathing method for determining cardiac output (Q) has to be evaluated during arm exercise. The purpose of this study was (1) to compare three different methods of determining arterial CO2 tension (PaCO2) during arm exercise, (2) to verify the linearity of the relationship between Q and oxygen uptake (VO2) during arm exercise, and (3) to investigate whether the CO2 rebreathing method according to Collier can determine accurately Q during arm exercise. Sixty male subjects performed arm-cranking exercise at 20%, 40% and 60% of their individual maximal load. Carbon dioxide output (VCO2) was measured by gas exchange measurement, and mixed venous CO2 tension (PvCO2) was determined from the CO2 rebreathing plateau at each exercise level. PaCO2 was estimated in three different ways: (A) by the modified Bohr formula for dead space, (B) by an arterialized blood sample from the hyperaemic ear-lobe, and (C) by the end-expiratory CO2 tension. A, B, and C were used to calculate Qa, Qb and Qc, respectively. The Pearson's correlation coefficient was high (P < 0.01) among the three different ways of estimating PaCO2. The Q-VO2 relationship proved to be linear (P < 0.01). The Q-values showed a good agreement with the direct Fick measurements, and were in the same range compared to other results obtained by dye dilution, electrical impedance cardiography and the exponential CO2 rebreathing method during arm exercise. In conclusion, the CO2 rebreathing method appeared to be accurate to determine Q during submaximal arm exercise.

Estimates of mean alveolar PCO2 during steady-state exercise in man: a theoretical study

The partial pressure of carbon dioxide in arterial blood is an important operator in the control of breathing, by actions on peripheral and central chemoreceptors. In experiments on man we must often assume that lung alveolar PCO2 equals arterial PCO2 and obtain estimates of the former derived from measurements in expired gas sampled at the mouth. This paper explores the potential errors of such estimates, which are magnified during exercise. We used a published model of the cardiopulmonary system to simulate various levels of exercise up to 300 W. We tested three methods of estimating mean alveolar PCO2 (PACO2) against the true value derived from a time average of the within-breath oscillation in steady-state exercise. We used both sinusoidal and square-wave ventilatory flow wave forms. Over the range 33-133 W end-tidal PCO2 (P(et)CO2) overestimated PACO2 progressively with increasing workload, by about 4 mmHg at 133 W with normal respiratory rate for that load. PCO2 by a graphical approximation technique (PgCO2; "graphical method") underestimated PACO2 by 1-2 mmHg. PCO2 from an experimentally obtained empirical equation (PnjCO2; "empirical method") overestimated PACO2 by 0.5-1.0 mmHg. Graphical and empirical methods were insensitive to alterations in cardiac output or respiratory rate. End-tidal PCO2 was markedly affected by respiratory rate during exercise, the overestimate of PACO2 increasing if respiratory rate was slowed. An increase in anatomical dead space with exercise tends to decrease the error in P(et)CO2 and increase the error in the graphical method. Changes in the proportion of each breath taken up by inspiration make no important difference, and changes in functional residual capacity, while important in principle, are too small to have any major effect on the estimates. Changes in overall alveolar ventilation which alter steady-state PACO2 over a range of 30-50 mmHg have no important effect. At heavy work loads (200-300 W), P(et)CO2 grossly overestimates by 6-9 mmHg. The graphical method progressively underestimates, by about 5 mmHg at 300 W. A simulated CO2 response (the relation between ventilation and increasing PCO2) performed at 100 W suggests that a response slope close to the true one can be obtained by using any of the three methods. The graphical method gave results closest to the true absolute values. Either graphical or empirical methods should be satisfactory for detecting experimentally produced changes in PACO2 during steady-state exercise, to make comparisons between different steady-state exercise loads, and to assess CO2 response in exercise.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiac output determination during progressive exercise in cystic fibrosis

Cardiac output (Q) determination using the equilibrium CO2-rebreathe indirect Fick technique (Equil) to estimate mixed venous PCO2 (Pv-CO2) has been validated during steady state (SS) exercise in subjects with lung disease. A modification of the exponential method using a low concentration of CO2 with an exponential rise in PEt-CO2 (Ex) during rebreathing to estimate Pv-CO2 has been validated during nonsteady state exercise. The purpose of the present study was to validate the Ex method in subjects with lung disease. Q was measured by Ex at every second work load during Prog. Q was measured after 5 min of SS exercise by both Ex and Equil. Arterial PCO2 was estimated from PEtCO2. There was no significant difference in the Q-VO2 relationship during Prog exercise between the combined control and mild (FEV1 > 70%) CF subjects or the moderate and severe CF subjects. Q can be determined in the nonsteady state using the exponential CO2-rebreathe indirect Fick technique in subjects with CF, allowing for noninvasive examination of cardiopulmonary interaction during exercise at a wide range of work loads.

A two-bag system for continuous measurement of oxygen uptake

Collection of mixed expired gas in a bag has been a classic method for the estimation of VO2 during the steady state but has not been employed during unsteady state exercise in part because there is a need for suspending the acquisition of data during the period of gas analysis unless many bags are used. In this study a two-bag system is described in which one bag fills while the other is analyzed. Bag volume is under the control of the operator, and we employed volumes of 30 to 50 L. Thirty-one subjects were studied with this circuit in a progressive treadmill test. Although VO2 could be falsely elevated during periods of overbreathing, this source of error could be identified and its effect reduced if VO2 was plotted against both ventilation and power requirement. Plateau values of VO2 were identified only in six subjects and the ventilatory threshold in 16.

Application of noninvasive techniques for measuring cardiac output in hypertensive patients

The hemodynamic hallmark of hypertension is increased systemic vascular resistance, although this variable is usually not determined in hypertensive patients because it has generally required invasive procedures to measure cardiac output. Reliable, totally noninvasive methods are now available that measure cardiac output accurately enough under a variety of conditions, including rest, exercise, and pharmacologic interventions. These methods include echocardiography, Doppler echocardiography, CO2 rebreathing, and impedance cardiography. Their serial application to large numbers of patients offers the opportunity to significantly broaden our understanding of the spectrum and course of hemodynamic alterations associated with hypertension. A more complete knowledge of underlying hemodynamics could improve our diagnostic and prognostic accuracy in hypertensive patients and enhance our understanding of the pathophysiology of hypertension and the mechanism of action of antihypertensive interventions.