Noninvasive cardiac output measurements in patients with pulmonary hypertension

Abstract

Pulmonary hypertension (PH) is characterised by a progressive decline in cardiac output (CO) and right heart failure. NICOM1 (noninvasive cardiac output monitor) is a bioreactance-based technology that has been broadly validated, but its specific application in right heart failure and PH is unknown.Cardiac catheterisation was performed in 50 consecutive patients with PH. CO measurements were performed using three different methods (thermodilution, Fick and NICOM) at baseline and after vasodilator challenge. We compared the precision (coefficient of variation) and accuracy of NICOM compared to thermodilution and Fick.The mean CO (L?min -1 ) at baseline as measured by the three methods was 4.73¡1.15 (NICOM), 5.69¡1.74 (thermodilution) and 4.84¡1.39 (Fick). CO measured by NICOM was more precise than by thermodilution (3.5¡0.3% versus 9.6¡6.1%, p,0.001). Bland-Altman analyses comparing NICOM to thermodilution and Fick revealed bias and 95% limits of agreement that were comparable to those comparing Fick to thermodilution. All three CO methods detected an increase in CO in response to vasodilator challenge.CO measured via NICOM is precise and reliably measures CO at rest and changes in CO with vasodilator challenge in patients with PH. NICOM may allow for the noninvasive haemodynamic assessment of patients with PH and their response to therapy. @ERSpublications Cardiac output measurements allow for haemodynamic assessment of patients with PH and their response to therapy

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…RA pressure, cardiac index (CI) and mixed venous oxygen saturation (SvO 2 ) are the most robust indicators of RV function and prognosis, whereas PAPm provides little prognostic information (except for CCB responders) [96,97,99,100,114]. Non-invasive assessment of CO by rebreathing techniques [71] or bioreactance [115] has not yet been sufficiently validated to allow routine clinical use and therapeutic decision making.…”

Validation of impedance cardiography in pulmonary arterial hypertension

“…Nonetheless, change in cardiac index measured by PhysioFlow has been associated with 6-min walk distance and heart rate recovery in 30 patients with pulmonary hypertension of various aetiologies (Tonelli et al, 2013). (Rich et al, 2013). Therefore, previous evidence on the validity and reliability of ICG and similar technologies in precapillary pulmonary hypertension remains limited to small, individual studies with some encouraging but preliminary results.…”

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…Ciśnienie w RA, wskaźnik sercowy (CI) i saturacja tlenem mieszanej krwi żylnej (SvO 2 ) są najbardziej uznanymi wskaźnikami czynności RV i rokowania, natomiast PAPm dostarcza niewiele informacji prognostycznych (z wyjątkiem chorych odpowiadających na CCB) [96,97,99,100,114]. Nieinwazyjne sposoby oceny CO polegające na zastosowaniu techniki ponownego wdechu powietrza (rebreathing technique) [71] lub bioreaktywności (bioreactance) [115] nie zostały jeszcze wystarczająco potwierdzone, aby umożliwić ich rutynowe zastosowanie kliniczne i podejmowanie decyzji terapeutycznych.…”