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Non-Invasive Determination of Cardiac Output in Pre-Capillary Pulmonary Hypertension.

Lador F, Hervé P, Bringard A, Günther S, Garcia G, Savale L, Ferretti G, Soccal PM, Chemla D, Humbert M, Simonneau G, Sitbon O - PLoS ONE (2015)

Bottom Line: After application of a correction factor (1.17 ± 0.25), neither proportional nor fixed bias was found for subsequent CO determination (n = 48).LoA ranged from -1.23 to 1.17 L·min-1 and PE was ±19.8%.After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH.

View Article: PubMed Central - PubMed

Affiliation: Service de Pneumologie, Programme Hypertension Pulmonaire, Hôpitaux Universitaires de Genève, Genève, Switzerland.

ABSTRACT

Background: Cardiac output (CO) is a major diagnostic and prognostic factor in pre-capillary pulmonary hypertension (PH). Reference methods for CO determination, like thermodilution (TD), require invasive procedures and allow only steady-state measurements. The Modelflow (MF) method is an appealing technique for this purpose as it allows non-invasive and beat-by-beat determination of CO.

Methods: We aimed to compare CO values obtained simultaneously from non-invasive pulse wave analysis by MF (COMF) and by TD (COTD) to determine its precision and accuracy in pre-capillary PH. The study was performed on 50 patients with pulmonary arterial hypertension (PAH) or chronic thrombo-embolic PH (CTEPH). CO was determined at rest in all patients (n = 50) and during nitric oxide vasoreactivity test, fluid challenge or exercise (n = 48).

Results: Baseline COMF and COTD were 6.18 ± 1.95 and 5.46 ± 1.95 L·min-1, respectively. Accuracy and precision were 0.72 and 1.04 L·min-1, respectively. Limits of agreement (LoA) ranged from -1.32 to 2.76 L·min-1. Percentage error (PE) was ±35.7%. Overall sensitivity and specificity of COMF for directional change were 95.2% and 82.4%, (n = 48) and 93.3% and 100% for directional changes during exercise (n = 16), respectively. After application of a correction factor (1.17 ± 0.25), neither proportional nor fixed bias was found for subsequent CO determination (n = 48). Accuracy was -0.03 L·min-1 and precision 0.61 L·min-1. LoA ranged from -1.23 to 1.17 L·min-1 and PE was ±19.8%.

Conclusions: After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH.

No MeSH data available.


Related in: MedlinePlus

Comparison of baseline values of COMF and COTD.Simultaneous determination of cardiac output by thermodilution (COTD) and Modelflow (COMF) in 50 patients with pre-capillary pulmonary hypertension. (A) The figure describes median (line), 25th to 75th percentile (box), 5th to 95th percentile (whiskers) and the dots represent outliers. The mean values for COTD and COMF were 5.46 ± 1.95 L·min-1 and 6.18 ± 1.95 L·min-1, respectively (p<0.05). (B) Difference between resting COMF and COTD values plotted against their mean. Broken line represents the mean (+ 0.72 L·min-1) and the solid lines the 95% limits of agreement (-1.32 to + 2.76 L·min-1).
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pone.0134221.g002: Comparison of baseline values of COMF and COTD.Simultaneous determination of cardiac output by thermodilution (COTD) and Modelflow (COMF) in 50 patients with pre-capillary pulmonary hypertension. (A) The figure describes median (line), 25th to 75th percentile (box), 5th to 95th percentile (whiskers) and the dots represent outliers. The mean values for COTD and COMF were 5.46 ± 1.95 L·min-1 and 6.18 ± 1.95 L·min-1, respectively (p<0.05). (B) Difference between resting COMF and COTD values plotted against their mean. Broken line represents the mean (+ 0.72 L·min-1) and the solid lines the 95% limits of agreement (-1.32 to + 2.76 L·min-1).

Mentions: The clinical and haemodynamic data at baseline are shown in Tables 1, 2 and 3. The conditions and number of simultaneous COTD and COMF measurements are shown in Table 4. Baseline uncorrected COMF and COTD were 6.18 ± 1.95 and 5.46 ± 1.95 L·min-1, respectively, (p<0.05, Fig 2A). The coefficients of variation were 10.63% and 5.66% for COMF and COTD, respectively (p<0.01). The Bland–Altman plot for baseline CO values appears in Fig 2B. Accuracy and precision were 0.72 and 1.04 L·min-1, respectively. LoA ranged from -1.32 to 2.76 L·min-1. PE was ±35.7%. The relationships between COMF and the corresponding COTD are reported in Fig 3A, 3B and 3C. For CTEPH (n = 43), PAH (n = 55) and overall (n = 98), the intercept a was 0.207 ± 0.336, 0.516 ± 0.294 and 0.493 ± 0.209, respectively. Corresponding slope b was 1.167 ± 0.062, 1.082 ± 0.043 and 1.095 ± 0.034 L·min-1, respectively. A proportional bias was found for CTEPH (Fig 3A). Merging groups implied both proportional and fixed bias (Fig 3C). The Bland–Altman plot for merged groups is shown in Fig 3D. The accuracy was 1.05 L·min−1 (p <0.01). The precision was 1.20 L·min-1. LoA ranged from -1.30 to 3.40 L·min-1. PE was ±37.9%. The overall sensitivity and specificity of COMF for directional change in response to any of the experimental manoeuvres (nitric oxide vasoreactivity test, fluid challenge or exercise) were 95.2% and 82.4%, respectively (n = 48). Mean calibration factor for COMF was 1.17 ± 0.25. COMFcorr. in all conditions except baseline (which was used to determine the correction factor) are plotted against the corresponding COTD in Fig 4A. The regression line was characterized by a and b of 0.094 ± 0.254 L·min−1 and 0.990 ± 0.038, respectively. Neither proportional nor fixed bias was found. The Bland–Altman plot (Fig 4B) showed an accuracy of -0.03 l·min−1 (NS). Precision was 0.61 L·min−1. LoA ranged from -1.23 to 1.17 L·min-1. PE was ±19.8%. COMFcorr. values at exercise (n = 16) are plotted against their corresponding COTD in Fig 5A. The regression equation had intercept a and slope b of -1.093 ± 0.760 and 1.117 ± 0.091 L·min−1, respectively. Neither proportional nor fixed bias was found. The Bland–Altman plot (Fig 5B) revealed a -0.15 L·min−1 accuracy (NS). Precision was 0.65 L·min−1. LoA ranged from -1.42 to 1.12 L·min-1. PE was ±16.4%. The changes of COMFcorr (ΔCOMFcorr) from baseline for each subject are plotted against the corresponding ΔCOTD in Fig 5C. The sensitivity and specificity of COMF for directional change in response to exercise were 93.3%. and 100%, respectively (n = 16). In one case, a COMF decrease < 10% (-0.22 L·min-1) did not accompany a COTD increase ≥ 10% (+0.70 L·min-1) and was considered a false negative.


Non-Invasive Determination of Cardiac Output in Pre-Capillary Pulmonary Hypertension.

Lador F, Hervé P, Bringard A, Günther S, Garcia G, Savale L, Ferretti G, Soccal PM, Chemla D, Humbert M, Simonneau G, Sitbon O - PLoS ONE (2015)

Comparison of baseline values of COMF and COTD.Simultaneous determination of cardiac output by thermodilution (COTD) and Modelflow (COMF) in 50 patients with pre-capillary pulmonary hypertension. (A) The figure describes median (line), 25th to 75th percentile (box), 5th to 95th percentile (whiskers) and the dots represent outliers. The mean values for COTD and COMF were 5.46 ± 1.95 L·min-1 and 6.18 ± 1.95 L·min-1, respectively (p<0.05). (B) Difference between resting COMF and COTD values plotted against their mean. Broken line represents the mean (+ 0.72 L·min-1) and the solid lines the 95% limits of agreement (-1.32 to + 2.76 L·min-1).
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4520479&req=5

pone.0134221.g002: Comparison of baseline values of COMF and COTD.Simultaneous determination of cardiac output by thermodilution (COTD) and Modelflow (COMF) in 50 patients with pre-capillary pulmonary hypertension. (A) The figure describes median (line), 25th to 75th percentile (box), 5th to 95th percentile (whiskers) and the dots represent outliers. The mean values for COTD and COMF were 5.46 ± 1.95 L·min-1 and 6.18 ± 1.95 L·min-1, respectively (p<0.05). (B) Difference between resting COMF and COTD values plotted against their mean. Broken line represents the mean (+ 0.72 L·min-1) and the solid lines the 95% limits of agreement (-1.32 to + 2.76 L·min-1).
Mentions: The clinical and haemodynamic data at baseline are shown in Tables 1, 2 and 3. The conditions and number of simultaneous COTD and COMF measurements are shown in Table 4. Baseline uncorrected COMF and COTD were 6.18 ± 1.95 and 5.46 ± 1.95 L·min-1, respectively, (p<0.05, Fig 2A). The coefficients of variation were 10.63% and 5.66% for COMF and COTD, respectively (p<0.01). The Bland–Altman plot for baseline CO values appears in Fig 2B. Accuracy and precision were 0.72 and 1.04 L·min-1, respectively. LoA ranged from -1.32 to 2.76 L·min-1. PE was ±35.7%. The relationships between COMF and the corresponding COTD are reported in Fig 3A, 3B and 3C. For CTEPH (n = 43), PAH (n = 55) and overall (n = 98), the intercept a was 0.207 ± 0.336, 0.516 ± 0.294 and 0.493 ± 0.209, respectively. Corresponding slope b was 1.167 ± 0.062, 1.082 ± 0.043 and 1.095 ± 0.034 L·min-1, respectively. A proportional bias was found for CTEPH (Fig 3A). Merging groups implied both proportional and fixed bias (Fig 3C). The Bland–Altman plot for merged groups is shown in Fig 3D. The accuracy was 1.05 L·min−1 (p <0.01). The precision was 1.20 L·min-1. LoA ranged from -1.30 to 3.40 L·min-1. PE was ±37.9%. The overall sensitivity and specificity of COMF for directional change in response to any of the experimental manoeuvres (nitric oxide vasoreactivity test, fluid challenge or exercise) were 95.2% and 82.4%, respectively (n = 48). Mean calibration factor for COMF was 1.17 ± 0.25. COMFcorr. in all conditions except baseline (which was used to determine the correction factor) are plotted against the corresponding COTD in Fig 4A. The regression line was characterized by a and b of 0.094 ± 0.254 L·min−1 and 0.990 ± 0.038, respectively. Neither proportional nor fixed bias was found. The Bland–Altman plot (Fig 4B) showed an accuracy of -0.03 l·min−1 (NS). Precision was 0.61 L·min−1. LoA ranged from -1.23 to 1.17 L·min-1. PE was ±19.8%. COMFcorr. values at exercise (n = 16) are plotted against their corresponding COTD in Fig 5A. The regression equation had intercept a and slope b of -1.093 ± 0.760 and 1.117 ± 0.091 L·min−1, respectively. Neither proportional nor fixed bias was found. The Bland–Altman plot (Fig 5B) revealed a -0.15 L·min−1 accuracy (NS). Precision was 0.65 L·min−1. LoA ranged from -1.42 to 1.12 L·min-1. PE was ±16.4%. The changes of COMFcorr (ΔCOMFcorr) from baseline for each subject are plotted against the corresponding ΔCOTD in Fig 5C. The sensitivity and specificity of COMF for directional change in response to exercise were 93.3%. and 100%, respectively (n = 16). In one case, a COMF decrease < 10% (-0.22 L·min-1) did not accompany a COTD increase ≥ 10% (+0.70 L·min-1) and was considered a false negative.

Bottom Line: After application of a correction factor (1.17 ± 0.25), neither proportional nor fixed bias was found for subsequent CO determination (n = 48).LoA ranged from -1.23 to 1.17 L·min-1 and PE was ±19.8%.After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH.

View Article: PubMed Central - PubMed

Affiliation: Service de Pneumologie, Programme Hypertension Pulmonaire, Hôpitaux Universitaires de Genève, Genève, Switzerland.

ABSTRACT

Background: Cardiac output (CO) is a major diagnostic and prognostic factor in pre-capillary pulmonary hypertension (PH). Reference methods for CO determination, like thermodilution (TD), require invasive procedures and allow only steady-state measurements. The Modelflow (MF) method is an appealing technique for this purpose as it allows non-invasive and beat-by-beat determination of CO.

Methods: We aimed to compare CO values obtained simultaneously from non-invasive pulse wave analysis by MF (COMF) and by TD (COTD) to determine its precision and accuracy in pre-capillary PH. The study was performed on 50 patients with pulmonary arterial hypertension (PAH) or chronic thrombo-embolic PH (CTEPH). CO was determined at rest in all patients (n = 50) and during nitric oxide vasoreactivity test, fluid challenge or exercise (n = 48).

Results: Baseline COMF and COTD were 6.18 ± 1.95 and 5.46 ± 1.95 L·min-1, respectively. Accuracy and precision were 0.72 and 1.04 L·min-1, respectively. Limits of agreement (LoA) ranged from -1.32 to 2.76 L·min-1. Percentage error (PE) was ±35.7%. Overall sensitivity and specificity of COMF for directional change were 95.2% and 82.4%, (n = 48) and 93.3% and 100% for directional changes during exercise (n = 16), respectively. After application of a correction factor (1.17 ± 0.25), neither proportional nor fixed bias was found for subsequent CO determination (n = 48). Accuracy was -0.03 L·min-1 and precision 0.61 L·min-1. LoA ranged from -1.23 to 1.17 L·min-1 and PE was ±19.8%.

Conclusions: After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH.

No MeSH data available.


Related in: MedlinePlus