Non-invasive measurement of cardiac output in heart failure patients using a new foreign gas rebreathing technique

2002 ◽  
Vol 102 (2) ◽  
pp. 247-252 ◽  
Author(s):  
Anders GABRIELSEN ◽  
Regitze VIDEBÆK ◽  
Morten SCHOU ◽  
Morten DAMGAARD ◽  
Jens KASTRUP ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Reliable Estimate ◽  
Shunt Flow ◽  
Heart Failure Patients ◽  
Non Invasive ◽  
Patients With Heart Failure ◽  
Flow Through ◽  
The Mean ◽  
Rebreathing Method

Values of effective pulmonary blood flow (QEP) and cardiac output, determined by a non-invasive foreign gas rebreathing method (CORB) using a new infrared photoacoustic gas analysing system, were compared with measurements of cardiac output obtained by the direct Fick (COFICK) and thermodilution (COTD) methods in patients with heart failure or pulmonary hypertension. In 11 patients, of which three had shunt flow through areas without significant gas exchange, the mean difference (bias) and limits of agreement (±2S.D.) were 0.6±1.2litreċmin-1 when comparing COFICK and QEP, and -0.8±1.3litreċmin-1 when comparing COFICK and COTD. When correction for intrapulmonary shunt flow was applied (i.e. calculation of CORB) in all 11 patients, the bias between COFICK and CORB was 0.1±0.9litreċmin-1, primarily because agreement improved in the three patients with significant shunt flow. In the eight patients without significant shunt flow, the agreement between QEP and COFICK was 0.3±0.9litreċmin-1. In conclusion, a foreign gas rebreathing method with a new infrared photoacoustic gas analyser provided at least as reliable a measure of cardiac output as did thermodilution. In the absence of significant shunt flow, measurement of QEP itself provides a reliable estimate of cardiac output in heart failure patients. The infrared photoacoustic gas analyser markedly facilitates clinical use of the rebreathing method in general, which makes the method available to a larger group of clinicians working with patients with cardiovascular diseases.

Non-invasive measurement of cardiac output in heart failure patients using a new foreign gas rebreathing technique

2002 ◽  
Vol 102 (2) ◽  
pp. 247 ◽  
Author(s):  
Anders GABRIELSEN ◽  
Regitze VIDEBÆK ◽  
Morten SCHOU ◽  
Morten DAMGAARD ◽  
Jens KASTRUP ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Heart Failure Patients ◽  
Non Invasive ◽  
Invasive Measurement

scholarly journals Limitations of a non-invasive model of the estimation of pulmonary vascular resistance by magnetic resonance imaging in patients with heart failure

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
V Vidal Urrutia ◽  
A Cubillos-Arango ◽  
P Garcia-Gonzalez ◽  
J Gradoli-Palmero ◽  
J Nunez-Villota ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Magnetic Resonance ◽  
Pulmonary Vascular Resistance ◽  
Altman Analysis ◽  
Resonance Imaging ◽  
Bland Altman Analysis ◽  
Non Invasive ◽  
Patients With Heart Failure ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Pulmonary vascular resistance (PVR) is a hemodynamic parameter with important diagnostic and prognostic implications in patients with heart failure. Currently the gold standard technique for its quantification is right heart catheterization (RHC). However, cardiovascular magnetic resonance imaging (CMR) has been postulated as a non-invasive alternative for its estimation. The aim of this study is to assess the accuracy of a non-invasive model of PVR estimated by CMR in a specific subgroup of patients with acute heart failure (AHF). Methods. Between January 2014 and December 2018, 108 patients with AHF who underwent RHC and CMR on the same day were prospectively included. PVR was assessed by CMR using the model: 19.38 - [4.62 x Ln mean pulmonary artery velocity - 0.08 x right ventricular ejection fraction (RVEF)]. During RHC, PVR were calculated using the ratio between transpulmonary gradient and cardiac output. We evaluated their correlation using the Spearman correlation coefficient, receiver operating characteristic [ROC] curves, and Bland-Altman analysis. Results. The mean age of our cohort was 65 ± 11 years and 64.8% were male. The median PVR (Wood Units, WU) assessed by CMR and RHC were 5.1 WU (3.4 - 6.8) and 3 WU (1.5 - 3.9); p < 0.001, respectively. A weak correlation was observed between the PVR obtained by RHC and those obtained by CMR in our population (r = 0.21; p = 0.02). On Bland-Altman analysis, the mean bias was -1.7, and the 95% limits of agreement ranged from -10.02 to 6.6 WU. The area under the ROC curve for PVR assessed by CMR to detect PVR ³3 WU was 0.57, 95% confidence interval (CI): 0.47-0.68. Conclusions. In patients with AHF, the non-invasive estimation of PVR using CMR shows poor accuracy, as well as a limited capacity to discriminate increased PVR values.

Abstract 1597: Safety and Efficacy of Inhaled Iloprost Via a Disposable Nebulizer in Heart Failure Patients With Elevated Pulmonary Vascular Resistance

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
David Baran ◽  
Luis H Arroyo ◽  
Jill Hebron ◽  
Candace Carr ◽  
Mark J Zucker
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Heart Failure Patients ◽  
Inhaled Iloprost ◽  
The Mean

Background : Pulmonary vascular resistance (PVR) is routinely measured in patients (pts) being evaluated for a heart transplant. Pts with a high PVR are often treated with a milrinone or intravenous vasodilator “challenge” to establish that the PVR is not “fixed”. However, all current agents have dose-limiting side effects such as arrhythmias and hypotension. Inhaled iloprost would be an option but it is given with a costly adaptive aerosol delivery device. In addition, the efficacy and safety of this drug in left heart failure is poorly studied. Methods : 10 adult heart failure pts who were found to have a PVR of greater than 200 dyne-sec on routine right heart catheterization were enrolled. 50 micrograms (mcg) of iloprost was inhaled while in the catheterization laboratory using a disposable nebulizer and outflow filter, over 10 minutes. Hemodynamics were monitored at baseline, following drug inhalation, and 20 minutes later. Results : The average age of the patients (6 male, 4 female) was 64.8 ± 8.9 years. The mean left ventricular ejection fraction was 20.6 ± 8.6 %. The mean creatinine clearance (Cockroft-Gault) was 48.7 ± 18.9 ml/hr. The mean arterial pressure (MAP), pulmonary artery systolic (PAS), PA diastolic (PAD), PCWP, transpulmonic gradient (TPG), cardiac output (CO), and PVR at baseline, 10 minutes and 20 minutes post-inhalation are detailed below. Iloprost significantly reduced PAS, TPG and PVR without changes in MAP, PAD, PCWP or CO. These effects remained significant at study completion as well. There were no adverse events noted. Conclusion : Iloprost inhalation was well tolerated in heart failure patients undergoing right heart catheterization. Inhalation of 50 mcg of iloprost via a simple hospital nebulizer was associated with safe, rapid, and significant declines in indices of pulmonary vascular tone, without affecting cardiac output or PCWP. Further investigation of this novel use of iloprost is warranted. Results

Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Galli ◽  
Y Bouali ◽  
C Laurin ◽  
A Gallard ◽  
A Hubert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Rank Test ◽  
Reduced Ejection Fraction ◽  
Non Invasive ◽  
Patients With Heart Failure ◽  
Increase Risk ◽  
Echocardiographic Examination ◽  
Constructive Work

Abstract Background The non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66±12 years; LV ejection fraction: 28±9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased global myocardial constructive work (CW) (1023±449 vs 1424±484 mmHg%, p<0.0001) and myocardial work efficiency (WE) [87 (78–90) vs 90 (86–95), p<0.0001]. During FU (2.6±0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, CW was the only predictor of MACEs (Table 1). A CW<910 mmHg (AUC=0.81, p<0.0001, Figure 1A) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45–98.94), p=0.002, log-rank test p<0.0001] (Figure 1 B). Conclusions In patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Funding Acknowledgement Type of funding source: None

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