Abstract
Purpose
Through pulse contour analysis (PCA) devices would enable to obtain non-invasive operator-independent cardiac output (CO) measurements [CO(PCA)]. The agreement between CO(PCA) and data from two-dimensional [CO(2D)] or Doppler [CO(VTI)] echocardiography (references) remains controversial.
Aims
To analyze: (1) CO(PCA), CO(2D) and CO(VTI) agreement, (2) determinants of methods’ differences in measured CO values.
Methods
Simultaneous echocardiography and PCA records (Mobil-O-Graph/Germany) were obtained in 130 subjects (age: 29 ± 17 years). Hemodynamic (e.g., heart rate [HR]), arterial (e.g., arterial stiffness, augmentation index [AIx]) and cardiac structural–functional (e.g., left ventricle end-diastolic diameters [LVEDD]) parameters were obtained. Data from the entire group (all; 10–85 years), children (≤ 16 years), adolescents (17–24 years) and adults (> 24 years) were separately analyzed.
Results
The highest Lin’s concordance correlation coefficient (CCC) were obtained when analyzing CO(PCA)/CO(2D) association (0.672, 0.785, 0.721, 0.487 for all, children, adolescents and adults, respectively); CCC levels were higher at younger ages. Bland–Altman’s systematic errors between CO(PCA)/CO(2D) were 0.12, 0.17, 0.07 and 0.14 L/min, for all, children, adolescents and adults, respectively (non-significant). CO(VTI)/CO(PCA) systematic error only reached significance in adults (0.34 L/min, p = 0.002). Bland–Altman’s proportional errors were not statistically significant when CO(PCA)/CO(2D) differences were analysed in children and adolescents. Higher AIx and LVEDD levels associated greater CO(2D)/CO(PCA) differences; higher AIx and HR levels were associated to differences between CO(VTI) and CO(PCA).
Conclusion
CO(PCA) had systematic (< 0.17 L/min) and percent (≤ 30%) errors, which allow us to postulate that its use allows reaching levels comparable to those of echocardiography. Differences in CO-data between methods were associated with arterial and cardiac properties.
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Disclousure of interest
Yanina Zócalo, Alejandro Díaz, and Daniel Bia have no conflicts of interest to declare.
Funding
This work was supported by the Agencia Nacional de Investigación e Innovación (ANII) under Grant (PRSCT-008-020) and Espacio Interdisciplinario (EI) and Comisión Sectorial de Investigación Científica (CSIC-Udelar) of the Republic University, Uruguay. Additionally, this work was supported by extrabudgetary funds generated by CUiiDARTE Centre and Project. None of these organizations influenced the study design or collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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13239_2019_439_MOESM6_ESM.tif
Figure S1 Association analysis (correlation) between cardiac output (CO) obtained by different methods, for the entire group (All) and age related subgroups. Regression and equality lines are shown in each scatter-diagram. (TIFF 656 kb)
13239_2019_439_MOESM7_ESM.tif
Figure S2 Association analysis (correlation) between cardiac output (CO) obtained with different Mobil-O-Graph related signal quality scores, for the entire group (All) and age-related subgroups. Regression and equality lines are shown in each scatter-diagram. (TIFF 230 kb)
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Zócalo, Y., Díaz, A. & Bia, D. Cardiac Output Monitoring in Children, Adolescents and Adults Based on Pulse Contour Analysis: Comparison with Echocardiography-Derived Data and Identification of Factors Associated with Their Differences. Cardiovasc Eng Tech 11, 67–83 (2020). https://doi.org/10.1007/s13239-019-00439-w
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DOI: https://doi.org/10.1007/s13239-019-00439-w