Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement
Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validatio...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.015794 |
| _version_ | 1811333615864250368 |
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| author | E. Ashley Hardin Douglas Stoller Justin Lawley Erin J. Howden Michinari Hieda James Pawelczyk Sara Jarvis Kim Prisk Satyam Sarma Benjamin D. Levine |
| author_facet | E. Ashley Hardin Douglas Stoller Justin Lawley Erin J. Howden Michinari Hieda James Pawelczyk Sara Jarvis Kim Prisk Satyam Sarma Benjamin D. Levine |
| author_sort | E. Ashley Hardin |
| collection | DOAJ |
| description | Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C2H2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [r=0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [r=0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C2H2 correlated well with thermodilution (supine: r=0.84, TE=1.02; exercise: r=0.82, TE=2.36). In patients with clinical disease during supine rest, C2H2 correlated with thermodilution (r=0.85, TE=1.43). C2H2 was similar to thermodilution and nitrous oxide (N2O) rebreathing technique compared with Fick in healthy adults (C2H2 rest: r=0.85, TE=0.84; C2H2 exercise: r=0.87, TE=2.39; thermodilution rest: r=0.72, TE=1.11; thermodilution exercise: r=0.73, TE=2.87; N2O rest: r=0.82, TE=0.94; N2O exercise: r=0.84, TE=2.18). The accuracy of the C2H2 and N2O methods was excellent (r=0.99, TE=0.58). Conclusions The C2H2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N2O rebreathing method approved by the US Food and Drug Administration. |
| first_indexed | 2024-04-13T16:55:33Z |
| format | Article |
| id | doaj.art-0ff51b813b3f455e9564b46f72df509e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:55:33Z |
| publishDate | 2020-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0ff51b813b3f455e9564b46f72df509e2022-12-22T02:38:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-09-0191710.1161/JAHA.120.015794Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output MeasurementE. Ashley Hardin0Douglas Stoller1Justin Lawley2Erin J. Howden3Michinari Hieda4James Pawelczyk5Sara Jarvis6Kim Prisk7Satyam Sarma8Benjamin D. Levine9Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDepartment of Physiology Pennsylvania State University University Park and Hershey PADepartment of Biological Sciences Northern Arizona University Flagstaff AZDepartment of Medicine University of California at San Diego La Jolla CADivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXDivision of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TXBackground Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C2H2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [r=0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [r=0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C2H2 correlated well with thermodilution (supine: r=0.84, TE=1.02; exercise: r=0.82, TE=2.36). In patients with clinical disease during supine rest, C2H2 correlated with thermodilution (r=0.85, TE=1.43). C2H2 was similar to thermodilution and nitrous oxide (N2O) rebreathing technique compared with Fick in healthy adults (C2H2 rest: r=0.85, TE=0.84; C2H2 exercise: r=0.87, TE=2.39; thermodilution rest: r=0.72, TE=1.11; thermodilution exercise: r=0.73, TE=2.87; N2O rest: r=0.82, TE=0.94; N2O exercise: r=0.84, TE=2.18). The accuracy of the C2H2 and N2O methods was excellent (r=0.99, TE=0.58). Conclusions The C2H2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N2O rebreathing method approved by the US Food and Drug Administration.https://www.ahajournals.org/doi/10.1161/JAHA.120.015794acetylenecardiac outputexerciseFicknoninvasive diagnosticsheart failure |
| spellingShingle | E. Ashley Hardin Douglas Stoller Justin Lawley Erin J. Howden Michinari Hieda James Pawelczyk Sara Jarvis Kim Prisk Satyam Sarma Benjamin D. Levine Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acetylene cardiac output exercise Fick noninvasive diagnostics heart failure |
| title | Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement |
| title_full | Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement |
| title_fullStr | Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement |
| title_full_unstemmed | Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement |
| title_short | Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed‐Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement |
| title_sort | noninvasive assessment of cardiac output accuracy and precision of the closed circuit acetylene rebreathing technique for cardiac output measurement |
| topic | acetylene cardiac output exercise Fick noninvasive diagnostics heart failure |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.015794 |
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