Validity of hemodynamic monitoring using inert gas rebreathing method in patients with chronic heart failure and those implanted with a left ventricular assist device

Nduka C Okwose, Noelia Bouzas-Cruz, Oscar Gonzalez Fernandez, Aaron Koshy, Thomas Green, Andrew Woods, Nicola Robinson-Smith, Sian Tovey, Adam McDiarmid, Gareth Parry, Stephan Schueler, Guy A MacGowan, Djordje G Jakovljevic

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    Abstract

    Objective: The present study assessed agreement between resting cardiac output estimated by inert gas rebreathing (IGR) and thermodilution methods in patients with heart failure and those implanted with a left ventricular assist device (LVAD). Methods and Results: Hemodynamic measurements were obtained in 42 patients, 22 with chronic heart failure and 20 with implanted continuous flow LVAD (34 males, aged 50 ± 11 years). Measurements were performed at rest using thermodilution and IGR methods. Cardiac output derived by thermodilution and IGR were not significantly different in LVAD (4.4 ± 0.9 L/min vs 4.7 ± 0.8 L/min, P =.27) or patients with heart failure (4.4 ± 1.4 L/min vs 4.5 ± 1.3 L/min, P =.75). There was a strong relationship between thermodilution and IGR cardiac index (r = 0.81, P =.001) and stroke volume index (r = 0.75, P =.001). Bland–Altman analysis showed acceptable limits of agreement for cardiac index derived by thermodilution and IGR, namely, the mean difference (lower and upper limits of agreement) for patients with heart failure –0.002 L/min/m 2 (–0.65 to 0.66 L/min/m 2), and –0.14 L/min/m 2 (–0.78 to 0.49 L/min/m 2) for patients with LVAD. Conclusions: IGR is a valid method for estimating cardiac output and should be used in clinical practice to complement the evaluation and management of chronic heart failure and patients with an LVAD.

    Original languageEnglish
    Pages (from-to)414-418
    Number of pages5
    JournalJournal of Cardiac Failure
    Volume27
    Issue number4
    Early online date6 Oct 2020
    DOIs
    Publication statusPublished - 1 Apr 2021

    Bibliographical note

    NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Cardiac Failure. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Cardiac Failure, 27, (2021)
    DOI: 10.1016/j.cardfail.2020.09.479

    © 2020, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

    Keywords

    • cardiac output
    • heart failure
    • inert gas rebreathing
    • thermodilution

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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