Modern gold standard of cardiac output measurement – A simplified bedside measurement of individual oxygen uptake in the cath lab
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Georg Schmücker
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Jan-Henrik Blohm
Abstract
Objectives
Cardiac output (CO) measurements employing the direct Fick principle represent the gold standard in right-sided heart catheterization (RHC). The current widespread approach in hemodynamic workup however uses the indirect Fick principle with assumed values for oxygen uptake (VO2) leading to incorrect CO values in up to 25% of patients. We have tested a contemporary breath-by-breath gas analyzer that allows precise real-time measurements of VO2 with appropriate time and effort to serve the direct Fick principle.
Methods
By means of a small and mobile metabolic cart assembled with widely used components of a standard spiroergometer, we performed bedside measurements of individual VO2. In 33 unselected, consecutive patients with various indications for RHC we compared CO values derived from indirect vs. direct Fick calculations.
Results
In 28 of the 33 patients, VO2 measurements were completed with a plausible dataset within a median of 3.2 (interquartile range 2.8–6.2) min. In nine of the 28 patients, CO values based on measured VO2 values differed by more than 20% from CO calculations based on assumed VO2 values with value deviations scattering over a broad range in both directions (maximally +52% to minimally −46%).
Conclusions
The bedside measurement of VO2 for gold standard CO determination is technically feasible within a few min and can thus be easily included in any RHC protocol. As modern therapy for numerus indications demand a precise upfront measurement of hemodynamics, our method might help to correctly identify patients for costly therapies.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Written informed consent was not required for this study in accordance with the local legislation and institutional requirements.
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Ethical approval: The study protocol was approved by an institutional review and safety board at the Heart and Vascular Center Bad Bevensen (date of approval: 04th August 2021).
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jbcpp-2021-0293).
© 2022 Walter de Gruyter GmbH, Berlin/Boston
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- Frontmatter
- Editorial
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- Minireview
- PCSK9 and LRP6: potential combination targets to prevent and reduce atherosclerosis
- Reviews
- The complex relationship between physical activity and diabetes: an overview
- Methotrexate related cutaneous adverse drug reactions: a systematic literature review
- Long-term use of proton pump inhibitors adversely affects minerals and vitamin metabolism, bone turnover, bone mass, and bone strength
- An update on the physiologic changes during pregnancy and their impact on drug pharmacokinetics and pharmacogenomics
- Original Articles
- Apelin-13 protects human neuroblastoma SH-SY5Y cells against amyloid-beta induced neurotoxicity: Involvement of anti oxidant and anti apoptotic properties
- Are hypertensive patients with history of coronary artery disease at risk for silent lower extremity artery disease?
- The effect of long-term ketogenic diet on serum adiponectin and insulin-like growth factor-1 levels in mice
- Increase in cardioprotective SUR2A does not alter heart rate and heart rate regulation by physical activity and diurnal rhythm
- Effect of ascorbic acid supplementation on pulmonary functions in healthy adults: a randomized controlled pilot study
- Alpha2-antiplasmin deficiency affects depression and anxiety-like behavior and apoptosis induced by stress in mice
- Modern gold standard of cardiac output measurement – A simplified bedside measurement of individual oxygen uptake in the cath lab
- Electrical vestibular nerve stimulation (VeNS): a follow-up safety assessment of long-term usage
- Psychological impact of abnormally invasive placenta: an underestimated and hidden morbidity
- Limited diagnostic value of questionnaire-based pre-participation screening algorithms: a “risk-exposed” approach to sports activity
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