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    Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed-Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement.

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    Author
    Hardin, EA; Stoller, D; Lawley, J; Howden, EJ; Hieda, M; Pawelczyk, J; Jarvis, S; Prisk, K; Sarma, S; Levine, BD
    Date
    2020-09
    Source Title
    Journal of the American Heart Association
    Publisher
    Ovid Technologies (Wolters Kluwer Health)
    University of Melbourne Author/s
    Howden, Erin
    Affiliation
    Melbourne Medical School
    Metadata
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    Document Type
    Journal Article
    Citations
    Hardin, E. A., Stoller, D., Lawley, J., Howden, E. J., Hieda, M., Pawelczyk, J., Jarvis, S., Prisk, K., Sarma, S. & Levine, B. D. (2020). Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed-Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement.. J Am Heart Assoc, 9 (17), pp.e015794-. https://doi.org/10.1161/JAHA.120.015794.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/252913
    DOI
    10.1161/JAHA.120.015794
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660774
    Abstract
    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.

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