Vol 28, No 6 (2021)
Original Article
Published online: 2020-03-11

open access

Page views 7420
Article views/downloads 1439
Get Citation

Connect on Social Media

Connect on Social Media

Stroke volume and cardiac output non-invasive monitoring based on brachial oscillometry-derived pulse contour analysis: Explanatory variables and reference intervals throughout life (3–88 years)

Yanina Zócalo1, Victoria García-Espinosa1, Juan M. Castro1, Agustina Zinoveev1, Mariana Marin1, Pedro Chiesa2, Alejandro Díaz3, Daniel Bia1
Pubmed: 32207845
Cardiol J 2021;28(6):864-878.

Abstract

Background: Non-invasive assessment of stroke volume (SV), cardiac output (CO) and cardiac index (CI) has shown to be useful for the evaluation, diagnosis and/or management of different clinical conditions. Through pulse contour analysis (PCA) cuff‑based oscillometric devices would enable obtaining ambulatory operator-independent non-invasive hemodynamic monitoring. There are no reference intervals (RIs), when considered as a continuum in childhood, adolescence and adult life, for PCA-derived SV [SV(PCA)], CO [CO(PCA)] and CI [CI(PCA)]. The aim of the study were to analyze the associations of SV(PCA), CO(PCA) and CI(PCA) with demographic, anthropometric, cardiovascular risk factors (CVRFs) and hemodynamic parameters, and to define RIs and percentile curves for SV(PCA), CO(PCA) and CI(PCA), considering the variables that should be considered when expressing them.
Methods: In 1449 healthy subjects (3–88 years) SV(PCA), CO(PCA) and CI(PCA) were non-invasively obtained (Mobil-O-Graph; Germany). Analysis: associations between subject characteristics and SV(PCA), CO(PCA) and CI(PCA) levels (correlations; regression models); RIs and percentiles for SV(PCA), CO(PCA) and CI(PCA) (parametric methods; fractional polynomials).
Results: Sex, age, and heart rate would be explanatory variables for SV, CO, and CI levels. SV levels were also examined by body height, while body surface area (BSA) contributing to evaluation of CO and CI. CVRFs exposure did not contribute to independently explain the values of the dependent variables. SV, CO and CI levels were partially explained by the oscillometric-derived signal quality. RIs and percentiles were defined.
Conclusions: Reference intervals and percentile for SV(PCA), CO(PCA) and CI(PCA), were defined for subjects from 3–88 years of age, results are expressed according to sex, age, heart rate, body height and/or BSA.

Article available in PDF format

View PDF Download PDF file

References

  1. García X, Mateu L, Maynar J, et al. [Estimating cardiac output. Utility in the clinical practice. Available invasive and non-invasive monitoring]. Med Intensiva. 2011; 35(9): 552–561.
  2. Porter TR, Shillcutt SK, Adams MS, et al. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2015; 28(1): 40–56.
  3. Majonga ED, Rehman AM, McHugh G, et al. Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa. Int J Cardiol. 2017; 248: 409–413.
  4. Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010; 23(5): 465–95; quiz 576.
  5. Lang R, Badano L, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233–271.
  6. Gottdiener JS, Bednarz J, Devereux R, et al. American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004; 17(10): 1086–1119.
  7. Savage DD, Garrison RJ, Kannel WB, et al. Considerations in the use of echocardiography in epidemiology. The Framingham Study. Hypertension. 1987; 9(2 Pt 2): II40–II44.
  8. de Wilde RBP, Schreuder JJ, van den Berg PCM, et al. An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery. Anaesthesia. 2007; 62(8): 760–768.
  9. Camporota L, Beale R. Pitfalls in haemodynamic monitoring based on the arterial pressure waveform. Crit Care. 2010; 14(2): 124.
  10. Schlöglhofer T, Gilly H, Schima H. Semi-invasive measurement of cardiac output based on pulse contour: a review and analysis. Can J Anaesth. 2014; 61(5): 452–479.
  11. Broch O, Bein B, Gruenewald M, et al. Accuracy of cardiac output by nine different pulse contour algorithms in cardiac surgery patients: a comparison with transpulmonary thermodilution. Biomed Res Int. 2016; 2016: 3468015.
  12. Grensemann J. Cardiac output monitoring by pulse contour analysis, the technical basics of less-invasive techniques. Front Med (Lausanne). 2018; 5: 64.
  13. Weiss W, Gohlisch C, Harsch-Gladisch C, et al. Oscillometric estimation of central blood pressure: validation of the Mobil-O-Graph in comparison with the SphygmoCor device. Blood Press Monit. 2012; 17(3): 128–131.
  14. Weber T, Wassertheurer S, Rammer M, et al. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension. 2011; 58(5): 825–832.
  15. Wassertheurer S, Kropf J, Weber T, et al. A new oscillometric method for pulse wave analysis: comparison with a common tonometric method. J Hum Hypertens. 2010; 24(8): 498–504.
  16. Solanki J, Mehta H, Shah C. Aortic blood pressure and central hemodynamics measured by noninvasive pulse wave analysis in Gujarati normotensives. Int J Clin Exp Physiol. 2018; 5(2): 75.
  17. Nakagomi A, Okada S, Funabashi N, et al. Age-related change in contribution of stroke volume to central pulse pressure. Clin Exp Hypertens. 2017; 39(3): 284–289.
  18. Díaz A, Zócalo Y, Cabrera-Fischer E, et al. Reference intervals and percentile curve for left ventricular outflow tract (LVOT), velocity time integral (VTI), and LVOT-VTI-derived hemodynamic parameters in healthy children and adolescents: Analysis of echocardiographic methods association and agreement. Echocardiography. 2018; 35(12): 2014–2034.
  19. Díaz A, Zócalo Y, Bia D. Reference Intervals and Percentile Curves of Echocardiographic Left Ventricular Mass, Relative Wall Thickness and Ejection Fraction in Healthy Children and Adolescents. Pediatr Cardiol. 2019; 40(2): 283–301.
  20. Diaz A, Zócalo Y, Bia D, et al. Reference intervals and percentiles for carotid-femoral pulse wave velocity in a healthy population aged between 9 and 87 years. J Clin Hypertens (Greenwich). 2018; 20(4): 659–671.
  21. Díaz A, Zócalo Y, Bia D, et al. Reference intervals of aortic pulse wave velocity assessed with an oscillometric device in healthy children and adolescents from Argentina. Clin Exp Hypertens. 2019; 41(2): 101–112.
  22. Curcio S, García-Espinosa V, Arana M, et al. Growing-Related changes in arterial properties of healthy children, adolescents, and young adults nonexposed to cardiovascular risk factors: analysis of gender-related differences. Int J Hypertens. 2016; 2016: 4982676.
  23. Farro I, Bia D, Zócalo Y, et al. Pulse wave velocity as marker of preclinical arterial disease: reference levels in a uruguayan population considering wave detection algorithms, path lengths, aging, and blood pressure. Int J Hypertens. 2012; 2012: 169359.
  24. Royston P, Wright E. A method for estimating age‐specific reference intervals (‘normal ranges’) based on fractional polynomials and exponential transformation. J R Statist Soc. 1998; 161(1): 79–101.
  25. Engelen L, Ferreira I, Stehouwer CD, et al. Reference Values for Arterial Measurements Collaboration. Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. Eur Heart J. 2013; 34(30): 2368–2380.
  26. Engelen L, Bossuyt J, Ferreira I, et al. Reference Values for Arterial Measurements Collaboration. Reference values for local arterial stiffness. Part A: carotid artery. J Hypertens. 2015; 33(10): 1981–1996.
  27. Bossuyt J, Engelen L, Ferreira I, et al. Reference Values for Arterial Measurements Collaboration. Reference values for local arterial stiffness. Part B: femoral artery. J Hypertens. 2015; 33(10): 1997–2009.
  28. Bellera CA, Hanley JA. A method is presented to plan the required sample size when estimating regression-based reference limits. J Clin Epidemiol. 2007; 60(6): 610–615.
  29. Lumley T, Diehr P, Emerson S, et al. The importance of the normality assumption in large public health data sets. Annu Rev Public Health. 2002; 23: 151–169.
  30. Bernard A, Addetia K, Dulgheru R, et al. 3D echocardiographic reference ranges for normal left ventricular volumes and strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2017; 18(4): 475–483.
  31. Maceira AM, Prasad SK, Khan M, et al. Normalized left ventricular systolic and diastolic function by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2006; 8(3): 417–426.
  32. Cattermole G, Leung P, Ho G, et al. The normal ranges of cardiovascular parameters measured using the ultrasonic cardiac output monitor. Physiol Rep. 2017; 5(6): e13195.
  33. Ho GYL, Cattermole GN, Chan SSW, et al. Noninvasive transcutaneous Doppler ultrasound-derived hemodynamic reference ranges in Chinese adolescents. Pediatr Crit Care Med. 2013; 14(5): e225–e232.
  34. Chan CPY, Agarwal N, Sin KK, et al. Age-specific non-invasive transcutaneous Doppler ultrasound derived haemodynamic reference ranges in elderly Chinese adults. BBA Clin. 2014; 2: 48–55.
  35. Cain PA, Ahl R, Hedstrom E, et al. Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study. BMC Med Imaging. 2009; 9: 2.