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Int J Sports Med 2019; 40(02): 125-132
DOI: 10.1055/a-0809-5408
Training & Testing
© Georg Thieme Verlag KG Stuttgart · New York

Reproducibility of Inert Gas Rebreathing Method to Estimate Cardiac Output at Rest and During Cardiopulmonary Exercise Stress Testing

Nduka Charles Okwose
1   Institute of Cellular Medicine, Newcastle university, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Jie Zhang
2   Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
,
Shakir Chowdhury
1   Institute of Cellular Medicine, Newcastle university, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
David Houghton
3   Institute of Neuroscience, Newcastle university, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Srdjan Ninkovic
4   Department of Surgery, University of Kragujevac and Clinical Centre Kragujavac, Kragujevac, Serbia
,
Saša Jakovljević
5   Faculty for Sport and Physical Education, Тheory and methodology of Basketball, Belgrade, Serbia
,
Branislav Jevtic
6   Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
,
Robert Ropret
6   Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
,
Christopher Eggett
7   Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
8   Newcastle Upon Tyne Hospitals NHS Foundation Trust, Echocardiography, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Matthew Bates
9   James Cook University Hospital, Cardiothoracic Department, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
,
Guy MacGowan
1   Institute of Cellular Medicine, Newcastle university, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
10   Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cardio-thoracic Department, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Djordje Jakovljevic
1   Institute of Cellular Medicine, Newcastle university, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
11   Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Sciences, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
12   Newcastle University Centre for Ageing and Vitality, Clinical Exercise Physiology, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History



accepted 16 November 2018

Publication Date:
03 January 2019 (online)

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Abstract

The present study evaluated reproducibility of the inert gas rebreathing method to estimate cardiac output at rest and during cardiopulmonary exercise testing. Thirteen healthy subjects (10 males, 3 females, ages 23–32 years) performed maximal graded cardiopulmonary exercise stress test using a cycle ergometer on 2 occasions (Test 1 and Test 2). Participants cycled at 30-watts/3-min increments until peak exercise. Hemodynamic variables were assessed at rest and during different exercise intensities (i. e., 60, 120, 150, 180 watts) using an inert gas rebreathing technique. Cardiac output and stroke volume were not significantly different between the 2 tests at rest 7.4 (1.6) vs. 7.1 (1.2) liters min−1, p=0.54; 114 (28) vs. 108 (15) ml beat−1, p=0.63) and all stages of exercise. There was a significant positive relationship between Test 1 and Test 2 cardiac outputs when data obtained at rest and during exercise were combined (r=0.95, p<0.01 with coefficient of variation of 6.0%), at rest (r=0.90, p<0.01 with coefficient of variation of 5.1%), and during exercise (r=0.89, p<0.01 with coefficient of variation 3.3%). The mean difference and upper and lower limits of agreement between repeated measures of cardiac output at rest and peak exercise were 0.4 (−1.1 to 1.8) liter min−1 and 0.5 (−2.3 to 3.3) liter min−1, respectively. The inert gas rebreathing method demonstrates an acceptable level of test-retest reproducibility for estimating cardiac output at rest and during cardiopulmonary exercise testing at higher metabolic demands.

Key words

cardiac output - cardiopulmonary exercise testing - inert gas rebreathing
 

  • References

  • 1 Agostoni P, Cattadori G, Apostolo A, Contini M, Palermo P, Marenzi G, Wasserman K. Noninvasive measurement of cardiac output during exercise by inert gas rebreathing technique: A new tool for heart failure evaluation. J Am Coll Cardiol 2005; 46: 1779-1781
    CrossrefPubMedGoogle Scholar
  • 2 Bartels Sa, Stok WJ, Bezemer R, Boksem RJ, Van Goudoever J, Cherpanath TGV, Van Lieshout JJ, Westerhof BE, Karemaker JM, Ince C. Noninvasive cardiac output monitoring during exercise testing: Nexfin pulse contour analysis compared to an inert gas rebreathing method and respired gas analysis. J Clin Monit Comput 2011; 25: 315-321
    CrossrefPubMedGoogle Scholar
  • 3 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
    PubMedGoogle Scholar
  • 4 Christensen P, Clemensen P, Andersen PK, Henneberg SW. Thermodilution versus inert gas rebreathing for estimation of effective pulmonary blood flow. Crit Care Med 2000; 28: 51-56
    CrossrefPubMedGoogle Scholar
  • 5 Coats AJ, Adamopoulos S, Radaelli A, McCance A, Meyer TE, Bernardi L, Solda PL, Davey P, Ormerod O, Forfar C. Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation 1992; 85: 2119-2131
    CrossrefPubMedGoogle Scholar
  • 6 Critchley LA, Calcroft RM, Tan PY, Kew J, Critchley JA. The effect of lung injury and excessive lung fluid, on impedance cardiac output measurements, in the critically ill. Intensive Care Med 2000; 26: 679-685
    CrossrefPubMedGoogle Scholar
  • 7 Critchley LA, Lee A, Ho AMH. A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg 2010; 111: 1180-1192
    CrossrefPubMedGoogle Scholar
  • 8 Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth 2011; 25: 536-546
    CrossrefPubMedGoogle Scholar
  • 9 Dong L, Wang J, Jiang C. Validation of the use of foreign gas rebreathing method for non-invasive determination of cardiac output in heart disease patients. J Zhejiang Univ Sci B 2005; 6: 1157-1162
    CrossrefPubMedGoogle Scholar
  • 10 Feldman JM. Is It a bird? is it a plane? the role of patient monitors in medical decision making. Anesth Analg 2009; 108: 707-710
    CrossrefPubMedGoogle Scholar
  • 11 Fernandes SM, Alexander ME, Graham DA, Khairy P, Clair M, Rodriguez E, Pearson DD, Landzberg MJ, Rhodes J. Exercise testing identifies patients at increased risk for morbidity and mortality following fontan surgery. Congenit Heart Dis 2011; 6: 294-303
    CrossrefPubMedGoogle Scholar
  • 12 Fleisher La, Beckman Ja, Brown Ka, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager Ma, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt Sa, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: Executive summary. Anesth Analg 2008; 106: 685-712
    CrossrefPubMedGoogle Scholar
  • 13 Fontana P, Boutellier U, Toigo M. Non-invasive hemodynamic assessments using Innocor TM during standard graded exercise tests. Eur J Appl Physiol 2010; 108: 573-580
    CrossrefPubMedGoogle Scholar
  • 14 Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting. Anesth Analg 2009; 108: 887-897
    CrossrefPubMedGoogle Scholar
  • 15 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 Update. Int J Sports Med 2017; 38: 1126-1131
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Hassan M, Wagdy K, Kharabish A, Selwanos PP, Nabil A, Elguindy A, ElFaramawy A, Elmahdy MF, Mahmoud H, Yacoub MH. Validation of noninvasive measurement of cardiac output using inert gas rebreathing in a cohort of patients with heart failure and reduced ejection fraction clinical perspective. Circ Hear Fail 2017; 10: e003592
    PubMedGoogle Scholar
  • 17 Hombach V, Merkle N, Bernhard P, Rasche V, Rottbauer W. Prognostic significance of cardiac magnetic resonance imaging: Update 2010. Cardiol J 2010; 17: 549-557
    PubMedGoogle Scholar
  • 18 Jakovljevic DG, Nunan D, Donovan G, Hodges LD, Sandercock GRH, Brodie Da. Comparison of cardiac output determined by different rebreathing methods at rest and at peak exercise. Eur J Appl Physiol 2008; 102: 593-599
    CrossrefPubMedGoogle Scholar
  • 19 Jakovljevic DG, Seferovic PM, Nunan D, Donovan G, Trenell MI, Grocott-Mason R, Brodie DA. Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure. Clin Sci (Lond) 2012; 122: 175-181
    CrossrefPubMedGoogle Scholar
  • 20 Jarvis SS, Levine BD, Prisk GK, Shykoff BE, Elliott aR, Rosow E, Blomqvist CG, Pawelczyk JA. Simultaneous determination of the accuracy and precision of closed-circuit cardiac output rebreathing techniques. J Appl Physiol 2007; 103: 867-874
    CrossrefPubMedGoogle Scholar
  • 21 Keteyian SJ, Brawner CA, Ehrman JK. Reproducibility of Peak Oxygen Uptake Implications for Clinical Trials and Clinical Practice. Chest 2010; 138: 950-955
    CrossrefPubMedGoogle Scholar
  • 22 Lang CC, Karlin P, Haythe J, Lim TK, Mancini DM. Peak cardiac power output, measured noninvasively, is a powerful predictor of outcome in chronic heart failure. Circ Hear Fail 2009; 2: 33-38
    PubMedGoogle Scholar
  • 23 Laszlo G. Respiratory measurements of cardiac output: From elegant idea to useful test. J Appl Physiol 2004; 96: 428-437
    CrossrefPubMedGoogle Scholar
  • 24 Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 2005; 353: 349-361
    CrossrefPubMedGoogle Scholar
  • 25 Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: A systematic review. Br J Anaesth 2016; 116: 177-191
    CrossrefPubMedGoogle Scholar
  • 26 Myers J, Froelicher VF. Optimizing the exercise test for pharmacological investigations. Circulation 1990; 82: 1839-1846
    CrossrefPubMedGoogle Scholar
  • 27 Ohlsson J, Wranne B. Non-invasive assessment of cardiac output and stroke volume in patients during exercise - Evaluation of a CO2-rebreathing method. Eur J Appl Physiol Occup Physiol 1986; 55: 538-544
    CrossrefPubMedGoogle Scholar
  • 28 Okwose NC, Chowdhury S, Houghton D, Trenell MI, Eggett C, Bates M, Macgowan GA, Jakovljevic DG. Comparison of cardiac output estimates by bioreactance and inert gas rebreathing methods during cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2017; 38: 483-490
    PubMedGoogle Scholar
  • 29 Peyton PJ, Chong SW. Minimally invasive measurement of cardiac output during surgery and critical care: A meta-analysis of accuracy and precision. Anesthesiology 2010; 113: 1220-1235
    CrossrefPubMedGoogle Scholar
  • 30 Peyton PJ, Thompson B. Agreement of an inert gas rebreathing device with thermodilution and the direct oxygen Fick method in measurement of pulmonary blood flow. J Clin Monit Comput 2004; 18: 373-378
    CrossrefPubMedGoogle Scholar
  • 31 Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, Baars HF, Yo TI, Trocino G, Vigna C, Roelandt JR, van Urk H. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341: 1789-1794
    CrossrefPubMedGoogle Scholar
  • 32 Raue W, Swierzy M, Koplin G, Schwenk W. Comparison of electrical velocimetry and transthoracic thermodilution technique for cardiac output assessment in critically ill patients. Eur J Anaesthesiol 2009; 26: 1067-1071
    CrossrefPubMedGoogle Scholar
  • 33 Reutershan J, Kapp T, Unertl K, Fretschner R. Noninvasive determination of cardiac output in ventilated patients Clinical evaluation of a simplified quick method.. Anaesthesist 2003; 52: 778-786
    CrossrefPubMedGoogle Scholar
  • 34 Roul G, Moulichon ME, Bareiss P, Gries P, Koegler a, Sacrez J, Germain P, Mossard JM, Sacrez A. Prognostic factors of chronic heart failure in NYHA class II or III: Value of invasive exercise hemodynamic data. Eur Heart J 1995; 16: 1387-1398
    CrossrefPubMedGoogle Scholar
  • 35 Saur J, Fluechter S, Trinkmann F, Papavassiliu T, Schoenberg S, Weissmann J, Haghi D, Borggrefe M, Kaden JJ. Noninvasive determination of cardiac output by the inert-gas-rebreathing method–comparison with cardiovascular magnetic resonance imaging. Cardiology 2009; 114: 247-254
    CrossrefPubMedGoogle Scholar
  • 36 Saur J, Kraus F, Brade J, Haghi D, Behnes M, Hoffmann U, Borggrefe M, Kaden JJ, Trinkmann F. Influence of bag volume on reproducibility of inert gas rebreathing pulmonary blood flow measurements in patients with pulmonary diseases. Lung 2013; 191: 467-473
    CrossrefPubMedGoogle Scholar
  • 37 Saur J, Trinkmann F, Doesch C, Weissmann J, Hamm K, Schoenberg SO, Borggrefe M, Haghi D, Kaden JJ. Non-invasive measurement of cardiac output during atrial fibrillation: Comparison between cardiac magnetic resonance imaging and inert gas rebreathing. Cardiology 2010; 115: 212-216
    CrossrefPubMedGoogle Scholar
  • 38 Saur J, Trinkmann F, Weissmann J, Borggrefe M, Kaden JJ. Non-invasive determination of cardiac output: Comparison of a novel CW Doppler ultrasonic technique and inert gas rebreathing. Int J Cardiol 2009; 136: 248-250
    CrossrefPubMedGoogle Scholar
  • 39 Siebenmann C, Rasmussen P, Sørensen H, Zaar M, Hvidtfeldt M, Pichon A, Secher NH, Lundby C. Cardiac output during exercise: A comparison of four methods. Scand J Med Sci Sports 2015; 25: e20-e27
    CrossrefPubMedGoogle Scholar
  • 40 Smeltzer SC, Hinkle JL, Cheever KH, Bare BG. Brunner & Suddarth’s Textbook of Medical Surgical Nursing. Lippincott Williams & Wilkins. (12th ed.). 2010
    PubMed
  • 41 West MA, Lythgoe D, Barben CP, Noble L, Kemp GJ, Jack S, Grocott MPW. Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: A prospective blinded observational study. Br J Anaesth 2014; 112: 665-671
    CrossrefPubMedGoogle Scholar
  • 42 Wijeysundera DN, Beattie WS, Austin PC, Hux JE, Laupacis A. Non-invasive cardiac stress testing before elective major non-cardiac surgery: Population based cohort study. BMJ 2010; 340: b5526
    CrossrefPubMedGoogle Scholar
  • 43 Williams SG, Cooke Ga, Wright DJ, Parsons WJ, Riley RL, Marshall P, Tan LB. Peak exercise cardiac power output: A direct indicator of cardiac function strongly predictive of prognosis in chronic heart failure. Eur Heart J 2001; 22: 1496-1503
    CrossrefPubMedGoogle Scholar