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Cardiac Output Monitoring in Children, Adolescents and Adults Based on Pulse Contour Analysis: Comparison with Echocardiography-Derived Data and Identification of Factors Associated with Their Differences

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Abstract

Purpose

Through pulse contour analysis (PCA) devices would enable to obtain non-invasive operator-independent cardiac output (CO) measurements [CO(PCA)]. The agreement between CO(PCA) and data from two-dimensional [CO(2D)] or Doppler [CO(VTI)] echocardiography (references) remains controversial.

Aims

To analyze: (1) CO(PCA), CO(2D) and CO(VTI) agreement, (2) determinants of methods’ differences in measured CO values.

Methods

Simultaneous echocardiography and PCA records (Mobil-O-Graph/Germany) were obtained in 130 subjects (age: 29 ± 17 years). Hemodynamic (e.g., heart rate [HR]), arterial (e.g., arterial stiffness, augmentation index [AIx]) and cardiac structural–functional (e.g., left ventricle end-diastolic diameters [LVEDD]) parameters were obtained. Data from the entire group (all; 10–85 years), children (≤ 16 years), adolescents (17–24 years) and adults (> 24 years) were separately analyzed.

Results

The highest Lin’s concordance correlation coefficient (CCC) were obtained when analyzing CO(PCA)/CO(2D) association (0.672, 0.785, 0.721, 0.487 for all, children, adolescents and adults, respectively); CCC levels were higher at younger ages. Bland–Altman’s systematic errors between CO(PCA)/CO(2D) were 0.12, 0.17, 0.07 and 0.14 L/min, for all, children, adolescents and adults, respectively (non-significant). CO(VTI)/CO(PCA) systematic error only reached significance in adults (0.34 L/min, p = 0.002). Bland–Altman’s proportional errors were not statistically significant when CO(PCA)/CO(2D) differences were analysed in children and adolescents. Higher AIx and LVEDD levels associated greater CO(2D)/CO(PCA) differences; higher AIx and HR levels were associated to differences between CO(VTI) and CO(PCA).

Conclusion

CO(PCA) had systematic (< 0.17 L/min) and percent (≤ 30%) errors, which allow us to postulate that its use allows reaching levels comparable to those of echocardiography. Differences in CO-data between methods were associated with arterial and cardiac properties.

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Disclousure of interest

Yanina Zócalo, Alejandro Díaz, and Daniel Bia have no conflicts of interest to declare.

Funding

This work was supported by the Agencia Nacional de Investigación e Innovación (ANII) under Grant (PRSCT-008-020) and Espacio Interdisciplinario (EI) and Comisión Sectorial de Investigación Científica (CSIC-Udelar) of the Republic University, Uruguay. Additionally, this work was supported by extrabudgetary funds generated by CUiiDARTE Centre and Project. None of these organizations influenced the study design or collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, General Flores 2125, 11800, Montevideo, Uruguay

    Yanina Zócalo & Daniel Bia

  2. Instituto de Investigación en Ciencias de la Salud, UNICEN, CCT-Tandil, CONICET, Tandil, Argentina

    Alejandro Díaz

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  1. Yanina Zócalo
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Correspondence to Yanina Zócalo.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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13239_2019_439_MOESM6_ESM.tif

Figure S1 Association analysis (correlation) between cardiac output (CO) obtained by different methods, for the entire group (All) and age related subgroups. Regression and equality lines are shown in each scatter-diagram. (TIFF 656 kb)

13239_2019_439_MOESM7_ESM.tif

Figure S2 Association analysis (correlation) between cardiac output (CO) obtained with different Mobil-O-Graph related signal quality scores, for the entire group (All) and age-related subgroups. Regression and equality lines are shown in each scatter-diagram. (TIFF 230 kb)

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Zócalo, Y., Díaz, A. & Bia, D. Cardiac Output Monitoring in Children, Adolescents and Adults Based on Pulse Contour Analysis: Comparison with Echocardiography-Derived Data and Identification of Factors Associated with Their Differences. Cardiovasc Eng Tech 11, 67–83 (2020). https://doi.org/10.1007/s13239-019-00439-w

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