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Stroke volume and cardiac output measurement in cardiac patients during a rehabilitation program: comparison between tonometry, impedancemetry and echocardiography

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Abstract

Given the increasing use of noninvasive techniques for the assessment of cardiac function in clinical practice, the aim of this study was to evaluate if stroke volume (SV) and cardiac output (CO) measurements obtained by PhysioFlow impedance cardiography or HDI CR-2000 pulse wave analysis (Pulse) are interchangeable with measurements obtained by echocardiography in patients with coronary artery disease (CAD) or heart failure (HF). The study involved 48 men with heart disease (CAD or HF). We compared SV and CO measurements with the three devices at rest, as well as relative changes in SV and CO derived from a rehabilitation program. SV and CO measurements were carried out first by echocardiography and immediately after using tonometry and impedancemetry techniques simultaneously. The Bland–Altman analysis showed a significant bias in the measurement of absolute SV and CO values with Pulse and PhysioFlow. Four quadrant plot and polar plot analysis of relative change SV between Pulse and echocardiography show a rate of concordance of 77% (95% CI 60–88%) and 79% (95% CI 63–89%) respectively. The polar plot analysis showed a mean polar angle of 34° ± 22°, and a 30° radial sector containing 52% of the data points. Both Pulse and PhysioFlow devices overestimate absolute SV and CO values compared to values recorded using echocardiography. Similarly, neither Pulse nor PhysioFlow reliably track SV or CO changes after a rehabilitation program compared with echocardiography.

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Acknowledgements

The authors thank the patients for their time and cooperation, and Catherine Monpère and Fawzi Ounissi for supervision of the rehabilitation program and echocardiography evaluations.

Funding

This work was funded by Grants from the French Ministry of National Education of Research and of Technology (EA 3813 and EA3920), the Fédération Française de Cardiologie and the Fondation de l’Avenir.

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Authors and Affiliations

  1. Department Functional Biology and Health Sciences, University of Vigo, Vigo, Spain

    Alicia Gonzalez-Represas

  2. Research Unit EA3920 Prognostic Markers and Regulatory, Factors of Cardiovascular Diseases and Exercise Performance Health, Innovation Platform, Univ. Bourgogne Franche-Comté, Besançon, France

    Laurent Mourot

  3. Department of Physical Culture of School of Core Engineering Education, National Research Tomsk Polytechnic University, Tomsk, Russia

    Laurent Mourot

  4. UFR SMP 19 rue Ambroise Paré, Plateforme Exercice Performance Santé Innovation (EPSI) – Bâtiment Socrate, Bureau 245, 25030, Besançon Cedex, France

    Laurent Mourot

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  1. Alicia Gonzalez-Represas
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Correspondence to Laurent Mourot.

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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. The study was reviewed and accepted by the Tours Ethics Committee (France; no. 2005-2025). The participants were provided with information about the study methods and gave their written informed consent.

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Gonzalez-Represas, A., Mourot, L. Stroke volume and cardiac output measurement in cardiac patients during a rehabilitation program: comparison between tonometry, impedancemetry and echocardiography. Int J Cardiovasc Imaging 36, 447–455 (2020). https://doi.org/10.1007/s10554-019-01738-y

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  • DOI: https://doi.org/10.1007/s10554-019-01738-y

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