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Noninvasive cardiac output monitoring during exercise testing: Nexfin pulse contour analysis compared to an inert gas rebreathing method and respired gas analysis

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Abstract

Purpose

Exercise testing is often used to assess cardiac function during physical exertion to obtain diagnostic information. However, this procedure is limited to measuring the electrical activity of the heart using electrocardiography and intermittent blood pressure (BP) measurements and does not involve the continuous assessment of heart functioning. In this study, we compared continuous beat-to-beat pulse contour analysis to monitor noninvasive cardiac output (CO) during exercise with inert gas rebreathing and respired gas analysis.

Methods

Nineteen healthy male volunteers were subjected to bicycle ergometry testing with increasing workloads. Cardiac output was deter- mined noninvasively by continuous beat-to-beat pulse contour analysis (Nexfin) and by inert gas rebreathing, and estimated using the respired gas analysis method. The effects of the rebreathing maneuver on heart rate (HR), stroke volume (SV), and CO were evaluated.

Results

The CO values derived from the Nexfin- and inert gas rebreathing methods were well correlated (r = 0.88, P < 0.01) and the limits of agreement were 30.3% with a measurement bias of 0.4 ± 1.8 L/min. Nexfin- and respired gas analysis-derived CO values correlated even better (r = 0.94, P < 0.01) and the limits of agreement were 21.5% with a measurement bias of −0.70 ± 1.6 L/min. At rest, the rebreathing maneuver increased HR by 13 beats/min (P < 0.01), SV remained unaffected (P = 0.7), while CO increased by 1.0 L/min (P < 0.01). Rebreathing did not affect these parameters during exercise.

Conclusions

Nexfin continuous beat-to-beat pulse contour analysis is an appropriate method for noninvasive assessment of CO during exercise.

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Abbreviations

BP:

Blood pressure

CO:

Cardiac output

HR:

Heart rate

SV:

Stroke volume

VO2 :

Oxygen uptake

CO2 :

Carbon dioxide

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Author information

Authors and Affiliations

  1. Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Sebastiaan A. Bartels, Rick Bezemer & Can Ince

  2. Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Sebastiaan A. Bartels, Rick Bezemer & Can Ince

  3. Department of Intensive Care, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Sebastiaan A. Bartels

  4. Laboratory for Clinical Cardiovascular Physiology, Heart Failure Research Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Wim J. Stok, Jeroen van Goudoever, Johannes J. van Lieshout & Berend E. Westerhof

  5. Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Remco J. Boksem

  6. BMEYE B.V. Building: Centerpoint 1, Hoogoorddreef 60, 1101 BE, Amsterdam, The Netherlands

    Jeroen van Goudoever & Berend E. Westerhof

  7. Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Thomas G. V. Cherpanath

  8. Acute Admissions Unit, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Johannes J. van Lieshout

  9. School of Biomedical Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH, UK

    Johannes J. van Lieshout

  10. Department of Systems Physiology, Heart Failure Research Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    John M. Karemaker

Authors
  1. Sebastiaan A. Bartels
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  2. Wim J. Stok
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  7. Johannes J. van Lieshout
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Corresponding author

Correspondence to Sebastiaan A. Bartels.

Additional information

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.

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Bartels, S.A., Stok, W.J., Bezemer, R. et al. 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 25, 315–321 (2011). https://doi.org/10.1007/s10877-011-9310-4

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  • DOI: https://doi.org/10.1007/s10877-011-9310-4

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