Noninvasive cardiac output estimation by inert gas rebreathing in pediatric and congenital heart disease

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• 作者：Amanda K. Marma ; MD^a ; Alexander R. Opotowsky ; MD ; MPH^a ; ^b ; ^{Alexander.Opotowsky@cardio.chboston.org" class="auth_mail" title="E-mail the corresponding author} ; Brian S. Fromm ; BS^a ; Ana Ubeda-Tikkanen ; MD ; PhD^a ; ^c ; Diego Porras ; MD^a ; Jonathan Rhodes ; MD^a ; ^{Jonathan.Rhodes@cardio.chboston.org" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：174
• 期：Complete
• 页码：80-88
• 全文大小：313 K

文摘

Inert gas rebreathing (IGR) techniques provide rapid, reliable estimates of cardiac output in adults with structurally normal hearts. Data on IGR reliability in pediatric and congenital heart disease populations are lacking. Our objective was to validate pulmonary blood flow (Qp) measurement by IGR compared with clinical reference tests, cardiovascular magnetic resonance (CMR), and indirect Fick.

Methods

Pulmonary blood flow was measured by IGR and CMR or indirect Fick in 80 patients grouped by presence and type of shunt lesion. Inert gas rebreathing precision was assessed using Bland-Altman analysis, repeatability coefficient, intraclass correlation, and coefficient of error. Agreement with the reference tests was assessed with Bland-Altman plots. For comparison, agreement between the 2 reference tests, CMR and indirect Fick, was assessed in 34 contemporary patients.

Results

Subjects were aged 7-78 years and had a wide range of cardiac diagnoses. Inert gas rebreathing Qp showed good repeatability (95% limits of agreement for 2 trials = ±22%, repeatability coefficient = 1.2 L/min, intraclass correlation = 0.92, and coefficient of error = 5%). In the absence of left-to-right shunting (n = 67), IGR Qp estimates agreed with CMR and indirect Fick Qp estimates, and the reference tests agreed with each other, with mean bias ≤10% (≤0.5 L/min) and 95% limits of agreement ±33%-38%. Conversely, IGR was unreliable in patients with left-to-right shunt (n = 14), with large bias (−58%, −4.0 L/min) and wide limits of agreement (±76%).

Conclusions

Inert gas rebreathing reliably estimates Qp in children and adults with congenital heart disease in the absence of left-to-right shunting, with agreement comparable to that seen between CMR and indirect Fick estimates.