The Influence of Methods for Cardiac Output Determination on the Diagnosis of Precapillary Pulmonary Hypertension: A Mathematical Model.

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License: CC BY 4.0
Serval ID
serval:BIB_29C6F37820A8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The Influence of Methods for Cardiac Output Determination on the Diagnosis of Precapillary Pulmonary Hypertension: A Mathematical Model.
Journal
Journal of clinical medicine
Author(s)
Genecand L., Simian G., Desponds R., Wacker J., Ulrich S., Lechartier B., Fellrath J.M., Sitbon O., Beghetti M., Lador F.
ISSN
2077-0383 (Print)
ISSN-L
2077-0383
Publication state
Published
Issued date
04/01/2023
Peer-reviewed
Oui
Volume
12
Number
2
Pages
410
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Background: precapillary pulmonary hypertension (PH, PcPH) is now defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg, a pulmonary artery wedge pressure (PAWP) ≤ 15 mmHg and a pulmonary vascular resistance (PVR) > 2 WU. For PVR calculation, the measurement of cardiac output (CO) is necessary. It is generally measured using thermodilution. However, recent data showed that the agreement with direct Fick method, historically the gold standard, is less than previously reported. We aimed to create a mathematical model that calculated the probability of being classified differently (PcPH or unclassified PH) if CO measured by direct Fick was used instead of thermodilution for any individual patients with a mPAP > 20 mmHg and a PAWP ≤ 15 mmHg. Methods: The model is based on Bland and Altman analysis with a normally distributed difference of cardiac output, fixed 1.96 standard deviation of bias, bias and physiological cardiac output limits. Results: Following a literature review of the studies comparing CO measured with direct Fick and thermodilution, we fixed the 1.96 standard deviation of bias at 2 L/min, bias at 0 L/min and physiological resting CO limits between 1.3 L/min and 10.2 L/min. Conclusions: This model can help the clinician to evaluate the potential benefit of measuring CO using direct Fick during the diagnostic work-up and its utility in confirming or ruling out a diagnosis of PcPH in any given patient with a mPAP > 20 mmHg and a PAWP ≤ 15 mmHg.
Keywords
cardiac output, direct Fick, mathematical model, pulmonary hypertension, thermodilution
Pubmed
Web of science
Open Access
Yes
Create date
31/01/2023 17:21
Last modification date
19/10/2023 7:14
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