title: The reliability of noninvasive cardiac output measurement using the inert gas rebreathing method in patients with advanced heart failure.
abstract: BACKGROUND
  Impaired cardiac output (CO) is a key element of heart failure (HF). So far, there has been no simple, reliable, inexpensive and non-invasive CO measurement method feasible for clinical practice. Not a single diagnostic test has been elaborated to diagnose and monitor HF. The aim of the study was the evaluation of the reliability of a new, non-invasive CO measurement device utilizing an inert gas rebreathing technique and an infrared photoacoustic gas analyzer, in comparison with standard invasive methods.
  
  
  METHODS
  In 21 patients with advanced HF (NYHA classes III and IV) undergoing cardiac catheterization as a routine hemodynamic evaluation before heart transplantation, CO measurements with the tested non-invasive method were carried out during invasive examination.
  
  
  RESULTS
  CO measured by the inert gas rebreathing technique (CO(RB)), according to the statistical Bland-Altman method, was, on average, 0.1 L/min higher than that determined by thermodilution (CO(TD)) and 0.006 L/min higher than the CO determined by the Fick formula (CO(Fick)). This magnitude of difference equals 2.8% of CO(TD) and 0.15% of CO(Fick) values. The limits of agreement between CO(RB) and CO(TD) were +/- 1.4 L/min, and between CO(RB) and CO(Fick) +/- 1.3 L/min. In the subgroup with atrial fibrillation, the mean difference between tested and reference methods (0.3 +/- 1.0 L/min for both CO(TD) and CO(Fick)) was higher than in the sinus rhythm subgroup (0.06 +/- 1.5 L/min for CO(TD) and 0.08 +/- 1.5 for CO(Fick)).
  
  
  CONCLUSIONS
  CO measurement with the inert gas rebreathing method utilizing an infrared photoacoustic gas analyzer seems reliable enough to be employed in clinical practice. Being non-invasive, it may well be used for repeated determinations in patients with HF.
authors.affiliation: Department of Cardiology, Regional Heart Failure Centre, Regional Hospital in Bydgoszcz, Poland. psoban@wp.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Sobański
authors.forename: Władysław
authors.initials: W
authors.lastname: Sinkiewicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.forename: Jan
authors.initials: J
authors.lastname: Błazejewski
authors.forename: Robert
authors.initials: R
authors.lastname: Bujak
mesh_terms: D001944:Breath Tests / Q000379:methods; D002248:Carbon Monoxide / Q000032:analysis; D002302:Cardiac Output; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D002248:Carbon Monoxide