Thermodilution and Fick cardiac outputs differ: impact on pulmonary hypertension evaluation.
BACKGROUND
The relationship between thermodilution and indirect Fick cardiac output determination methods has not been well described.


OBJECTIVE
To describe the relationship between these two cardiac output determination methods in patients evaluated for pulmonary hypertension and to highlight potential clinical implications.


METHODS
A retrospective review of charts of all adult patients who underwent a right heart catheterization (RHC) between January 1, 2007 and November 10, 2010, and participated in the pulmonary hypertension program of the pulmonary division at an academic institution was conducted. For validation, the charts of all patients who underwent RHC during the same period within the cardiology division were reviewed.


RESULTS
A total of 198 patients underwent 213 RHCs, 79 (40%) of whom had pulmonary arterial hypertension, were included. Forty-three per cent of patients had >20% difference between thermodilution and Fick. The average difference (thermodilution - Fick ±SD) was -0.39±2.03 L⁄min (n=213; P=0.006). There was no significant difference in bias or variability between thermodilution and Fick among patients with tricuspid regurgitant jet velocity (TRJ) of <3 m⁄s versus those with TRJ >3 m⁄s (-0.41±2.10 L⁄min versus -0.36±1.93 L⁄min, respectively; P=0.87). In a multivariable analysis, the thermodilution-Fick difference increased with age (P=0.001).


CONCLUSIONS
The presence of such discrepancy in 36% of patients evaluated for heart failure and⁄or heart transplant validated the results. In total, 37% of the 1315 procedures (213 performed by pulmonologists and 1102 performed by cardiologists) had a difference of >20% between thermodilution and Fick.


CONCLUSIONS
Significant discrepancy exists between thermodilution and indirect Fick methods. This discrepancy potentially impacts pulmonary arterial hypertension prognostication and diagnosis, and is independent of TRJ.
Yale University, School of Medicine, Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Pulmonary Vascular Disease Program, New Haven, Connecticut 06510, USA. wassim.fares@yale.edu
Wassim H
WH
Fares
Sarah K
SK
Blanchard
George A
GA
Stouffer
Patricia P
PP
Chang
Wayne D
WD
Rosamond
Hubert James
HJ
Ford
Robert M
RM
Aris
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002302:Cardiac Output; D003430:Cross-Sectional Studies; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D012189:Retrospective Studies; D013815:Thermodilution / Q000706:statistics & numerical data