PMID- 26226280 OWN - NLM STAT- MEDLINE DCOM- 20160513 LR - 20181113 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 10 IP - 7 DP - 2015 TI - Non-Invasive Determination of Cardiac Output in Pre-Capillary Pulmonary Hypertension. PG - e0134221 LID - 10.1371/journal.pone.0134221 [doi] LID - e0134221 AB - BACKGROUND: Cardiac output (CO) is a major diagnostic and prognostic factor in pre-capillary pulmonary hypertension (PH). Reference methods for CO determination, like thermodilution (TD), require invasive procedures and allow only steady-state measurements. The Modelflow (MF) method is an appealing technique for this purpose as it allows non-invasive and beat-by-beat determination of CO. METHODS: We aimed to compare CO values obtained simultaneously from non-invasive pulse wave analysis by MF (COMF) and by TD (COTD) to determine its precision and accuracy in pre-capillary PH. The study was performed on 50 patients with pulmonary arterial hypertension (PAH) or chronic thrombo-embolic PH (CTEPH). CO was determined at rest in all patients (n = 50) and during nitric oxide vasoreactivity test, fluid challenge or exercise (n = 48). RESULTS: Baseline COMF and COTD were 6.18 +/- 1.95 and 5.46 +/- 1.95 L.min-1, respectively. Accuracy and precision were 0.72 and 1.04 L.min-1, respectively. Limits of agreement (LoA) ranged from -1.32 to 2.76 L.min-1. Percentage error (PE) was +/-35.7%. Overall sensitivity and specificity of COMF for directional change were 95.2% and 82.4%, (n = 48) and 93.3% and 100% for directional changes during exercise (n = 16), respectively. After application of a correction factor (1.17 +/- 0.25), neither proportional nor fixed bias was found for subsequent CO determination (n = 48). Accuracy was -0.03 L.min-1 and precision 0.61 L.min-1. LoA ranged from -1.23 to 1.17 L.min-1 and PE was +/-19.8%. CONCLUSIONS: After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH. FAU - Lador, Frederic AU - Lador F AD - Service de Pneumologie, Programme Hypertension Pulmonaire, Hopitaux Universitaires de Geneve, Geneve, Switzerland. FAU - Herve, Philippe AU - Herve P AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France. FAU - Bringard, Aurelien AU - Bringard A AD - Departement des Neuroscience Fondamentales, Centre Medical Universitaire, Universite de Geneve, Geneve, Switzerland. FAU - Gunther, Sven AU - Gunther S AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Universite Paris-Sud, Faculte de Medecine, Le Kremlin Bicetre, France. FAU - Garcia, Gilles AU - Garcia G AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Universite Paris-Sud, Faculte de Medecine, Le Kremlin Bicetre, France. FAU - Savale, Laurent AU - Savale L AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Universite Paris-Sud, Faculte de Medecine, Le Kremlin Bicetre, France. FAU - Ferretti, Guido AU - Ferretti G AD - Departement des Neuroscience Fondamentales, Centre Medical Universitaire, Universite de Geneve, Geneve, Switzerland; Dipartimento di Scienze Cliniche e Sperimentali, Universita di Brescia, Brescia, Italy. FAU - Soccal, Paola M AU - Soccal PM AD - Service de Pneumologie, Programme Hypertension Pulmonaire, Hopitaux Universitaires de Geneve, Geneve, Switzerland. FAU - Chemla, Denis AU - Chemla D AD - Departement de Physiologie, Universite Paris-Sud, Faculte de Medecine-EA4533-APHP, Le Kremlin Bicetre, France. FAU - Humbert, Marc AU - Humbert M AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Universite Paris-Sud, Faculte de Medecine, Le Kremlin Bicetre, France. FAU - Simonneau, Gerald AU - Simonneau G AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Universite Paris-Sud, Faculte de Medecine, Le Kremlin Bicetre, France. FAU - Sitbon, Olivier AU - Sitbon O AD - AP-HP, Centre de Reference de l'Hypertension Pulmonaire Severe, Departement Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hopital de Bicetre, Le Kremlin Bicetre, France; Universite Paris-Sud, Faculte de Medecine, Le Kremlin Bicetre, France. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150730 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Cardiac Catheterization/methods MH - Cardiac Output/*physiology MH - Exercise Test MH - Female MH - Hemodynamics/physiology MH - Humans MH - Hypertension, Pulmonary/diagnosis/*physiopathology MH - Male MH - Middle Aged MH - Thermodilution PMC - PMC4520479 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2015/08/01 06:00 MHDA- 2016/05/14 06:00 PMCR- 2015/07/30 CRDT- 2015/07/31 06:00 PHST- 2015/05/08 00:00 [received] PHST- 2015/07/07 00:00 [accepted] PHST- 2015/07/31 06:00 [entrez] PHST- 2015/08/01 06:00 [pubmed] PHST- 2016/05/14 06:00 [medline] PHST- 2015/07/30 00:00 [pmc-release] AID - PONE-D-15-20052 [pii] AID - 10.1371/journal.pone.0134221 [doi] PST - epublish SO - PLoS One. 2015 Jul 30;10(7):e0134221. doi: 10.1371/journal.pone.0134221. eCollection 2015.