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

Publié dansJournal of clinical medicine, vol. 12, no. 2, 410
Date de mise en ligne2023-01-04
Résumé

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.

eng
Mots-clés
  • Cardiac output
  • Direct Fick
  • Mathematical model
  • Pulmonary hypertension
  • Thermodilution
Citation (format ISO)
GENECAND, Léon et al. The Influence of Methods for Cardiac Output Determination on the Diagnosis of Precapillary Pulmonary Hypertension: A Mathematical Model. In: Journal of clinical medicine, 2023, vol. 12, n° 2, p. 410. doi: 10.3390/jcm12020410
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Identifiants
ISSN du journal2077-0383
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Informations techniques

Création20/10/2023 14:07:17
Première validation15/11/2023 07:45:35
Heure de mise à jour15/11/2023 07:45:35
Changement de statut15/11/2023 07:45:35
Dernière indexation06/05/2024 17:21:18
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