Cardiac output and cardiac index measured with cardiovascular magnetic resonance in healthy subjects, elite athletes and patients with congestive heart failure

Abstract

BackgroundCardiovascular Magnetic Resonance (CMR) enables non-invasive quantification of cardiac output (CO) and thereby cardiac index (CI, CO indexed to body surface area). The aim of this study was to establish if CI decreases with age and compare the values to CI for athletes and for patients with congestive heart failure (CHF).MethodsCI was measured in 144 healthy volunteers (39 ± 16 years, range 21–81 years, 68 females), in 60 athletes (29 ± 6 years, 30 females) and in 157 CHF patients with ejection fraction (EF) below 40% (60 ± 13 years, 33 females). CI was calculated using aortic flow by velocity-encoded CMR and is presented as mean ± SD. Flow was validated in vitro using a flow phantom and in 25 subjects with aorta and pulmonary flow measurements.ResultsThere was a slight decrease of CI with age in healthy subjects (8 ml/min/m2 per year, r2 = 0.07, p = 0.001). CI in males (3.2 ± 0.5 l/min/m2) and females (3.1 ± 0.4 l/min/m2) did not differ (p = 0.64). The mean ± SD of CI in healthy subjects in the age range of 20–29 was 3.3 ± 0.4 l/min/m2, in 30–39 years 3.3 ± 0.5 l/min/m2, in 40–49 years 3.1 ± 0.5 l/min/m2, 50–59 years 3.0 ± 0.4 l/min/m2 and >60 years 3.0 ± 0.4 l/min/m2. There was no difference in CI between athletes and age-controlled healthy subjects but HR was lower and indexed SV higher in athletes. CI in CHF patients (2.3 ± 0.6 l/min/m2) was lower compared to the healthy population (p < 0.001). There was a weak correlation between CI and EF in CHF patients (r2 = 0.07, p < 0.001) but CI did not differ between patients with NYHA-classes I-II compared to III-IV (n = 97, p = 0.16) or patients with or without hospitalization in the previous year (n = 100, p = 0.72). In vitro phantom validation showed low bias (−0.8 ± 19.8 ml/s) and in vivo validation in 25 subjects also showed low bias (0.26 ± 0.61 l/min, QP/QS 1.04 ± 0.09) between pulmonary and aortic flow.ConclusionsCI decreases in healthy subjects with age but does not differ between males and females. We found no difference in CI between athletes and healthy subjects at rest but CI was lower in patients with congestive heart failure. The presented values can be used as reference values for flow velocity mapping CMR.

A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

“…The same study suggests that 50% of patients with heart failure reduced ejection fraction demonstrate reduced cardiac index at rest compared with healthy controls 26. However, it appears that both heart failure patients with reduced as well as preserved ejection fraction demonstrate diminished cardiac output (cardiac index) in response to exercise‐induced stress 27, 28, 29…”

Años de experiencia como factor limitante en corredores veteranos de largas distancias / Training Experience as a Limiting Factor in Master Long Distance Runners

“…La hipertermia puede afectar a los procesos centrales y periféricos involucrados en la producción de fuerza y potencia ( Además, las características fisiológicas podrían influir en gran medida en los resultados de las pruebas en relación con la edad, tales como el consumo máximo de oxígeno (VO2 máx.) o el rendimiento cardíaco que parecen disminuir con el aumento de la edad (Carlsson et al, 2012). Katzel, Sorkin y Fleg (2001) mostraron que el volumen de entrenamiento tuvo un impacto importante en el grado de pérdida de VO2máx.…”

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“…It reflects the ability of the heart to meet the oxygen demands (VO2) of the organism [1]. Cardiovascular magnetic resonance (CMR) has become an excellent imaging technique for global cardiac assessment in patients with ischemic heart disease.…”

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