Non-Invasive Cardiac Output Determination Using Magnetic Resonance Imaging and Thermodilution in Pulmonary Hypertension

Crowe, Lindsey A.; Genecand, Léon; Hachulla, Anne-Lise; Noble, Stéphane; Beghetti, Maurice; Vallée, Jean‐Paul; Lador, Frédéric

doi:10.3390/jcm11102717

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Other non-invasive methods have been studied in PcPH including inert gas rebreathing, bioimpendance, bioreactance, pulse wave analysis, cardiac magnetic resonance imaging and echocardiography [ 7 ]. The most promising method might be cardiac magnetic resonance imaging that showed excellent agreement when compared to TD or DF with LoA close to 1 L/min [ 15 , 16 ]. Since the characteristics of the presented mathematical model were based on the agreement between TD and DF, it cannot be readily used for other methods, such as indirect Fick or cardiac magnetic resonance, that have different agreement with the gold standard DF.…”

Section: Discussionmentioning

confidence: 99%

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

Genecand

Simian

Desponds

et al. 2023

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

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

Genecand

Simian

Desponds

et al. 2023

JCM

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“…However, this method is reserved for patients who have not developed irreversible, end-stage heart 2 of 18 failure and those who have no irreversible, severe structural heart changes. One diagnostic method that enables an insight into structural changes, intracardiac shunts, and cardiac function is magnetic resonance imaging (MRI), which has gained importance recently [4,5].…”

Section: Introductionmentioning

confidence: 99%

Novel Hybrid Treatment for Pulmonary Arterial Hypertension with or without Eisenmenger Syndrome: Double Lung Transplantation with Simultaneous Endovascular or Classic Surgical Closure of the Patent Ductus Arteriosus (PDA)

Stącel

Sybila

Mędrala

et al. 2022

JCDD

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Patients with pulmonary arterial hypertension (PAH) become candidates for lung or lung and heart transplantation when the maximum specific therapy is no longer effective. The most difficult challenge is choosing one of the above options in the event of symptoms of right ventricular failure. Here, we present two female patients with PAH: (1) a 21-year-old patient with Eisenmenger syndrome, caused by a congenital defect—patent ductus arteriosus (PDA); and (2) a 39-year-old patient with idiopathic PAH and coexistent PDA. Their common denominator is PDA and the hybrid surgery performed: double lung transplantation with simultaneous PDA closure. The operation was performed after pharmacological bridging (conditioning) to transplantation that lasted for 33 and 70 days, respectively. In both cases, PDA closure effectiveness was 100%. Both patients survived the operation (100%); however, patient no. 1 died on the 2nd postoperative day due to multi-organ failure; while patient no. 2 was discharged home in full health. The authors did not find a similar description of the operation in the available literature and PubMed database. Hence, we propose this new treatment method for its effectiveness and applicability proven in our practice.

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How to Reliably Measure Stroke Volume Index in Pulmonary Arterial Hypertension: A Comparison of Thermodilution, Direct and Indirect Fick, and Cardiac MRI

Baccelli,

Gopalan,

Davies

et al. 2025

Life

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Background. Stroke volume index (SVI) is an important prognostic parameter in pulmonary arterial hypertension (PAH). The direct Fick (DF) method represents the gold standard for measuring it. Indirect Fick (IF) and thermodilution (TD) are simpler and widely used alternatives. However, data on the accuracy of these methods in estimating SVI in PAH are scant. We aimed to compare these different invasive methods, and in a subgroup of patients, to a non-invasive method using MRI. Methods. We enrolled 103 PAH patients undergoing a diagnostic or follow-up right heart catheterization at our centre (mean age 56 years, 56% female). The Bland–Altman analysis was used to assess agreement between methods. Potential demographic, clinical, and hemodynamic biases were explored. The accuracy of cardiac magnetic resonance (CMR)-derived SVI was assessed in a subset of patients. Results. The mean bias for IF-SVI vs. DF-SVI was −5.53 mL/min/m2 with a median percentage error (PE) of 15%. The mean bias was lower, 0.09 mL/min/m2, for TD-SVI vs. DF-SVI with a median PE of 10%. Low cardiac index and severe tricuspid regurgitation (TR) were associated with a greater bias between TD and DF. CMR-SVI showed good accuracy and precision even in patients with severe TR, compared to DF. Conclusions. The indirect Fick is the less reliable method to assess SVI also in PAH patients. Thermodilution is a valid alternative to direct Fick, but it should be used with caution in patients with severe TR or low cardiac index. SVI measured by cardiac MRI is a promising non-invasive alternative, especially in patients with severe TR. Our observation needs to be confirmed by other series and larger studies.

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Non-Invasive Cardiac Output Determination Using Magnetic Resonance Imaging and Thermodilution in Pulmonary Hypertension

Cited by 3 publications

References 33 publications

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

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

Novel Hybrid Treatment for Pulmonary Arterial Hypertension with or without Eisenmenger Syndrome: Double Lung Transplantation with Simultaneous Endovascular or Classic Surgical Closure of the Patent Ductus Arteriosus (PDA)

How to Reliably Measure Stroke Volume Index in Pulmonary Arterial Hypertension: A Comparison of Thermodilution, Direct and Indirect Fick, and Cardiac MRI

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