Cardiac output derived from left ventricular pressure during conductance catheter evaluations

An extended modelflow method

Sergio Valsecchi, Giovanni B. Perego, Jan J. Schreuder, Federica Censi, Jos R C Jansen

Research output: Contribution to journalArticle

Abstract

Objective: The Modelflow method computes cardiac output (CO) from arterial pressure (CO-MFao) by simulating a non-linear three-element Windkessel model of aortic input impedance. We present a novel technique to apply the Modelflow method to the left ventricular pressure (Plv) signal, to obtain an estimation of CO (CO-MFlv). Methods: We extended the model by simulating the aortic valve as a resistance placed in series to the characteristic impedance. In our model the valve resistance is infinite in diastole, while it has a patient related value during systole. Twenty one patients with heart failure were studied with a combined pressure-conductance catheter positioned in the left ventricle and a micromanometer in the aorta. CO changes were induced during temporary sequential atrio-biventricular pacing with different atrio-ventricular and inter-ventricular intervals. After a single calibration we compared CO-MFlv with CO-MFao (516 measurement series) and with CO estimated by the conductance catheter volume technique (CO-cond) (267 series). Results: CO ranged from 2.42 to 7.59 l/min with an overall mean of 4.36 (1.38) l/min. Comparing the two Modelflow methods, the bias was -0.04 (0.36) l/min, with limits of agreement of -0.77 and 0.70 l/min, and a coefficient of variation of 8.4%. Of the 516 changes in CO from baseline values, 112 were greater than 0.5 l/min and 110 of these (98%) were scored in the same direction by both methods. For comparisons between CO-MFlv and CO-cond the bias was 0.10 (0.49), with limits of agreement of -1.12 and 0.90 l/min, and a coefficient of variation of 12.5%. Conclusions: Cardiac output estimates by the modelflow method from aortic pressure and left ventricular pressure are interchangeable in patients without mitral and aortic abnormalities. After an initial calibration, CO-MFlv presents near zero bias and an adequate precision.

Original languageEnglish
Pages (from-to)227-235
Number of pages9
JournalJournal of Clinical Monitoring and Computing
Volume21
Issue number4
DOIs
Publication statusPublished - Aug 2007

Fingerprint

Ventricular Pressure
Cardiac Output
Catheters
Electric Impedance
Calibration
Arterial Pressure
Cardiac Resynchronization Therapy
Diastole
Systole
Aortic Valve
Heart Ventricles
Aorta

Keywords

  • Cardiac output
  • Conductance catheter
  • Left ventricular pressure
  • Windkessel model

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Health Informatics
  • Health Information Management

Cite this

Cardiac output derived from left ventricular pressure during conductance catheter evaluations : An extended modelflow method. / Valsecchi, Sergio; Perego, Giovanni B.; Schreuder, Jan J.; Censi, Federica; Jansen, Jos R C.

In: Journal of Clinical Monitoring and Computing, Vol. 21, No. 4, 08.2007, p. 227-235.

Research output: Contribution to journalArticle

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abstract = "Objective: The Modelflow method computes cardiac output (CO) from arterial pressure (CO-MFao) by simulating a non-linear three-element Windkessel model of aortic input impedance. We present a novel technique to apply the Modelflow method to the left ventricular pressure (Plv) signal, to obtain an estimation of CO (CO-MFlv). Methods: We extended the model by simulating the aortic valve as a resistance placed in series to the characteristic impedance. In our model the valve resistance is infinite in diastole, while it has a patient related value during systole. Twenty one patients with heart failure were studied with a combined pressure-conductance catheter positioned in the left ventricle and a micromanometer in the aorta. CO changes were induced during temporary sequential atrio-biventricular pacing with different atrio-ventricular and inter-ventricular intervals. After a single calibration we compared CO-MFlv with CO-MFao (516 measurement series) and with CO estimated by the conductance catheter volume technique (CO-cond) (267 series). Results: CO ranged from 2.42 to 7.59 l/min with an overall mean of 4.36 (1.38) l/min. Comparing the two Modelflow methods, the bias was -0.04 (0.36) l/min, with limits of agreement of -0.77 and 0.70 l/min, and a coefficient of variation of 8.4{\%}. Of the 516 changes in CO from baseline values, 112 were greater than 0.5 l/min and 110 of these (98{\%}) were scored in the same direction by both methods. For comparisons between CO-MFlv and CO-cond the bias was 0.10 (0.49), with limits of agreement of -1.12 and 0.90 l/min, and a coefficient of variation of 12.5{\%}. Conclusions: Cardiac output estimates by the modelflow method from aortic pressure and left ventricular pressure are interchangeable in patients without mitral and aortic abnormalities. After an initial calibration, CO-MFlv presents near zero bias and an adequate precision.",
keywords = "Cardiac output, Conductance catheter, Left ventricular pressure, Windkessel model",
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T1 - Cardiac output derived from left ventricular pressure during conductance catheter evaluations

T2 - An extended modelflow method

AU - Valsecchi, Sergio

AU - Perego, Giovanni B.

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AU - Censi, Federica

AU - Jansen, Jos R C

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N2 - Objective: The Modelflow method computes cardiac output (CO) from arterial pressure (CO-MFao) by simulating a non-linear three-element Windkessel model of aortic input impedance. We present a novel technique to apply the Modelflow method to the left ventricular pressure (Plv) signal, to obtain an estimation of CO (CO-MFlv). Methods: We extended the model by simulating the aortic valve as a resistance placed in series to the characteristic impedance. In our model the valve resistance is infinite in diastole, while it has a patient related value during systole. Twenty one patients with heart failure were studied with a combined pressure-conductance catheter positioned in the left ventricle and a micromanometer in the aorta. CO changes were induced during temporary sequential atrio-biventricular pacing with different atrio-ventricular and inter-ventricular intervals. After a single calibration we compared CO-MFlv with CO-MFao (516 measurement series) and with CO estimated by the conductance catheter volume technique (CO-cond) (267 series). Results: CO ranged from 2.42 to 7.59 l/min with an overall mean of 4.36 (1.38) l/min. Comparing the two Modelflow methods, the bias was -0.04 (0.36) l/min, with limits of agreement of -0.77 and 0.70 l/min, and a coefficient of variation of 8.4%. Of the 516 changes in CO from baseline values, 112 were greater than 0.5 l/min and 110 of these (98%) were scored in the same direction by both methods. For comparisons between CO-MFlv and CO-cond the bias was 0.10 (0.49), with limits of agreement of -1.12 and 0.90 l/min, and a coefficient of variation of 12.5%. Conclusions: Cardiac output estimates by the modelflow method from aortic pressure and left ventricular pressure are interchangeable in patients without mitral and aortic abnormalities. After an initial calibration, CO-MFlv presents near zero bias and an adequate precision.

AB - Objective: The Modelflow method computes cardiac output (CO) from arterial pressure (CO-MFao) by simulating a non-linear three-element Windkessel model of aortic input impedance. We present a novel technique to apply the Modelflow method to the left ventricular pressure (Plv) signal, to obtain an estimation of CO (CO-MFlv). Methods: We extended the model by simulating the aortic valve as a resistance placed in series to the characteristic impedance. In our model the valve resistance is infinite in diastole, while it has a patient related value during systole. Twenty one patients with heart failure were studied with a combined pressure-conductance catheter positioned in the left ventricle and a micromanometer in the aorta. CO changes were induced during temporary sequential atrio-biventricular pacing with different atrio-ventricular and inter-ventricular intervals. After a single calibration we compared CO-MFlv with CO-MFao (516 measurement series) and with CO estimated by the conductance catheter volume technique (CO-cond) (267 series). Results: CO ranged from 2.42 to 7.59 l/min with an overall mean of 4.36 (1.38) l/min. Comparing the two Modelflow methods, the bias was -0.04 (0.36) l/min, with limits of agreement of -0.77 and 0.70 l/min, and a coefficient of variation of 8.4%. Of the 516 changes in CO from baseline values, 112 were greater than 0.5 l/min and 110 of these (98%) were scored in the same direction by both methods. For comparisons between CO-MFlv and CO-cond the bias was 0.10 (0.49), with limits of agreement of -1.12 and 0.90 l/min, and a coefficient of variation of 12.5%. Conclusions: Cardiac output estimates by the modelflow method from aortic pressure and left ventricular pressure are interchangeable in patients without mitral and aortic abnormalities. After an initial calibration, CO-MFlv presents near zero bias and an adequate precision.

KW - Cardiac output

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