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Noninvasive pulse contour analysis for determination of cardiac output in patients with chronic heart failure
Sebastian Roth1, Henrik Fox1, Uwe Fuchs2
1Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
Insights
Noninvasive pulse contour analysis (NPCA) overestimates cardiac output in heart failure patients with reduced ejection fraction. This method is not recommended for this patient group due to inaccurate readings.
Area of Science:
- Cardiology
- Medical Devices
- Physiology
Background:
- Accurate cardiac output (CO) determination is critical for managing heart failure (HF).
- Invasive thermodilution (TD) is the gold standard for CO measurement.
- Noninvasive pulse contour analysis (NPCA) offers a potential alternative but requires validation in HF.
Purpose of the Study:
- To validate the accuracy of auto-calibrated NPCA for CO determination in patients with chronic-stable HF and reduced ejection fraction (HF-REF).
- To compare NPCA-derived CO measurements with invasive TD measurements in this specific patient population.
Main Methods:
- Prospective study involving 84 HF-REF patients undergoing right heart catheterization with TD.
- Simultaneous CO measurement using the CNAP Monitor (NPCA) and TD.
- Comparison of three standardized TD measurements with simultaneous auto-calibrated NPCA CO measurements.
Main Results:
- NPCA signal acquisition failed in 26% of patients (18 with LVAD).
- Bland-Altman analysis of 58 patients showed a mean bias of +1.92 L/min (limits of agreement ±2.28 L/min, 47.4% error).
- NPCA systematically overestimated CO, particularly in patients with lower cardiac index (r = -0.75, p < 0.001), misclassifying HF severity.
Conclusions:
- Auto-calibrated NPCA demonstrates systematic overestimation of cardiac output in HF-REF patients as cardiac function declines.
- The observed inaccuracies and limitations in signal acquisition render NPCA unreliable for CO assessment in this cohort.
- NPCA is currently not recommended for CO determination in patients with HF-REF.
Background:
Determination of cardiac output (CO) is essential in diagnosis and management of heart failure (HF). The gold standard to obtain CO is invasive assessment via thermodilution (TD). Noninvasive pulse contour analysis (NPCA) is supposed as a new method of CO determination. However, a validation of this method in HF is pending and performed in the present study.
Methods:
Patients with chronic-stable HF and reduced left ventricular ejection fraction (LVEF ≤ 45%; HF-REF) underwent right heart catheterization including TD. NPCA using the CNAP Monitor (V5.2.14, CNSystems Medizintechnik AG) was performed simultaneously. Three standardized TD measurements were compared with simultaneous auto-calibrated NPCA CO measurements.
Results:
In total, 84 consecutive HF-REF patients were enrolled prospectively in this study. In 4 patients (5%), TD was not successful and for 22 patients (26%, 18 with left ventricular assist device), no NPCA signal could be obtained. For the remaining 58 patients, Bland-Altman analysis revealed a mean bias of + 1.92 L/min (limits of agreement ± 2.28 L/min, percentage error 47.4%) for CO. With decreasing cardiac index, as determined by the gold standard of TD, there was an increasing gap between CO values obtained by TD and NPCA (r = - 0.75, p < 0.001), resulting in a systematic overestimation of CO in more severe HF. TD-CI classified 52 (90%) patients to have a reduced CI (< 2.5 L/min/m2), while NPCA documented a reduced CI in 18 patients (31%) only.
Conclusions:
In HF-REF patients, auto-calibrated NPCA systematically overestimates CO with decrease in cardiac function. Therefore, to date, NPCA cannot be recommended in this cohort.
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