ISSN 2149-2263 | E-ISSN 2149-2271
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Could Impedance Cardiography be a Non-Invasive Alternative Method of Measuring Cardiac Output in Patients with Pulmonary Hypertension? [Anatol J Cardiol]
Anatol J Cardiol. 2023; 27(11): 650-656 | DOI: 10.14744/AnatolJCardiol.2023.2820

Could Impedance Cardiography be a Non-Invasive Alternative Method of Measuring Cardiac Output in Patients with Pulmonary Hypertension?

Burcu Yağmur1, Evrim Şimşek1, Meral Kayıkçıoğlu1, Elif İlkay Yüce2, Yeşim Bayazıt Candemir1, Sanem Nalbantgil1, Nesrin Moğolkoç3, Levent Can1, Hakan Kültürsay1
1Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
2Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
3Department of Pulmonology, Faculty of Medicine, Ege University, İzmir, Türkiye

Background: Pulmonary hypertension guidelines recommend invasive right heart catheterization for diagnosis and clinical follow-up. Our aim was to compare non-invasive impedance cardiography with invasive techniques for cardiac index measurements and mortality prediction in patients with pulmonary hypertension.

Methods: Between 2008 and 2018, 284 right heart catheterizations were performed for the diagnosis of pulmonary hypertension in 215 patients with mean pulmonary artery pressure >25 mm Hg, and at least 2 methods used for cardiac output measurement were included in the study retrospectively. Patients were evaluated with Pearson’s correlation in 3 groups: estimated Fick (eFick) method and thermodilution (group 1), eFick method and impedance cardiography (group 2), and thermodilution and impedance cardiography (group 3). We also compared the predictive power of cardiac index measured by different methods for 1-year overall mortality and hospitalizations.

Results: There were strong and moderate positive correlations in groups 1 and 3, respectively (r = 0.634, P <.001, r = 0.534, P =.001), and the weakest correlation was in group 2 (r = 0.390, P =.001). The mean difference (bias) between eFick method versus impedance cardiography, impedance cardiography vs. thermodilution, and eFick method vs.
thermodilution was 0.6 mL/min, 0.47 mL/min, and −0.2 mL/min respectively, but limits of agreement were wide. In both groups, cardiac index <2.5 L/min/m2 as measured by thermodilution significantly predicted 1-year mortality. Also, impedance cardiography was better than eFick method in predicting mortality (P =.02).

Conclusions: Our single-center real-life data showed that for cardiac output and cardiac index measurements, impedance cardiography provides a moderate correlation with thermodilution and is fair with eFick method methods. Moreover, thermodilution appeared superior to both eFick method and impedance cardiography, while impedance cardiography was even better than eFick method in predicting 1-year adverse events, including total mortality and hospitalization, in patients with pulmonary hypertension.

Keywords: Hemodynamics, impedance cardiography, mortality, noninvasive assessment, pulmonary circulation and right ventricular

Burcu Yağmur, Evrim Şimşek, Meral Kayıkçıoğlu, Elif İlkay Yüce, Yeşim Bayazıt Candemir, Sanem Nalbantgil, Nesrin Moğolkoç, Levent Can, Hakan Kültürsay. Could Impedance Cardiography be a Non-Invasive Alternative Method of Measuring Cardiac Output in Patients with Pulmonary Hypertension?. Anatol J Cardiol. 2023; 27(11): 650-656

Corresponding Author: Burcu Yağmur
Manuscript Language: English


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