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Int J Sports Med 2014; 35(11): 925-932
DOI: 10.1055/s-0034-1367046
Training & Testing
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of Thoracic Bioimpedance with Acetylene Uptake for Measuring Cardiac Output

E. Wang
1   Department of Circulation and Medical Imaging, Faculty of Medicine, the Norwegian University of Science and ­Technology, Trondheim, Norway
,
C. Cruz
1   Department of Circulation and Medical Imaging, Faculty of Medicine, the Norwegian University of Science and ­Technology, Trondheim, Norway
,
M. R. Pettersen
1   Department of Circulation and Medical Imaging, Faculty of Medicine, the Norwegian University of Science and ­Technology, Trondheim, Norway
,
J. Hoff
1   Department of Circulation and Medical Imaging, Faculty of Medicine, the Norwegian University of Science and ­Technology, Trondheim, Norway
2   Department of Physical Medicine and Rehabilitation, St. Olavs University Hospital, Trondheim, Norway
,
J. Helgerud
1   Department of Circulation and Medical Imaging, Faculty of Medicine, the Norwegian University of Science and ­Technology, Trondheim, Norway
3   Hokksund Medical Rehabilitation Centre, Hokksund, Norway
4   Telemark University College, Department of Sports and Outdoor Life Studies, Bø, Norway
› Author Affiliations
Further Information

Publication History



accepted after revision 27 December 2013

Publication Date:
02 June 2014 (online)

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Abstract

Cardiac output is shown to be a key determinant for oxygen transport, performance and health. Reliable and accurate non-invasive measurements of cardiac output, especially during exercise, are therefore of importance. The present study compared a new thoracic bioimpedance method with the established single-breath acetylene uptake method. We assessed cardiac output in 20 (24±4 years.) moderately trained males, at rest and during cycling. Both methods showed good test-retest reliabilities with ±2 SD limits of agreement of 3.67 and −4.50 L ∙ min−1 (thoracic bioimpedance) and 4.46 and −5.69 L ∙ min−1 (single breath), respectively. When thoracic bioimpedance was compared with single breath, the ±2 SD limits of agreement were poor (−6.05 and 9.57 L ∙ min−1). Thoracic bioimpedance displayed significantly lower (p<0.05) absolute cardiac output values than single breath, and the cardiac output-oxygen consumption slopes (y=5.7x+5.5 (single breath) and y=5.0x+5.0 (thoracic bioimpedance) tended (p=0.08) to show less increase for thoracic bioimpedance. Conclusions: Results from the single-breath method are in line with previous findings, showing a good reliability. Although thoracic bioimpedance showed a similar reliability as the single-breath method, and is easier to use, the agreement with single breath was poor, and thoracic bioimpedance seems not to be able to replace it.

Key words

maximal oxygen consumption - reliability - test-retest - validation - stroke volume - single breath acetylene uptake
 

  • References

  • 1 Astrand PO, Cuddy TE, Saltin B, Stenberg J. Cardiac Output during Submaximal and Maximal Work. J Appl Physiol 1964; 19: 268-274
    PubMedGoogle Scholar
  • 2 Balouch J, Olfert IM, Wagner PD, Hopkins SR. The effect of incomplete acetylene washout on cardiac output measurement using open circuit acetylene uptake. Respir Physiol Neurobiol 2007; 155: 177-183
    CrossrefPubMedGoogle Scholar
  • 3 Barker RC, Hopkins SR, Kellogg N, Olfert IM, Brutsaert TD, Gavin TP, Entin PL, Rice AJ, Wagner PD. Measurement of cardiac output during exercise by open-circuit acetylene uptake. J Appl Physiol 1999; 87: 1506-1512
    CrossrefPubMedGoogle Scholar
  • 4 Baum MM, Moss JA, Kumar S, Wagner PD. Non-invasive measurement of cardiac output: evaluation of new infrared absorption spectrometer. Respir Physiol Neurobiol 2006; 153: 191-201
    CrossrefPubMedGoogle Scholar
  • 5 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
    PubMedGoogle Scholar
  • 6 Cander L, Forster RE. Determination of pulmonary parenchymal tissue volume and pulmonary capillary blood flow in man. J Appl Physiol 1959; 14: 541-551
    PubMedGoogle Scholar
  • 7 Carnethon MR, Gulati M, Greenland P. Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. JAMA 2005; 294: 2981-2988
    CrossrefPubMedGoogle Scholar
  • 8 Cecconi M, Dawson D, Grounds RM, Rhodes A. Lithium dilution cardiac output measurement in the critically ill patient: determination of precision of the technique. Intensive Care Med 2009; 35: 498-504
    CrossrefPubMedGoogle Scholar
  • 9 Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999; 15: 85-91
    CrossrefPubMedGoogle Scholar
  • 10 Critoph CH, Patel V, Mist B, Thomas MD, Elliott PM. Non-invasive assessment of cardiac output at rest and during exercise by finger plethysmography. Clin Physiol Funct Imaging 2013; 33: 338-343
    CrossrefPubMedGoogle Scholar
  • 11 Dibski DW, Smith DJ, Jensen R, Norris SR, Ford GT. Comparison and reliability of two non-invasive acetylene uptake techniques for the measurement of cardiac output. Eur J Appl Physiol 2005; 94: 670-680
    CrossrefPubMedGoogle Scholar
  • 12 Elliott A, Hull JH, Nunan D, Jakovljevic DG, Brodie D, Ansley L. Application of bioreactance for cardiac output assessment during exercise in healthy individuals. Eur J Appl Physiol 2010; 109: 945-951
    PubMedGoogle Scholar
  • 13 Elliott AD, Skowno J, Prabhu M, Ansley L. Measurement of cardiac output during exercise in healthy, trained humans using lithium dilution and pulse contour analysis. Physiol Meas 2012; 33: 1691-1701
    CrossrefPubMedGoogle Scholar
  • 14 Ferguson RJ, Faulkner JA, Julius S, Conway J. Comparison of cardiac output determined by CO2 rebreathing and dye-dilution methods. J Appl Physiol 1968; 25: 450-454
    PubMedGoogle Scholar
  • 15 Gledhill N, Cox D, Jamnik R. Endurance athletes’ stroke volume does not plateau: major advantage is diastolic function. Med Sci Sports Exerc 1994; 26: 1116-1121
    PubMedGoogle Scholar
  • 16 Gluer CC. Monitoring skeletal changes by radiological techniques. J Bone Miner Res 1999; 14: 1952-1962
    CrossrefPubMedGoogle Scholar
  • 17 Groepenhoff H, Holverda S, Marcus JT, Postmus PE, Boonstra A, Vonk-Noordegraaf A. Stroke volume response during exercise measured by acetylene uptake and MRI. Physiol Meas 2007; 28: 1-11
    CrossrefPubMedGoogle Scholar
  • 18 Grollman A. The determination of cardiac output of man by the use of acetylene. Am J Physiol 1929; 88: 432-445
    PubMedGoogle Scholar
  • 19 Harriss D, Atkinson G. 2014 Update-ethical standards in sport and exercise science research. Int J Sports Med 2013; 34: 1025-1028
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P, Bjerkaas M, Simonsen T, Helgesen C, Hjorth N, Bach R, Hoff J. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 2007; 39: 665-671
    CrossrefPubMedGoogle Scholar
  • 21 Helgerud J, Wang E, Mosti MP, Wiggen ON, Hoff J. Plantar flexion training primes peripheral arterial disease patients for improvements in cardiac function. Eur J Appl Physiol 2009; 106: 207-215
    CrossrefPubMedGoogle Scholar
  • 22 Huang YC, O’Brien SR, Vredenburgh J, Folz RJ, Macintyre NR. Intrabreath analysis of carbon monoxide uptake during exercise in patients at risk for lung injury. Respir Med 2006; 100: 1226-1233
    CrossrefPubMedGoogle Scholar
  • 23 Jakovljevic DG, Nunan D, Donovan G, Hodges LD, Sandercock GR, Brodie DA. Comparison of cardiac output determined by different rebreathing methods at rest and at peak exercise. Eur J Appl Physiol 2008; 102: 593-599
    CrossrefPubMedGoogle Scholar
  • 24 Jarvis SS, Levine BD, Prisk GK, Shykoff BE, Elliott AR, Rosow E, Blomqvist CG, Pawelczyk JA. Simultaneous determination of the accuracy and precision of closed-circuit cardiac output rebreathing techniques. J Appl Physiol 2007; 103: 867-874
    CrossrefPubMedGoogle Scholar
  • 25 Johnson BD, Beck KC, Proctor DN, Miller J, Dietz NM, Joyner MJ. Cardiac output during exercise by the open circuit acetylene washin method: comparison with direct Fick. J Appl Physiol 2000; 88: 1650-1658
    PubMedGoogle Scholar
  • 26 Kemps HM, Thijssen EJ, Schep G, Sleutjes BT, De Vries WR, Hoogeveen AR, Wijn PF, Doevendans PA. Evaluation of two methods for continuous cardiac output assessment during exercise in chronic heart failure patients. J Appl Physiol 2008; 105: 1822-1829
    CrossrefPubMedGoogle Scholar
  • 27 Kemps HM, Thijssen EJ, Schep G, Sleutjes BT, De Vries WR, Hoogeveen AR, Wijn PF, Doevendans PA. Evaluation of two methods for continuous cardiac output assessment during exercise in chronic heart failure patients. J Appl Physiol 2008; 105: 1822-1829
    CrossrefPubMedGoogle Scholar
  • 28 Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output system. Aerosp Med 1966; 37: 1208-1212
    PubMedGoogle Scholar
  • 29 Liu Y, Menold E, Dullenkopf A, Reissnecker S, Lormes W, Lehmann M, Steinacker JM. Validation of the acetylene rebreathing method for measurement of cardiac output at rest and during high-intensity exercise. Clin Physiol 1997; 17: 171-182
    CrossrefPubMedGoogle Scholar
  • 30 Mosti MP, Wang E, Wiggen ON, Helgerud J, Hoff J. Concurrent strength and endurance training improves physical capacity in patients with peripheral arterial disease. Scand J Med Sci Sports 2011; 21: e308-e314
    CrossrefPubMedGoogle Scholar
  • 31 Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793-801
    CrossrefPubMedGoogle Scholar
  • 32 Nystrom J, Celsing F, Carlens P, Ekblom B, Ring P. Evaluation of a modified acetylene rebreathing method for the determination of cardiac output. Clin Physiol 1986; 6: 253-268
    CrossrefPubMedGoogle Scholar
  • 33 Richard R, Lonsdorfer-Wolf E, Charloux A, Doutreleau S, Buchheit M, Oswald-Mammosser M, Lampert E, Mettauer B, Geny B, Lonsdorfer J. Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device. Eur J Appl Physiol 2001; 85: 202-207
    CrossrefPubMedGoogle Scholar
  • 34 Rowland T. Endurance athletes’ stroke volume response to progressive exercise: a critical review. Sports Med 2009; 39: 687-695
    CrossrefPubMedGoogle Scholar
  • 35 Saltin B, Blomqvist G, Mitchell JH, Johnson Jr RL, Wildenthal K, Chapman CB. Response to exercise after bed rest and after training. Circulation 1968; 38 (5 Suppl) VII1-VII78
    CrossrefPubMedGoogle Scholar
  • 36 Saltin B, Calbet JA. Point: in health and in a normoxic environment, VO2 max is limited primarily by cardiac output and locomotor muscle blood flow. J Appl Physiol; 2006. 100. 744-745
  • 37 Schwaiblmair M, Faul C, von Scheidt W, Berghaus TM. Differences of cardiac output measurements by open-circuit acetylene uptake in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a cohort study. Respir Res 2012; 13: 18
    CrossrefPubMedGoogle Scholar
  • 38 Smyth RJ, Gledhill N, Froese AB, Jamnik VK. Validation of noninvasive maximal cardiac output measurement. Med Sci Sports Exerc 1984; 16: 512-515
    CrossrefPubMedGoogle Scholar
  • 39 Taylor K, La Rotta G, McCrindle BW, Manlhiot C, Redington A, Holtby H. A comparison of cardiac output by thoracic impedance and direct fick in children with congenital heart disease undergoing diagnostic cardiac catheterization. J Cardiothorac Vasc Anesth 2011; 25: 776-779
    CrossrefPubMedGoogle Scholar
  • 40 Taylor K, Manlhiot C, McCrindle B, Grosse-Wortmann L, Holtby H. Poor accuracy of noninvasive cardiac output monitoring using bioimpedance cardiography [PhysioFlow(R)] compared to magnetic resonance imaging in pediatric patients. Anesth Analg 2012; 114: 771-775
    CrossrefPubMedGoogle Scholar
  • 41 Tonelli AR, Alnuaimat H, Li N, Carrie R, Mubarak KK. Value of impedance cardiography in patients studied for pulmonary hypertension. Lung 2011; 189: 369-375
    CrossrefPubMedGoogle Scholar
  • 42 Triebwasser JH, Johnson RL, Burpo RP, Campbell JC, Reardon WC, Blomqvist CG. Noninvasive determination of cardiac output by a modified acetylene rebreathing procedure utilizing mass spectrometer measurements. Aviat Space Environ Med 1977; 48: 203-209
    PubMedGoogle Scholar
  • 43 Wang E, Hoff J, Loe H, Kaehler N, Helgerud J. Plantar flexion: an effective training for peripheral arterial disease. Eur J Appl Physiol 2008; 104: 749-756
    CrossrefPubMedGoogle Scholar
  • 44 Wang E, Solli GS, Nyberg SK, Hoff J, Helgerud J. Stroke volume does not plateau in female endurance athletes. Int J Sports Med 2012; 33: 734-739
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Warburton DE, Gledhill N, Jamnik VK. Reproducibility of the acetylene rebreathe technique for determining cardiac output. Med Sci Sports Exerc 1998; 30: 952-957
    CrossrefPubMedGoogle Scholar
  • 46 Warburton DE, Haykowsky MJ, Quinney HA, Blackmore D, Teo KK, Humen DP. Myocardial response to incremental exercise in endurance-trained athletes: influence of heart rate, contractility and the Frank-Starling effect. Exp Physiol 2002; 87: 613-622
    CrossrefPubMedGoogle Scholar
  • 47 Warburton DE, Haykowsky MJ, Quinney HA, Humen DP, Teo KK. Reliability and validity of measures of cardiac output during incremental to maximal aerobic exercise. Part I: Conventional techniques. Sports Med 1999; 27: 23-41
    CrossrefPubMedGoogle Scholar
  • 48 Warburton DE, Haykowsky MJ, Quinney HA, Humen DP, Teo KK. Reliability and validity of measures of cardiac output during incremental to maximal aerobic exercise. Part II: Novel techniques and new advances. Sports Med 1999; 27: 241-260
    CrossrefPubMedGoogle Scholar
  • 49 Welsman J, Bywater K, Farr C, Welford D, Armstrong N. Reliability of peak VO(2) and maximal cardiac output assessed using thoracic bioimpedance in children. Eur J Appl Physiol 2005; 94: 228-234
    CrossrefPubMedGoogle Scholar
  • 50 Zenger MR, Brenner M, Haruno M, Mahon D, Wilson AF. Measurement of cardiac output by automated single-breath technique, and comparison with thermodilution and Fick methods in patients with cardiac disease. Am J Cardiol 1993; 71: 105-109
    CrossrefPubMedGoogle Scholar
  • 51 Zhou B, Conlee RK, Jensen R, Fellingham GW, George JD, Fisher AG. Stroke volume does not plateau during graded exercise in elite male distance runners. Med Sci Sports Exerc 2001; 33: 1849-1854
    CrossrefPubMedGoogle Scholar
  • 52 Åstrand PO, Rodahl K, Dahl HA, Strømme SB. Textbook of work physiology. Physiological bases of exercise. Leeds: Human Kinetics; 2003
    Google Scholar