The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension
ABSTRACT Cardiac output is essential to calculate pulmonary vascular resistance (PVR) and classify pulmonary hypertension (PH). Recent evidence has shown a lower agreement between thermodilution (COTD) and direct Fick (CODF) methods than historically estimated. The influence of the cardiac output me...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-04-01
|
| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.70112 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849426790776307712 |
|---|---|
| author | Léon Genecand Gaëtan Simian Mona Lichtblau Jean‐Marc Fellrath Julian Klug Hugues Turbé Christian Lovis Stéphane Noble Julie Wacker Julian Müller Roberto Desponds Maurice Beghetti Benoit Lechartier David Montani Olivier Sitbon Silvia Ulrich Frédéric Lador |
| author_facet | Léon Genecand Gaëtan Simian Mona Lichtblau Jean‐Marc Fellrath Julian Klug Hugues Turbé Christian Lovis Stéphane Noble Julie Wacker Julian Müller Roberto Desponds Maurice Beghetti Benoit Lechartier David Montani Olivier Sitbon Silvia Ulrich Frédéric Lador |
| author_sort | Léon Genecand |
| collection | DOAJ |
| description | ABSTRACT Cardiac output is essential to calculate pulmonary vascular resistance (PVR) and classify pulmonary hypertension (PH). Recent evidence has shown a lower agreement between thermodilution (COTD) and direct Fick (CODF) methods than historically estimated. The influence of the cardiac output measurement method on the classification of PH is poorly explored. We aimed to estimate the risk of diagnostic error when using COTD instead of CODF. We used a previously published mathematical model to consecutive patients diagnosed with PH at three centers in Switzerland. This model allows an individual estimation of the risk of diagnostic error when using COTD instead of CODF and is based on limits of agreement (LoA) between COTD and CODF of 2 L/min (average estimation) and 2.7 L/min (worst case scenario estimation). One thousand one hundred and forty‐two patients with PH were evaluated. The mean risk of diagnostic error using the model with LoA of 2 L/min was 6.0% in the overall population (n = 1142). The mean risk of diagnostic error was 2.9% among the 712 patients with precapillary PH, 15.0% among the 113 patients with isolated postcapillary PH (IpcPH), 7.2% among the 247 patients with combined post‐ and pre‐capillary PH, and 18.8% among the 70 patients with unclassified PH. The estimated diagnostic error when using COTD instead of CODF was generally low, particularly for patients with precapillary PH. Patients with PVR close to the diagnostic threshold of 2 WU (i.e., between 1 and 3 WU), mostly concerning patients with IpcPH and unclassified PH, exhibited a higher risk of diagnostic error. |
| format | Article |
| id | doaj-art-1aa820f1416e4ebeb1c2e1c75c8d17f3 |
| institution | Kabale University |
| issn | 2045-8940 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj-art-1aa820f1416e4ebeb1c2e1c75c8d17f32025-08-20T03:29:15ZengWileyPulmonary Circulation2045-89402025-04-01152n/an/a10.1002/pul2.70112The Impact of Cardiac Output Methods on the Classification of Pulmonary HypertensionLéon Genecand0Gaëtan Simian1Mona Lichtblau2Jean‐Marc Fellrath3Julian Klug4Hugues Turbé5Christian Lovis6Stéphane Noble7Julie Wacker8Julian Müller9Roberto Desponds10Maurice Beghetti11Benoit Lechartier12David Montani13Olivier Sitbon14Silvia Ulrich15Frédéric Lador16Division of Pulmonary Medicine, Department of Medicine Geneva University Hospitals Geneva SwitzerlandSection de mathématiques university of Geneva Geneva SwitzerlandDepartment of Pulmonology University of Zurich, University Hospital of Zurich Zurich SwitzerlandService of Pulmonary Medicine Hopital Pourtales, Reseau Hospitalier Neuchâtelois Neuchâtel SwitzerlandFaculty of Medicine University of Geneva Geneva SwitzerlandDivision of Medical Information Sciences University Hospitals of Geneva and University of Geneva Geneva SwitzerlandDivision of Medical Information Sciences University Hospitals of Geneva and University of Geneva Geneva SwitzerlandFaculty of Medicine University of Geneva Geneva SwitzerlandFaculty of Medicine University of Geneva Geneva SwitzerlandDepartment of Pulmonology University of Zurich, University Hospital of Zurich Zurich SwitzerlandSection de mathématiques university of Geneva Geneva SwitzerlandFaculty of Medicine University of Geneva Geneva SwitzerlandDivision of Respiratory Medicine Lausanne University Hospital Lausanne SwitzerlandUniversité Paris‐Saclay, School of Medicine Le Kremlin‐Bicêtre FranceUniversité Paris‐Saclay, School of Medicine Le Kremlin‐Bicêtre FranceDepartment of Pulmonology University of Zurich, University Hospital of Zurich Zurich SwitzerlandFaculty of Medicine University of Geneva Geneva SwitzerlandABSTRACT Cardiac output is essential to calculate pulmonary vascular resistance (PVR) and classify pulmonary hypertension (PH). Recent evidence has shown a lower agreement between thermodilution (COTD) and direct Fick (CODF) methods than historically estimated. The influence of the cardiac output measurement method on the classification of PH is poorly explored. We aimed to estimate the risk of diagnostic error when using COTD instead of CODF. We used a previously published mathematical model to consecutive patients diagnosed with PH at three centers in Switzerland. This model allows an individual estimation of the risk of diagnostic error when using COTD instead of CODF and is based on limits of agreement (LoA) between COTD and CODF of 2 L/min (average estimation) and 2.7 L/min (worst case scenario estimation). One thousand one hundred and forty‐two patients with PH were evaluated. The mean risk of diagnostic error using the model with LoA of 2 L/min was 6.0% in the overall population (n = 1142). The mean risk of diagnostic error was 2.9% among the 712 patients with precapillary PH, 15.0% among the 113 patients with isolated postcapillary PH (IpcPH), 7.2% among the 247 patients with combined post‐ and pre‐capillary PH, and 18.8% among the 70 patients with unclassified PH. The estimated diagnostic error when using COTD instead of CODF was generally low, particularly for patients with precapillary PH. Patients with PVR close to the diagnostic threshold of 2 WU (i.e., between 1 and 3 WU), mostly concerning patients with IpcPH and unclassified PH, exhibited a higher risk of diagnostic error.https://doi.org/10.1002/pul2.70112cardiac outputdirect fickpulmonary hypertensionthermodilution |
| spellingShingle | Léon Genecand Gaëtan Simian Mona Lichtblau Jean‐Marc Fellrath Julian Klug Hugues Turbé Christian Lovis Stéphane Noble Julie Wacker Julian Müller Roberto Desponds Maurice Beghetti Benoit Lechartier David Montani Olivier Sitbon Silvia Ulrich Frédéric Lador The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension Pulmonary Circulation cardiac output direct fick pulmonary hypertension thermodilution |
| title | The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension |
| title_full | The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension |
| title_fullStr | The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension |
| title_full_unstemmed | The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension |
| title_short | The Impact of Cardiac Output Methods on the Classification of Pulmonary Hypertension |
| title_sort | impact of cardiac output methods on the classification of pulmonary hypertension |
| topic | cardiac output direct fick pulmonary hypertension thermodilution |
| url | https://doi.org/10.1002/pul2.70112 |
| work_keys_str_mv | AT leongenecand theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT gaetansimian theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT monalichtblau theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT jeanmarcfellrath theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT julianklug theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT huguesturbe theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT christianlovis theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT stephanenoble theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT juliewacker theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT julianmuller theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT robertodesponds theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT mauricebeghetti theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT benoitlechartier theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT davidmontani theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT oliviersitbon theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT silviaulrich theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT fredericlador theimpactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT leongenecand impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT gaetansimian impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT monalichtblau impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT jeanmarcfellrath impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT julianklug impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT huguesturbe impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT christianlovis impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT stephanenoble impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT juliewacker impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT julianmuller impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT robertodesponds impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT mauricebeghetti impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT benoitlechartier impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT davidmontani impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT oliviersitbon impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT silviaulrich impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension AT fredericlador impactofcardiacoutputmethodsontheclassificationofpulmonaryhypertension |