Source: Annual Congress 2011 - Physiology of human pulmonary hypertension
Disease area: Pulmonary vascular diseases

Abstract

The indirect Fick method (Fick^Ind) is often used for the hemodynamic evaluation in pulmonary arterial hypertension (PAH). As the Fick^Ind calculates the cardiac output (CO) assuming physiological VO₂ values, this method might be unfeasible for patients with pulmonary vascular diseases. We evaluated the suitability of hemodynamic data obtained by Fick^Ind in PAH.
Right heart catheterization was performed in 43 PAH patients (age 61±13 yrs) and 9 controls. 61% of patients suffered from idiopathic PAH, 30% from PAH associated with connective tissue diseases, the remaining 9% from other forms of PAH. Hemodynamic results obtained by Fick^Ind were compared to data from the thermodilution (TD) method.
Patients and controls did not differ in age and BSA. No significant difference between heart rates during the different techniques was detected in either group. Mean CO determined by Fick^Ind (CO^Fick) was 4.3±1.8 and 4.7±1.2 L/min in PAH patients and controls, respectively. In PAH patients CO by TD method (CO^Thermo) was consistently higher than CO^Fick (4.9±2.0 L/min) showing a significant difference (Wilcoxon; p<0.001). In controls CO^Thermo was 5.4±1.4 L/min (not significant to CO^Fick). Agreement analysis of CO^Thermo with CO^Fick revealed a comparable bias between methods in both groups (0.5±1.1 L/min in patients; 0.65±0.82 L/min in controls) with wider limits of agreement for the patient cohort (-1.6 to 2.6 L/min versus -1.0 to 2.3 L/min in controls).
Determination of CO by the Fick^Ind cannot be used in PAH patients as this method consequently underestimates CO. It can be suggested that the estimated VO₂ values in use for the calculation of the CO are invalid for PAH patients.

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Citations should be made in the following way:
S. Desole, S. Czekay, T. Bollmann, K. Lau, R. Ewert, C. M. Kaehler (Innsbruck, Austria; Greifswald, Germany). The indirect Fick method is an unfeasible method for hemodynamic assessment in pulmonary arterial hypertension patients. Eur Respir J 2011; 38: Suppl. 55, 2310

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