Comparison of direct Fick's principle and thermodilution for calculating cardiac output in patients with pulmonary arterial hypertension.Does the assessment of cardiac index and pulmonary vascular resistance differ depending on which method is chosen?

Sammanfattning: Pulmonary arterial hypertension (PAH) is an uncommon but serious disease that causes increased pressure in the pulmonary vessels and increased pulmonary vascular resistance (PVR), which in turn leads to right heart failure. At diagnosis, mean pulmonary artery pressure (mPAP) must be >20 mmHg, pulmonary artery wedge pressure (PAWP) ≤15 mmHg and PVR >2 Wood units (WU). Calculation of cardiac output (CO) is an important hemodynamic parameter to be measured and assessed in these patients during a right heart catheterization (RHC). Prevailing ESC guidelines recommend using direct Fick's principle (dFp), which is considered the gold standard, or thermodilution when calculating CO. The aim of this study was to compare these two methods to see if there is a significant difference in the calculation of CO in patients with PAH. The aim was also to see if calculated cardiac index (CI) and PVR differ significantly depending on which of the methods for calculating CO is used. A retrospective study was conducted in which 34 patients who underwent RHC at the University Hospital in Örebro were included. The result showed a significant difference between dFp and thermodilution (p<0,05), where dFp on average measures higher volumes compared to thermodilution. It also showed a low agreement between the two methods. A significant difference was seen between CI and PVR (p<0,05) depending on which of the methods is used. Therefore, dFp and thermodilution cannot be said to have a good agreement in this patient group. It is important to use the same method for follow-up examinations as the assessment of PVR and CI is used as a predictor of whether the disease progresses or remains stable.