Noninvasive cardiac output monitoring during exercise testing: Nexfin pulse contour analysis compared to an inert gas rebreathing method and respired gas analysis

Purpose. Exercise testing is often used to assess cardiac function during physical exertion to obtain diagnostic information. However, this procedure is limited to measuring the electrical activity of the heart using electrocardiography and intermittent blood pressure (BP) measurements and does not involve the continuous assessment of heart functioning. In this study, we compared continuous beat-to-beat pulse contour analysis to monitor noninvasive cardiac output (CO) during exercise with inert gas rebreathing and respired gas analysis. Methods. Nineteen healthy male volunteers were subjected to bicycle ergometry testing with increasing workloads. Cardiac output was determined noninvasively by continuous beat-to-beat pulse contour analysis (Nexfin) and by inert gas rebreathing, and estimated using the respired gas analysis method. The effects of the rebreathing maneuver on heart rate (HR), stroke volume (SV), and CO were evaluated. Results. The CO values derived from the Nexfinand inert gas rebreathing methods were well correlated (r = 0.88, P<0.01) and the limits of agreement were 30.3% with a measurement bias of 0.4±1.8 L/min. Nexfin- and respired gas analysis-derived CO values correlated even better (r = 0.94, P<0.01) and the limits of agreement were 21.5% with a measurement bias of -0.70±1.6 L/min. At rest, the rebreathing maneuver increased HR by 13 beats/min (P<0.01), SV remained unaffected (P = 0.7), while CO increased by 1.0 L/min (P<0.01). Rebreathing did not affect these parameters during exercise. Conclusions. Nexfin continuous beat-to-beat pulse contour analysis is an appropriate method for noninvasive assessment of CO during exercise.

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