Comparison between Modelflow® and echocardiography in the determination of cardiac output during and following pregnancy at rest and during exercise
DOI:
https://doi.org/10.14198/jhse.2022.171.12Keywords:
Prenatal, Submaximal exercise, Finger photoplethysmography, ValidityAbstract
During pregnancy, assessment of cardiac output (Q ̇), a fundamental measure of cardiovascular function, provides important insight into maternal adaptation. However, methods for dynamic Q ̇ measurement require validation. The purpose of this study was to estimate the agreement of Q ̇ measured by echocardiography and Modelflow® at rest and during submaximal exercise in non-pregnant (n = 18), pregnant (n = 15, 22-26 weeks gestation) and postpartum women (n = 12, 12-16 weeks post-delivery). Simultaneous measurements of Q ̇ derived from echocardiography [criterion] and Modelflow® were obtained at rest and during low-moderate intensity (25% and 50% peak power output) cycling exercise and compared using Bland-Altman analysis and limits of agreement. Agreement between echocardiography and Modelflow® was poor in non-pregnant, pregnant and postpartum women at rest (mean difference ± SD: -1.1 ± 3.4; -1.2 ± 2.9; -1.9 ± 3.2 L.min-1), and this remained evident during exercise. The Modelflow® method is not recommended for Q ̇ determination in research involving young, healthy non-pregnant and pregnant women at rest or during dynamic challenge. Previously published Q ̇ data from studies utilising this method should be interpreted with caution.
Funding
NoneDownloads
References
Atkinson, G., & Nevill, A. M. (1998, Oct). Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med, 26(4), 217-238. https://doi.org/10.2165/00007256-199826040-00002
Balady, G. J., Chaitman, B., Driscoll, D., Foster, C., Froelicher, E., Gordon, N., Pate, R., Rippe, J., & Bazzarre, T. (1998, Jun 9). Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation, 97(22), 2283-2293. https://doi.org/10.1161/01.cir.97.22.2283
Balady, G. J., Larson, M. G., Vasan, R. S., Leip, E. P., O'Donnell, C. J., & Levy, D. (2004, Oct 05). Usefulness of exercise testing in the prediction of coronary disease risk among asymptomatic persons as a function of the Framingham risk score. Circulation, 110(14), 1920-1925. https://doi.org/10.1161/01.CIR.0000143226.40607.71
Bijl, R. C., Valensise, H., Novelli, G. P., Vasapollo, B., Wilkinson, I., Thilaganathan, B., Stohr, E. J., Lees, C., van der Marel, C. D., Cornette, J. M. J., & International Working Group on Maternal, H. (2019, Feb 8). Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics. Ultrasound Obstet Gynecol. https://doi.org/10.1002/uog.20231
Bland, J. M. (2000). An Introduction to Medical Statistics (3 ed.). Oxford University Press.
Bland, J. M., & Altman, D. G. (1986, Feb 8). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307-310. https://doi.org/10.1016/s0140-6736(86)90837-8
Bland, J. M., & Altman, D. G. (2003, Jul). Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol, 22(1), 85-93. https://doi.org/10.1002/uog.122
Bland, M. (2015). An introduction to medical statistics (Fourth edition. ed.). Oxford University Press.
Cecconi, M., Rhodes, A., Poloniecki, J., Della Rocca, G., & Grounds, R. M. (2009). Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies--with specific reference to the measurement of cardiac output. Crit Care, 13(1), 201. https://doi.org/10.1186/cc7129
Claessen, G., Claus, P., Delcroix, M., Bogaert, J., La Gerche, A., & Heidbuchel, H. (2014, Mar). Interaction between respiration and right versus left ventricular volumes at rest and during exercise: a real-time cardiac magnetic resonance study. Am J Physiol Heart Circ Physiol, 306(6), H816-824. https://doi.org/10.1152/ajpheart.00752.2013
Cornette, J., Laker, S., Jeffery, B., Lombaard, H., Alberts, A., Rizopoulos, D., Roos-Hesselink, J. W., & Pattinson, R. C. (2017, Jan). Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review. Ultrasound Obstet Gynecol, 49(1), 25-31. https://doi.org/10.1002/uog.16015
Critchley, L. A., & Critchley, J. A. (1999, Feb). A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput, 15(2), 85-91.
Critoph, C. H., Patel, V., Mist, B., Thomas, M. D., & Elliott, P. M. (2013, Sep). Non-invasive assessment of cardiac output at rest and during exercise by finger plethysmography. Clin Physiol Funct Imaging, 33(5), 338-343. https://doi.org/10.1111/cpf.12032
CSEP. (2015). PARmed-X for Pregnancy Physical Activity Readiness Medical Examination. Retrieved 2019-11-12 from http://www.csep.ca/CMFiles/publications/parq/parmed-xpreg.pdf
D'Amore, S., & Mora, S. (2006, Nov-Dec). Gender-specific prediction of cardiac disease: importance of risk factors and exercise variables. Cardiol Rev, 14(6), 281-285. https://doi.org/10.1097/01.crd.0000244460.25429.c8
Dyson, K. S., Shoemaker, J. K., Arbeille, P., & Hughson, R. L. (2010, Apr). Modelflow estimates of cardiac output compared with Doppler ultrasound during acute changes in vascular resistance in women. Exp Physiol, 95(4), 561-568. https://doi.org/10.1113/expphysiol.2009.050815
Egana, M., Columb, D., & O'Donnell, S. (2013, Apr). Effect of low recumbent angle on cycling performance, fatigue, and V O(2) kinetics. Med Sci Sports Exerc, 45(4), 663-673. https://doi.org/10.1249/MSS.0b013e318279a9f2
Elvan-Taspinar, A., Uiterkamp, L. A., Sikkema, J. M., Bots, M. L., Koomans, H. A., Bruinse, H. W., & Franx, A. (2003, Nov). Validation and use of the Finometer for blood pressure measurement in normal, hypertensive and pre-eclamptic pregnancy. J Hypertens, 21(11), 2053-2060. https://doi.org/10.1097/00004872-200311000-00014
Gibbons, R. J., Balady, G. J., Bricker, J. T., Chaitman, B. R., Fletcher, G. F., Froelicher, V. F., Mark, D. B., McCallister, B. D., Mooss, A. N., O'Reilly, M. G., Winters, W. L., Jr., Antman, E. M., Alpert, J. S., Faxon, D. P., Fuster, V., Gregoratos, G., Hiratzka, L. F., Jacobs, A. K., Russell, R. O., & Smith, S. C., Jr. (2002, Oct 1). ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 106(14), 1883-1892. https://doi.org/10.1161/01.cir.0000034670.06526.15
Karvonen, M. J., Kentala, E., & Mustala, O. (1957). The effects of training on heart rate; a longitudinal study. Ann Med Exp Biol Fenn, 35(3), 307-315. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/13470504
Kavroulaki, D., Gugleta, K., Kochkorov, A., Katamay, R., Flammer, J., & Orgul, S. (2010, Dec). Influence of gender and menopausal status on peripheral and choroidal circulation. Acta Ophthalmol, 88(8), 850-853. https://doi.org/10.1111/j.1755-3768.2009.01607.x
Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., & Voigt, J. U. (2015, Mar). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 16(3), 233-270. https://doi.org/10.1093/ehjci/jev014
Masini, G., Foo, L. F., Cornette, J., Tay, J., Rizopoulos, D., McEniery, C. M., Wilkinson, I. B., & Lees, C. C. (2019, May). Cardiac output changes from prior to pregnancy to post partum using two non-invasive techniques. Heart, 105(9), 715-720. https://doi.org/10.1136/heartjnl-2018-313682
Meah, V. L., Backx, K., Cockcroft, J. R., Shave, R. E., & Stöhr, E. J. (2019, Sep). Left ventricular mechanics in late second trimester of healthy pregnancy. Ultrasound Obstet Gynecol, 54(3), 350-358. https://doi.org/10.1002/uog.20177
Meah, V. L., Backx, K., Davenport, M. H., & International Working Group on Maternal, H. (2018, Mar). Functional hemodynamic testing in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. Ultrasound Obstet Gynecol, 51(3), 331-340. https://doi.org/10.1002/uog.18890
Meah, V. L., Cockcroft, J. R., Backx, K., Shave, R., & Stöhr, E. J. (2016, Apr). Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart, 102(7), 518-526. https://doi.org/10.1136/heartjnl-2015-308476
Melchiorre, K., Sutherland, G. R., Baltabaeva, A., Liberati, M., & Thilaganathan, B. (2011, Jan). Maternal cardiac dysfunction and remodeling in women with preeclampsia at term. Hypertension, 57(1), 85-93. https://doi.org/10.1161/hypertensionaha.110.162321
Mor-Avi, V., Lang, R. M., Badano, L. P., Belohlavek, M., Cardim, N. M., Derumeaux, G., Galderisi, M., Marwick, T., Nagueh, S. F., Sengupta, P. P., Sicari, R., Smiseth, O. A., Smulevitz, B., Takeuchi, M., Thomas, J. D., Vannan, M., Voigt, J. U., & Zamorano, J. L. (2011, Mar). Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr, 12(3), 167-205. https://doi.org/10.1016/j.echo.2011.01.015
Picone, D. S., Schultz, M. G., Peng, X., Black, J. A., Dwyer, N., Roberts-Thomson, P., Chen, C. H., Cheng, H. M., Pucci, G., Wang, J. G., & Sharman, J. E. (2018, Jun). Discovery of New Blood Pressure Phenotypes and Relation to Accuracy of Cuff Devices Used in Daily Clinical Practice. Hypertension, 71(6), 1239-1247. https://doi.org/10.1161/hypertensionaha.117.10696
Rang, S., de Pablo Lapiedra, B., van Montfrans, G. A., Bouma, B. J., Wesseling, K. H., & Wolf, H. (2007, Mar). Modelflow: a new method for noninvasive assessment of cardiac output in pregnant women. Am J Obstet Gynecol, 196(3), 235 e231-238. https://doi.org/10.1016/j.ajog.2006.10.896
Shin, S. Y., Park, J. I., Park, S. K., & Barrett-Connor, E. (2015, Feb 15). Utility of graded exercise tolerance tests for prediction of cardiovascular mortality in old age: The Rancho Bernardo Study. Int J Cardiol, 181, 323-327. https://doi.org/10.1016/j.ijcard.2014.12.026
Shrout, P. E., & Fleiss, J. L. (1979, Mar). Intraclass correlations: uses in assessing rater reliability. Psychol Bull, 86(2), 420-428. https://doi.org/10.1037/0033-2909.86.2.420
Stevens, J. H., Raffin, T. A., Mihm, F. G., Rosenthal, M. H., & Stetz, C. W. (1985, Apr 19). Thermodilution cardiac output measurement. Effects of the respiratory cycle on its reproducibility. JAMA, 253(15), 2240-2242. https://doi.org/10.1001/jama.1985.03350390082030
Tanaka, H., Monahan, K. D., & Seals, D. R. (2001, Jan). Age-predicted maximal heart rate revisited. J Am Coll Cardiol, 37(1), 153-156. https://doi.org/10.1016/s0735-1097(00)01054-8
Ulusoy, R. E., Demiralp, E., Kirilmaz, A., Kilicaslan, F., Ozmen, N., Kucukarslan, N., Kardesoglu, E., Tutuncu, L., Keskin, O., & Cebeci, B. S. (2006, Jan). Aortic elastic properties in young pregnant women. Heart Vessels, 21(1), 38-41. https://doi.org/10.1007/s00380-005-0872-2
Waksmonski, C. A. (2014, Aug). Cardiac imaging and functional assessment in pregnancy. Semin Perinatol, 38(5), 240-244. https://doi.org/10.1053/j.semperi.2014.04.012
Waldron, M., David Patterson, S., & Jeffries, O. (2018, Jan). Inter-Day Reliability of Finapres ((R)) Cardiovascular Measurements During Rest and Exercise. Sports Med Int Open, 2(1), E9-E15. https://doi.org/10.1055/s-0043-122081
Downloads
Statistics
Published
How to Cite
Issue
Section
License
Copyright (c) 2018 Journal of Human Sport and Exercise
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Each author warrants that his or her submission to the Work is original and that he or she has full power to enter into this agreement. Neither this Work nor a similar work has been published elsewhere in any language nor shall be submitted for publication elsewhere while under consideration by JHSE. Each author also accepts that the JHSE will not be held legally responsible for any claims of compensation.
Authors wishing to include figures or text passages that have already been published elsewhere are required to obtain permission from the copyright holder(s) and to include evidence that such permission has been granted when submitting their papers. Any material received without such evidence will be assumed to originate from the authors.
Please include at the end of the acknowledgements a declaration that the experiments comply with the current laws of the country in which they were performed. The editors reserve the right to reject manuscripts that do not comply with the abovementioned requirements. The author(s) will be held responsible for false statements or failure to fulfill the above-mentioned requirements.
This title is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license (CC BY-NC-ND 4.0).
You are free to share, copy and redistribute the material in any medium or format. The licensor cannot revoke these freedoms as long as you follow the license terms under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
NonCommercial — You may not use the material for commercial purposes.
NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
Transfer of Copyright
In consideration of JHSE’s publication of the Work, the authors hereby transfer, assign, and otherwise convey all copyright ownership worldwide, in all languages, and in all forms of media now or hereafter known, including electronic media such as CD-ROM, Internet, and Intranet, to JHSE. If JHSE should decide for any reason not to publish an author’s submission to the Work, JHSE shall give prompt notice of its decision to the corresponding author, this agreement shall terminate, and neither the author nor JHSE shall be under any further liability or obligation.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article, except as disclosed on a separate attachment. All funding sources supporting the Work and all institutional or corporate affiliations of the authors are acknowledged in a footnote in the Work.
Each author certifies that his or her institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.
Competing Interests
Biomedical journals typically require authors and reviewers to declare if they have any competing interests with regard to their research.
JHSE require authors to agree to Copyright Notice as part of the submission process.
