Modelflow estimates of cardiac output compared with Doppler ultrasound during acute changes in vascular resistance in women

Abstract

We compared Modelflow (MF) estimates of cardiac stroke volume (SV) from the finger pressure-pulse waveform (Finometer) with pulsed Doppler ultrasound (DU) of the ascending aorta during acute changes in total peripheral resistance (TPR) in the supine and head-up-tilt (HUT) postures. Twenty-four women were tested during intravenous infusion of 0.005 or 0.01 microg kg(-1) min(-1) isoprenaline, 10 or 50 ng kg(-1) min(-1) noradrenaline and 0.3 mg sublingual nitroglycerine. Responses to static hand-grip exercise (SHG), graded lower body negative pressure (LBNP, from 20 to 45 mmHg) and 45 deg HUT were evaluated on separate days. Bland-Altman analysis indicated that SV(MF) yielded lower estimates than SV(DU) during infusion of 0.01 microg kg(-1) min(-1) isoprenaline (SV(MF) 92.7 +/- 15.5 versus SV(DU) 104.3 +/- 22.9 ml, P = 0.03) and SHG (SV(MF) 78.8 +/- 12.0 versus SV(DU) 106.1 +/- 28.5 ml, P < 0.01), while larger estimates were recorded with SV(MF) during 45 mmHg LBNP (SV(MF) 52.6 +/- 10.7 versus SV(DU) 46.2 +/- 14.5 ml, P = 0.04) and HUT (SV(MF) 59.3 +/- 13.6 versus SV(DU) 45.2 +/- 11.3 ml, P < 0.01). Linear regression analysis revealed a relationship (r(2) = 0.41, P < 0.01) between the change in TPR from baseline and the between-methods discrepancy in SV measurements. This relationship held up under all of the experimental protocols (regression for fixed effects, P = 0.46). These results revealed a discrepancy in MF estimates of SV, in comparison with those measured by DU, during acute changes in TPR.