Non‑invasive measurement of hemodynamic response to postural stress using inert gas rebreathing

Stach,Ksenija; Michels,Julia  D.; Doesch,Christina; Brade,Joachim; Papavassiliu,Theano; Borggrefe,Martin; Akin,Ibrahim; Saur,Joachim; Trinkmann,Frederik

doi:10.3892/br.2019.1229

Non‑invasive measurement of hemodynamic response to postural stress using inert gas rebreathing

Authors:
- Ksenija Stach
- Julia D. Michels
- Christina Doesch
- Joachim Brade
- Theano Papavassiliu
- Martin Borggrefe
- Ibrahim Akin
- Joachim Saur
- Frederik Trinkmann
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Affiliations: First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine, University of Heidelberg, European Center for AngioScience, D‑68167 Mannheim, Germany, Department of Medical Statistics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, D‑68167 Mannheim, Germany
Published online on: July 18, 2019 https://doi.org/10.3892/br.2019.1229
Pages: 98-102

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Abstract

In postural stress, an increased preload volume leads to higher stroke volume (SV) according to the Frank‑Starling law of the heart. The present study aimed to evaluate the hemodynamic response to postural stress using non‑invasive inert gas rebreathing (IGR) in patients with normal as well as impaired left ventricular function. Hemodynamic measurements were performed in 91 patients undergoing cardiac magnetic resonance imaging (CMR). Mean cardiac output and SV determined by IGR were 4.4±1.3 l/min and 60±19 ml in the upright position, which increased significantly to 5.0±1.2 l/min and 75±23 ml in the supine position (P<0.01). Left ventricular systolic function was normal [ejection fraction (EF) ≥55%] in 42 patients as determined by CMR. In 21 patients, EF was mildly abnormal (45‑54%), in 16 patients moderately abnormal (30‑44%) and in 12 patients severely abnormal (<30%). An overall trend for a lower percentage change in SV (%ΔSV) was indicated with increasing impairment of ejection fraction. In patients with abnormal EF in comparison to those with normal EF, the %ΔSV was significantly lower (13% vs. 22%; P=0.03). Non‑invasive measurement of cardiac function using IGR during postural changes may be feasible and detected significant difference in %ΔSV in patients with normal and impaired EF according to the Frank‑Starling law of the heart. Several clinical scenarios including cases of heart rhythm disturbances or pulmonary or congenital heart disease are worthy of further investigation.

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