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Cardiology 2009;114:244246
DOI: 10.1159/000232406
Department of Cardiovascular Sciences, Monzino Cardiology Center, IRCCS, University of Milan, Milan, Italy;
Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Washington,
Seattle, Wash., USA
troduction of a small, portable device (Innocor rebreathing system; Innovision, Odense, Denmark). The IGR
technique uses an oxygen-enriched mixture of an inert
soluble gas (0.5% N2O) and an inert insoluble gas (0.1%
SF6) from a prefilled bag. Patients breath into a respiratory valve via a mouthpiece and a bacterial filter with a
nose clip. At the end of expiration, the valve is activated
so that patients will rebreathe from the prefilled bag for
a period of 1020 s. After this period, patients are switched
back to ambient air and CO measurement is terminated.
Photoacoustic analyzers measure gas concentrations over
a 5-breath interval. SF6 is insoluble in blood and it is used
to determine lung volume. N2O is soluble in blood and its
concentration decreases during rebreathing with a rate
proportional to pulmonary blood flow. The IGR technique is a safe, precise, repeatable and cheap tool to measure pulmonary blood flow and, more precisely, the portion of pulmonary blood flow which is involved in gas
exchange. Shunt flow in the lung can be estimated [7] and
this estimation is reliable, provided that arterial oxygen
saturation is within the normal range. The strength of the
paper by Saur et al. [7] is that it is a large-scale report with
almost 400 individuals studied at rest.
However, a further step ahead might be of advantage,
i.e. to measure CO during exercise noninvasively. Few reports showed that this is now possible using the IGR even
in HF patients [8, 9]. However, why should we push the
Piergiuseppe Agostoni
Department of Cardiovascular Sciences
Monzino Cardiology Center, IRCCS, University of Milan
via Parea 4, IT20138 Milan (Italy)
Tel. +39 02 5800 2299, Fax +39 02 5800 2283, E-Mail piergiuseppe.agostoni@ccfm.it
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Subject B
1.5
Subject A
1.0
0.5
0.3
0
4
6
8
10
12
14
16
18
Arteriovenous oxygen difference (ml/100 ml)
VO2 (l/min)
CO (l/min)
22
20
18
16
14
12
10
8
6
4
2
0
20
Noninvasive CO Measurement
Cardiology 2009;114:244246
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References
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Cardiology 2009;114:244246
Agostoni /Cattadori
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1 Weber KT, Janicki JS: Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985; 55: 22A
31A.
2 Griffin BP, Shah PK, Ferguson J, Rubin SA:
Incremental prognostic value of exercise hemodynamic variables in chronic congestive
heart failure secondary to coronary artery
disease or to dilated cardiomyopathy. Am J
Cardiol 1991;67:848853.
3 Chomsky DB, Lang CC, Rayos GH, Shyr Y,
Yeoh TK, Pierson RN 3rd, Davis SF, Wilson
JR: Haemodymanic exercise testing. A valuable tool in the selection of cardiac transplantation candidates. Circulation 1996; 94:
31763183.
4 Metra M, Faggiano P, DAloia A, Nodari S,
Gualeni A, Raccagni D, Dei Cas L: Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic
assessment of ambulatory patients with
chronic heart failure. J Am Coll Cardiol
1999;33:943950.