Effect of systemic vascular resistance on the agreement between stroke volume by non-invasive pulse wave analysis and Doppler ultrasound in healthy volunteers

Sole Lindvåg Lie; Jonny Hisdal; Marius Rehn; Lars Øivind Høiseth

doi:10.1371/journal.pone.0302159

Effect of systemic vascular resistance on the agreement between stroke volume by non-invasive pulse wave analysis and Doppler ultrasound in healthy volunteers

PLoS One. 2024 May 7;19(5):e0302159. doi: 10.1371/journal.pone.0302159. eCollection 2024.

Authors

Sole Lindvåg Lie^{1

2

3}, Jonny Hisdal^{2

3}, Marius Rehn^{1

2

4}, Lars Øivind Høiseth^{2

5}

Affiliations

¹ Norwegian Air Ambulance Foundation, Department of Research and Development, Oslo, Norway.
² Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway.
⁴ Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.
⁵ Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.

Abstract

Background: Stroke volume can be estimated beat-to-beat and non-invasively by pulse wave analysis (PWA). However, its reliability has been questioned during marked alterations in systemic vascular resistance (SVR). We studied the effect of SVR on the agreement between stroke volume by PWA and Doppler ultrasound during reductions in stroke volume in healthy volunteers.

Methods: In a previous study we simultaneously measured stroke volume by PWA (SVPWA) and suprasternal Doppler ultrasound (SVUS). We exposed 16 healthy volunteers to lower body negative pressure (LBNP) to reduce stroke volume in combination with isometric hand grip to elevate SVR. LBNP was increased by 20 mmHg every 6 minutes from 0 to 80 mmHg, or until hemodynamic decompensation. The agreement between SVPWA and SVUS was examined using Bland-Altman analysis with mixed regression. Within-subject limits of agreement (LOA) was calculated from the residual standard deviation. SVRUS was calculated from SVUS. We allowed for a sloped bias line by introducing the mean of the methods and SVRUS as explanatory variables to examine whether the agreement was dependent on the magnitude of stroke volume and SVRUS.

Results: Bias ± limits of agreement (LOA) was 27.0 ± 30.1 mL. The within-subject LOA was ±11.1 mL. The within-subject percentage error was 14.6%. The difference between methods decreased with higher means of the methods (-0.15 mL/mL, confidence interval (CI): -0.19 to -0.11, P<0.001). The difference between methods increased with higher SVRUS (0.60 mL/mmHg × min × L-1, 95% CI: 0.48 to 0.72, P<0.001).

Conclusion: PWA overestimated stroke volume compared to Doppler ultrasound during reductions in stroke volume and elevated SVR in healthy volunteers. The agreement between SVPWA and SVUS decreased during increases in SVR. This is relevant in settings where a high level of reliability is required.

Copyright: © 2024 Lie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Hand Strength / physiology
Healthy Volunteers*
Humans
Lower Body Negative Pressure
Male
Pulse Wave Analysis* / methods
Reproducibility of Results
Stroke Volume* / physiology
Ultrasonography, Doppler* / methods
Vascular Resistance* / physiology
Young Adult

Grants and funding

The author(s) received no specific funding for this work.