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Original Research: PULMONARY VASCULAR DISEASE |

Clinically Significant Change in Stroke Volume in Pulmonary Hypertension

Serge A. van Wolferen, MD; Marielle C. van de Veerdonk, BSc; Gert-Jan Mauritz, BSc; Wouter Jacobs, MD; J. Tim Marcus, PhD; Koen M. J. Marques, MD; Jean G. F. Bronzwaer, MD, PhD; Martijn W. Heymans, PhD; Anco Boonstra, MD, PhD; Pieter E. Postmus, MD, PhD, FCCP; Nico Westerhof, PhD; Anton Vonk Noordegraaf, MD, PhD
Author and Funding Information

From the Department of Pulmonary Disease (Drs van Wolferen, Jacobs, Boonstra, Postmus, Westerhof, and Vonk Noordegraaf; Mss van de Veerdonk; and Mr Mauritz), the Department of Physics and Medical Technology, Institute for Cardiovascular Research ICaR-VU (Dr Marcus), the Department of Cardiology (Drs Marques and Bronzwaer), and the Department of Epidemiology and Biostatistics (Dr Heymans), VU University Medical Center, Amsterdam, The Netherlands.

Correspondence to: Anton Vonk Noordegraaf, MD, PhD, VU University Medical Center, Department of Pulmonary Disease, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; e-mail: a.vonk@vumc.nl


Funding/Support: This work was financially supported by the Department of Pulmonary Disease, VU University Medical Center, Amsterdam, The Netherlands.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1003-1009. doi:10.1378/chest.10-1066
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Background:  Stroke volume is probably the best hemodynamic parameter because it reflects therapeutic changes and contains prognostic information in pulmonary hypertension (PH). Stroke volume directly reflects right ventricular function in response to its load, without the correction of compensatory increased heart rate as is the case for cardiac output. For this reason, stroke volume, which can be measured noninvasively, is an important hemodynamic parameter to monitor during treatment. However, the extent of change in stroke volume that constitutes a clinically significant change is unknown. The aim of this study was to determine the minimal important difference (MID) in stroke volume in PH.

Methods:  One hundred eleven patients were evaluated at baseline and after 1 year of follow-up with a 6-min walk test (6MWT) and cardiac MRI. Using the anchor-based method with 6MWT as the anchor, and the distribution-based method, the MID of stroke volume change could be determined.

Results:  After 1 year of treatment, there was, on average, a significant increase in stroke volume and 6MWT. The change in stroke volume was related to the change in 6MWT. Using the anchor-based method, an MID of 10 mL in stroke volume was calculated. The distribution-based method resulted in an MID of 8 to 12 mL.

Conclusions:  Both methods showed that a 10-mL change in stroke volume during follow-up should be considered as clinically relevant. This value can be used to interpret changes in stroke volume during clinical follow-up in PH.

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