Estimating exercise stroke volume from asymptotic oxygen pulse in humans.

Noninvasive techniques have been devised to estimate cardiac output (Q) during exercise to obviate vascular cannulation. However, although these techniques are noninvasive, they are commonly not nonintrusive to subjects' spontaneous ventilation and gas-exchange responses. We hypothesized that the exercise stroke volume (SV) and, hence, Q might be accurately estimated simply from the response pattern of two standardly determined variables: O2 uptake (VO2) and heart rate (HR). Central to the theory is the demonstration that the product of Q and mixed venous O2 content is virtually constant (k) during steady-state exercise. Thus from the Fick equation, VO2 = Q.CaCO2-k, where CaCO2 is the arterial CO2 content, the O2 pulse (O2-P) equals SV.CaCO2-(k/HR). Because the arterial O2 content (CaO2) is usually relatively constant in normal subjects during exercise, O2-P should change hyperbolically with HR, asymptoting at SV.CaO2. In addition, because the asymptotic O2-P equals the slope (S) of the linear O2-HR relationship, exercise SV may be predicted as S/CaO2. We tested this prediction in 23 normal subjects who underwent a 3-min incremental cycle-ergometer test with direct determination of CaO2 and mixed venous O2 content from indwelling catheters. The predicted SV closely reflected the measured value (r = 0.80). We therefore conclude that, in normal subjects, exercise SV may be estimated simply as five times S of the linear VO2-HR relationship (where 5 is approximately 1/CaO2).