PRES: The Controlled Noninvasiv Stimulation of the Carotid Baroreceptors in Humans

To study physiological and psychological effects of baroreceptor activity, the cervical neck cuff technique has been frequently used to stimulate the carotid baroreceptors mechanically. Using this technique, no satisfying control conditions to date have been available. Because the carotid stretch receptors are sensitive not only to the pressure level, but also to the rate of change, it is possible to manipulate the receptor firing through changes in carotid pulse amplitude. The device described here relies on the application of short changes in cuff pressure tied to different phases within the cardiac cycle (phase related external suction (PRES)). A brief external suction during systole has potent stimulatory effects on baroreceptors whereas the application of the very same pressure pulse during diastole inhibits the firing burst associated with the pulse wave. To allow an ongoing period of stimulation, a sequence of alternating negative/positive pressure pulses is applied. In the stimulation condition, the R-wave of the electrocardiogram triggers a negative pulse which is followed by a positive one during diastole. In the control condition this relationship is reversed. Two experiments are reported confirming different baroreceptor effects of the two conditions. PRES allows for blind or double-blind experiments to investigate effects of baroreceptor activity on physiology and behavior.     

Long-term pressure monitoring with arterial applanation tonometry: a non-invasive alternative during clinical intervention?

Arterial tonometry is a non-invasive technique for continuous registration of arterial pressure waveforms. This study aims to assess tonometric blood pressure recording (TBP) as an alternative for invasive long-term bedside monitoring. A prospective study was set up where patients undergoing neurosurgical intervention were subjected to both invasive (IBP) and non-invasive (TBP) blood pressure monitoring during the entire procedure. A single-element tonometric pressure transducer was used to better investigate different inherent error sources of TBP measurement. A total of 5.7 hours of combined IBP and TBP were recorded from three patients. Although TBP performed fairly well as an alternative for IBP in steady state scenarios and some short-term variations, it could not detect relevant long-term pressure variations at all times. These findings are discussed in comparison to existing work. Physiological alterations at the site of TBP measurement are highlighted as a potentially important source of artifacts. It is concluded that at this point arterial tonometry remains not enough understood for long-term use during a delicate operative procedure. Physiological changes at the TBP measurement site deserve further investigation before tonometry technology is to be considered as an non-invasive alternative for long-term clinical monitoring.     

Coronary microcirculation in the beating heart

The phase opposition of velocity waveforms between coronary arteries (predominantly diastolic) and veins (systolic) is the most prominent characteristic of coronary hemodynamics. This unique arterial and venous flow patterns indicate the importance of intramyocardial capacitance vessels and variable resistance vessels during a cardiac cycle. It was shown that during diastole the intramyocardial capacitance vessels have two functional components, unstressed volume and ordinary capacitance. Unstressed volume is defined as the volume of blood in a vessel at zero transmural pressure. In vivo observation of systolic narrowing of arterioles in mid-wall and in subendocardium indicates the increase in resistance by cardiac contraction.     

Non-invasive assessment of arterial distension waveforms using gradient-based Hough transform and power Doppler ultrasound imaging

The peripheral arterial vessel often appears as an elliptic shape under the constraints of the surrounding tissues. In this study, the gradient-based Hough transform was used to detect the central location of the ellipse and the lumen area of the arterial vessel non-invasively using power Doppler imaging. Sequential ultrasound images were used to construct arterial distension waveforms in both the major- and minor-axis directions for a few cardiac cycles. The common carotid arteries (CCAs) for nine healthy male volunteers (mean age 24 years), in the sitting position, were investigated in vivo. The CCAs (n=9) had a mean diameter of 5.83 mm, and the pulsatile diameter distension was 13.7±1.9%. The brachial artery and dorsalis pedis artery for five healthy male volunteers (mean age 26 years), in the supine position, had mean diameters of 4.03 mm and 2.83 mm and distensions of 16.7±4.6% and 15.5±5.4%, respectively. The movement of the arterial centre location during the cardiac cycle reflected the asymmetry of the reaction forces produced by the surrounding soft tissues. The present method can obtain the response of vessel distension to pulse pressure, as well as the constrained conditions of the arteries.     

Blood pressure waveform analysis by means of wavelet transform

The assessment of cardiovascular function by means of arterial pulse wave analysis (PWA) is well established in clinical practice. PWA is applied to study risk stratification in hypertension, with emphasis on the measurement of the augmentation index as a measure of aortic pressure wave reflections. Despite the fact that the prognostic power of PWA, in its current form, still remains to be demonstrated in the general population, there is general agreement that analysis and interpretation of the waveform might provide a deeper insight in cardiovascular pathophysiology. We propose here the use of wavelet analysis (WA) as a tool to quantify arterial pressure waveform features, with a twofold aim. First, we discuss a specific use of wavelet transform in the study of pressure waveform morphology, and its potential role in ascertaining the dynamics of temporal properties of arterial pressure waveforms. Second, we apply WA to evaluate a database of carotid artery pressure waveforms of healthy middle-aged women and men. Wavelet analysis has the potential to extract specific features (wavelet details), related to wave reflection and aortic valve closure, from a measured waveform. Analysis showed that the fifth detail, one of the waveform features extracted applying the wavelet decomposition, appeared to be the most appropriate for the analysis of carotid artery pressure waveforms. What remains to be assessed is how the information embedded in this detail can be further processed and transformed into quantitative data, and how it can be rendered useful for automated waveform classification and arterial function parameters with potential clinical applications.     

Role of total arterial compliance and peripheral resistance in the determination of systolic and diastolic aortic pressure.

The goal of the study was to define the major arterial parameters that determine aortic systolic (Ps) and diastolic (Pd) pressure in the dog. Measured aortic flows were used as input to the two-element windkessel model of the arterial system, with peripheral resistance calculated as mean pressure over mean flow and total arterial compliance calculated from the decay time in diastole. The windkessel model yielded an aortic pressure wave from which we obtained the predicted systolic (Ps, wk) and diastolic (Pd, wk) pressure. These predicted pressures were compared with the measured systolic and diastolic pressures. The measurements and calculations were carried out in 7 dogs in control conditions, during aortic occlusion at four locations (the trifurcation, between trifurcation and diaphragm, the diaphragm and the proximal descending thoracic aorta) and during occlusion of both carotid arteries. Under all conditions studied the predicted systolic and diastolic pressure matched the experimental ones very well: Ps, wk = (1.000 +/- 0.0055) Ps with r = 0.958 and Pd, wk = (1.024 +/- 0.0035) Pd with r = 0.995. Linear regression for pulse pressure gave PPwk = (0.99 +/- 0.016) PP (r = 0.911). We found the accuracy of prediction equally good under control conditions and in presence of aortic or carotid artery occlusions. Multiple regression between pulse pressure and arterial resistance and total arterial compliance yielded a poor regression constant (r2 = 0.19) suggesting that the two arterial parameters alone cannot explain pulse pressure and that flow is an important determinant as well. We conclude that, for a given ejection pattern (aortic flow), two arterial parameters, total arterial resistance and total arterial compliance are sufficient to accurately describe systolic and diastolic aortic pressure.     

Recent insights into carotid baroreflex function in humans using the variable pressure neck chamber

The variable pressure neck chamber has provided an invaluable research tool for the non-invasive assessment of carotid baroreflex (CBR) function in human investigations. The ability to construct complete stimulus-response curves and define specific parameters of the reflex function curve permits statistical comparisons of baroreflex function between different experimental conditions, such as rest and exercise. Results have convincingly indicated that the CBR stimulus-response curve is reset during exercise in an intensity-dependent manner to functionally operate around the prevailing pressure elicited by the exercise workload. Furthermore, both at rest and during exercise, alterations in stroke volume do not contribute importantly to the maintenance of arterial blood pressure by the carotid baroreceptors, and therefore, any reflex-induced changes in cardiac output (Q) are the result of CBR-mediated changes in heart rate. However, more importantly, the CBR-induced changes in mean arterial pressure (MAP) are primarily mediated by alterations in vascular conductance with only minimal contributions from Q to the initial reflex MAP response. Thus, the capacity of the CBR to regulate blood pressure depends critically on its ability to alter vascular tone both at rest and during exercise. This review will emphasize the utility of the variable pressure neck chamber to assess CBR function in human experimental investigations and the mechanisms by which the CBR responds to alterations in arterial blood pressure both at rest and during exercise.     

高频超声对OSAS患者颈动脉结构和顺应性的研究

目的应用高频超声对阻塞性睡眠呼吸暂停综合征(OSAS)患者颈动脉结构和顺应性变化进行研究,为OSAS的临床治疗效果提供依据。方法 40例OSAS患者(A组),均为男性,年龄21~55岁,平均年龄40.80岁;体质量指数(BMI)为(27.23±3.35)kg/m2。40例健康志愿者(B组),均无OSAS,均为男性,年龄22～57岁,平均年龄42.21岁;BMI为(25.71±2.31)kg/m2。用高频超声对A组患者和B组志愿者颈动脉进行二维超声检查,测量颈动脉内-中膜厚度(IMT)、收缩期内径(Ds)、舒张期内径(Dd),并测量肱动脉收缩压(SBP)、舒张压(DBP)和脉压(PP),计算颈动脉紧张度(AS)、扩张性(AD)和僵硬度(ASt),评价颈动脉顺应性。结果 A组IMT、SBP、DBP较B组增大,差异有统计学意义(P<0.05);PP、Ds、Dd两组间差异无统计学意义(P>0.05);A组颈动脉AS、AD较B组减小,ASt较对照组增大,差异有统计学意义(P<0.05)。结论高频超声能够反映颈动脉结构和功能变化,可为临床评价OSAS治疗效果提供颈动脉顺应性变化的监测数据,具有临床应用价值。     

Time domain analysis of the arterial pulse in clinical medicine

The arterial pulse at any site is created by an impulse generated by the left ventricle as it ejects blood into the aorta, together with multiple impulses travelling in the opposite direction from reflecting sites in the peripheral circulation. The compound wave at any site depends on the pattern of ventricular ejection, the properties of large arteries, particularly their stiffness (which determines rate of propagation) and the distance to and impedance mismatch at reflecting sites. Physicians are familiar with waveform analysis in the time domain, as in the electrocardiogram (ECG) where the principal features are explicable on the basis of atrial depolarisation followed by ventricular depolarisation, then repolarisation. Effects of cardiac functional and structural disease can be inferred from the ECG. It is more difficult to make similar interpretations from the pulse waveform and clinicians usually use this only to count heart rate, extremes of the pressure pulse to express systolic and diastolic pressure, and (sometimes) time from wave foot to incisural notch to measure time of systole and diastole. More information can be gleaned from the shape of the arterial pressure wave through consideration of the factors which create it—on stiffening of large arteries with age, effects of drugs on smallest arteries, and changes in such arterial properties on left ventricular load and function. Such is a major challenge to future physicians. It is aided by better and more accurate methods for measuring flow and diameter as well as pressure waveforms, and by appropriate use of other analytic techniques such as analysis of the pulse in the frequency domain. Michael F. O’Rourke is a founding director of AtCor Medical, manufacturer of systems for analysing the arterial pulse.     

Effects of graded pulsatile pressure on the reflex vasomotor responses elicited by changes of mean pressure in the perfused carotid sinus-aortic arch regions of the dog

1. In the anaesthetized dog, the carotid sinuses and aortic arch were isolated from the circulation and separately perfused with blood by a method which enabled the mean pressure, pulse pressure and pulse frequency to be varied independently in each vasosensory area. The systemic circulation was perfused at constant blood flow by means of a pump and the systemic venous blood was oxygenated by an extracorporeal isolated pump-perfused donor lung preparation.2. We have confirmed our previous observations that under steadystate conditions the vasomotor responses elicited reflexly by changes in mean carotid sinus pressure are modified by alterations in carotid sinus pulse pressure, whereas those evoked by changes of mean aortic arch pressure are only weakly affected by modifications of aortic pulse pressure.3. When the carotid sinus and aortic arch regions are perfused in combination at constant pulse frequency (110 c/min), the relationship between mean carotid sinus-aortic arch pressure and systemic arterial perfusion pressure is dependent on the size of the pulse pressure.4. Increasing the pulse pressure alters the curve relating the mean carotid sinus-aortic arch pressure to systemic arterial perfusion pressure in such a way that the perfusion pressure is lower at a given carotid sinus-aortic arch pressure within the range 80-150 mm Hg. The larger the pulse pressure, up to about 60 mm Hg, the greater the fall in systemic arterial perfusion pressure. Above a mean carotid sinus-aortic arch pressure of about 150 mm Hg, alterations of pulse pressure have little effect.5. There is a family of curves representing the relation between mean carotid sinus-aortic arch pressure and systemic vascular resistance, depending on the pulse pressure.     

Non-invasive assessment of cardiac output during exercise in healthy young humans: comparison between Modelflow method and Doppler echocardiography method

AIMS: The Modelflow method can estimate cardiac output from arterial blood pressure waveforms using a three-element model of aortic input impedance (aortic characteristic impedance, arterial compliance, and systemic vascular resistance). We tested the reliability of a non-invasive cardiac output estimation during submaximal exercise using the Modelflow method from finger arterial pressure waveforms collected by Portapres in healthy young humans. METHODS: The Doppler echocardiography method was used as a reference method. Sixteen healthy young subjects (nine males and seven females) performed a multi-stage cycle ergometer exercise at an intensity corresponding to 70, 90, 110 and 130% of their individual ventilatory threshold for 2 min each. The simultaneous estimation of cardiac output (15 s averaged data) using the Modelflow and Doppler echocardiography methods was performed at rest and during exercise. RESULTS AND CONCLUSION: The Modelflow-estimated cardiac output correlated significantly with the simultaneous estimates by the Doppler method in all subjects (r = 0.87, P < 0.0001) and the SE of estimation was 1.93 L min-1. Correlation coefficients in each subject ranged from 0.91 to 0.98. Although the Modelflow method overestimated cardiac output, the errors between two estimates were not significantly different among the exercise levels. These results suggest that the Modelflow method using Portapres could provide a reliable estimation of the relative change in cardiac output non-invasively and continuously during submaximal exercise in healthy young humans, at least in terms of the relative changes in cardiac output.     

Sympathetic nervous control of the cerebral circulation in sleep

Cerebral vessels are extensively innervated by sympathetic nerves arising from superior cervical ganglia, and these nerves might play a protective role during the large arterial pressure surges of active sleep (AS). We studied lambs (n=10) undergoing spontaneous sleep-wake cycles before and after bilateral removal of the superior cervical ganglia (SCGx, n=5) or sham ganglionectomy (n=5). Lambs were instrumented to record cerebral blood flow (CBF, flow probe on the superior sagittal sinus), carotid arterial pressure (P(ca)), intra-cranial pressure (P(ic)), cerebral perfusion pressure (Pcp=Pca-Pic) and cerebral vascular resistance (CVR). Prior to SCGx, CBF (mL min-1) was significantly higher in AS than in Quiet Sleep (QS) and Quiet Wakefulness (QW) (17+/-2, 13+/-3, and 14+/-3 respectively, mean+/-SD, P<0.05). Following SCGx, baseline CBF increased by 34, 31, and 29% respectively (P<0.05). CVR also decreased in all states by approximately 25% (P<0.05). During phasic AS, surges of Pca were associated with transient increases in Pcp, Pic and CBF. Following SCGx, peak CBF and Pic during surges became higher and more prolonged (P<0.05). Our study is the first to reveal that tonic sympathetic nerve activity (SNA) constricts the cerebral circulation and restrains baseline CBF in sleep. SNA is further incremented during arterial pressure surges of AS, limiting rises in CBF and Pic, possibly by opposing vascular distension as well as by constricting resistance vessels. Thus, SNA may protect cerebral microvessels from excessive distension during AS, when large arterial blood pressure surges are common.     

The effects of lower body negative pressure on baroreceptor responses in humans

In healthy human subjects the immediate responses of pulse interval and the steady-state responses of arterial blood pressure and cardiac output to changes in carotid sinus transmural pressure were determined before and during the application of a subatmospheric pressure to the lower part of the body. Increases in carotid sinus transmural pressure, effected by applications of subatmospheric pressure to the neck (neck suction) resulted in prolongation of pulse interval and decrease in blood pressure; opposite responses were obtained to application of a positive pressure (neck pressure). Application of lower body negative pressure resulted in a decrease in pulse interval (heart rate increase) but little change in blood pressure. During lower body negative pressure, the responses of pulse interval to neck pressure were reduced but those to neck suction were unaffected; the responses of blood pressure to neck suction were enhanced but those to neck pressure were unaffected. From experiments in which cardiac output was also determined, it was seen that lower body negative pressure reduced cardiac output, increased calculated total body vascular resistance and augmented the resistance response to neck suction although not to neck pressure. These results are compatible with the view that application of lower body negative pressure does not change the sensitivity of the baroreceptor reflex and that the changes in the responses are due to non-linearities of the stimulus-response curves.     

Effect of whole body resistance training on arterial compliance in young men

The effect of resistance training on arterial stiffening is controversial. We tested the hypothesis that resistance training would not alter central arterial compliance. Young healthy men (age, 23 +/- 3.9 (mean +/- s.e.m.) years; n = 28,) were whole-body resistance trained five times a week for 12 weeks, using a rotating 3-day split-body routine. Resting brachial blood pressure (BP), carotid pulse pressure, carotid cross-sectional compliance (CSC), carotid initima-media thickness (IMT) and left ventricular dimensions were evaluated before beginning exercise (PRE), after 6 weeks of exercise (MID) and at the end of 12 weeks of exercise (POST). CSC was measured using the pressure-sonography method. Results indicate reductions in brachial (61.1 +/- 1.4 versus 57.6 +/- 1.2 mmHg; P < 0.01) and carotid pulse pressure (52.2 +/- 1.9 versus 46.8 +/- 2.0 mmHg; P < 0.01) PRE to POST. In contrast, carotid CSC, beta-stiffness index, IMT and cardiac dimensions were unchanged. In young men, central arterial compliance is unaltered with 12 weeks of resistance training and the mechanisms responsible for cardiac hypertrophy and reduced arterial compliance are either not inherent to all resistance-training programmes or may require a prolonged stimulus.     

Blood flow redistribution during spontaneous wheel walk of the rat

Changes in regional blood flow and arterial pressure in the rat during spontaneous walk in a wheel were observed. An electromagnetic flow probe was implanted around the carotid, superior mesenteric, or renal artery, or the terminal aorta and a catheter for pressure measurement was inserted into the terminal aorta or the common carotid artery. The wheel had a diameter of 35 cm and rotated passively as the rat walked. When hindquarter (terminal aortic) flow increased markedly during wheel walk, carotid flow decreased, superior mesenteric flow decreased or remained unchanged, and renal flow did not change. Arterial pressure remained almost unchanged and heart rate increased an average of about 10%. Semiquantitative considerations indicated that arterial pressure was maintained in the face of the profuse increase in hindquarter flow during wheel walk by an increase in cardiac output rather than shifts of blood flow from other regions.     

Effects of blood-volume distribution on the characteristics of the carotid baroreflex in humans at rest and during exercise

Seven supine subjects were studied at rest and during mild to moderate dynamic leg exercise with and without unloading of the cardiopulmonary baroreceptors accomplished by exposing the lower portion of the body to a subatmospheric pressure of 20 mmHg (Lower Body Negative Pressure, LBNP). The function of the cardiac branch of the carotid baroreflex was studied over its full operational range by measuring R-R intervals during application of pulse synchronous graded pressures (40 to – 65 mmHg) in a neck-chamber device. Raising the carotid transmural pressure (systolic arterial pressure minus neck-chamber pressure) induced increasing R-R intervals in all conditions. In conformity with previous results from our laboratories it was found that the maximal rate of change in relative R-R intervals and the corresponding transmural pressure were higher during exercise than at rest, indicating that exercise increased the carotid baroreflex sensitivity and shifted its optimal buffering range to higher arterial pressures. LBNP did not affect the characteristics of the reflex at rest nor during exercise. It is concluded that reduced central venous pressure with consequent selective cardiopulmonary receptor disengagement exerts no influence on the carotid baroreflex control of heart rate (HR), as tested over the entire arterial pressure-effector response relation, either at rest or during mild-moderate exercise.     

Comparison of the reflex vasomotor responses to separate and combined stimulation of the carotid sinus and aortic arch baroreceptors by pulsatile and non-pulsatile pressures in the dog

1. In the anaesthetized dog the carotid sinuses and aortic arch were isolated from the circulation and separately perfused with blood by a method which enabled the mean pressure, pulse pressure and pulse frequency to be varied independently in each vasosensory area. The systemic circulation was perfused at constant blood flow by means of a pump and the systemic venous blood was oxygenated by an extracorporeal isolated pump-perfused donor lung preparation.2. When the vasosensory areas were perfused at non-pulsatile pressures within the normal physiological range of mean pressures, the reflex reduction in systemic vascular resistance produced by a given rise in mean carotid sinus pressure was significantly greater than that resulting from the same rise of aortic arch pressure.3. On the other hand, when the vasosensory areas were perfused at normal pulsatile pressures and within the normal physiological range of mean pressures, there was no difference in the size of the reflex vascular responses elicited by the same rise in mean pressure in the carotid sinuses and in the aortic arch.4. Whereas the vasomotor responses elicited reflexly by changes in mean carotid sinus pressure are modified by alterations in pulse pressure, those evoked by the aortic arch baroreceptors through changes of mean pressure are only weakly affected by modifications in pulse pressure. Evidence for this was obtained from single stepwise changes of mean pressure in each vasosensory area during pulsatile and non-pulsatile perfusion, and from curves relating the mean pressure in the carotid sinuses or aortic arch and systemic arterial perfusion pressure.5. The vasomotor response elicited by combined stimulation of the carotid sinus and aortic arch baroreceptors was greater than either response resulting from their separate stimulation.6. When the mean perfusion pressures in the two vasosensory areas are changed together, the curve relating mean pressure to systemic arterial pressure during pulsatile perfusion of the areas is considerably flatter than that for non-pulsatile perfusion.7. Increasing the pulse pressure in the carotid sinuses or aortic arch caused a decrease in systemic vascular resistance, the response elicited from the carotid sinuses being the larger.8. Altering the phase angle between the pulse pressure waves in the carotid sinuses and aortic arch had no effect on systemic vascular resistance.9. In both vasosensory areas, increasing the pulse frequency caused a reduction in systemic vascular resistance.     

Preliminary Report on Some Ultrasonic Methods for Detecting Carotid Artery Disease

The use of both Doppler and pulse-echo ultrasonic equipment for detecting carotid artery disease is discussed. The need for new non-invasive techniques, capable of detecting small stenoses, is demonstrated and the development of two techniques (analysis of blood velocity waveforms and the measurement of arterial wall movement) is described. The arterial wall movement showed no change with disease, but analysis of the blood velocity waveforms proved capable of detecting even minor stenosis in some cases. Methods for confirming these preliminary results are discussed.     

The human nociceptive flexion reflex threshold is higher during systole than diastole

A baroreflex mechanism may explain hypertensive hypoalgesia. At rest, arterial baroreceptors are stimulated during the systolic upstroke of the pressure pulse wave. This study examined the effects of naturally occurring variations in baroreceptor activity during the cardiac cycle on an objective measure of pain, the nociceptive flexion reflex (NFR). Two interleaved up-down staircase procedures determined separate NFR thresholds during systole and diastole in 36 healthy, normotensive young adults. On odd-numbered trials, the sural nerve was stimulated electrocutaneously at R + 300 ms whereas on even-numbered trials, stimulation was delivered at R + 600 ms. The NFR threshold was higher at R + 300 ms than R + 600 ms. In contrast, stimulus intensity ratings did not differ between R + 300 ms and R + 600 ms. Stimulation of baroreceptors by natural increases in blood pressure during the systolic phase of the cardiac cycle was associated with dampened nociception.     

Non‐invasive assessment of cardiac output during exercise in healthy young humans: comparison between Modelflow method and Doppler echocardiography method

Aims: The Modelflow method can estimate cardiac output from arterial blood pressure waveforms using a three‐element model of aortic input impedance (aortic characteristic impedance, arterial compliance, and systemic vascular resistance). We tested the reliability of a non‐invasive cardiac output estimation during submaximal exercise using the Modelflow method from finger arterial pressure waveforms collected by Portapres in healthy young humans. Methods: The Doppler echocardiography method was used as a reference method. Sixteen healthy young subjects (nine males and seven females) performed a multi‐stage cycle ergometer exercise at an intensity corresponding to 70, 90, 110 and 130% of their individual ventilatory threshold for 2 min each. The simultaneous estimation of cardiac output (15 s averaged data) using the Modelflow and Doppler echocardiography methods was performed at rest and during exercise. Results and Conclusion: The Modelflow‐estimated cardiac output correlated significantly with the simultaneous estimates by the Doppler method in all subjects (r = 0.87, P < 0.0001) and the SE of estimation was 1.93 L min^?1. Correlation coefficients in each subject ranged from 0.91 to 0.98. Although the Modelflow method overestimated cardiac output, the errors between two estimates were not significantly different among the exercise levels. These results suggest that the Modelflow method using Portapres could provide a reliable estimation of the relative change in cardiac output non‐invasively and continuously during submaximal exercise in healthy young humans, at least in terms of the relative changes in cardiac output.