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Shin K, Kim H, Seo WY, Kim HS, Shin JM, Kim DK, Park YS, Kim SH, Kim N. Enhancing the performance of premature ventricular contraction detection in unseen datasets through deep learning with denoise and contrast attention module. Comput Biol Med 2023; 166:107532. [PMID: 37816272 DOI: 10.1016/j.compbiomed.2023.107532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023]
Abstract
Premature ventricular contraction (PVC) is a common and harmless cardiac arrhythmia that can be asymptomatic or cause palpitations and chest pain in rare instances. However, frequent PVCs can lead to more serious arrhythmias, such as atrial fibrillation. Several PVC detection models have been proposed to enable early diagnosis of arrhythmias; however, they lack reliability and generalizability due to the variability of electrocardiograms across different settings and noise levels. Such weaknesses are known to aggravate with new data. Therefore, we present a deep learning model with a novel attention mechanism that can detect PVC accurately, even on unseen electrocardiograms with various noise levels. Our method, called the Denoise and Contrast Attention Module (DCAM), is a two-step process that denoises signals with a convolutional neural network (CNN) in the frequency domain and attends to differences. It focuses on differences in the morphologies and intervals of the remaining beats, mimicking how trained clinicians identify PVCs. Using three different encoder types, we evaluated 1D U-Net with DCAM on six external test datasets. The results showed that DCAM significantly improved the F1-score of PVC detection performance on all six external datasets and enhanced the performance of balancing both the sensitivity and precision of the models, demonstrating its robustness and generalization ability regardless of the encoder type. This demonstrates the need for a trainable denoising process before applying the attention mechanism. Our DCAM could contribute to the development of a reliable algorithm for cardiac arrhythmia detection under real clinical electrocardiograms.
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Affiliation(s)
- Keewon Shin
- Laboratory for Biosignal Analysis and Perioperative Outcome Research, Biomedical Engineering Center, Asan Institute of Lifesciences, Asan Medical Center, Seoul, Korea; Medical Device Research Platform, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyunjung Kim
- Department of Biomedical Engineering, University of Ulsan College of Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, Seoul, Korea
| | - Woo-Young Seo
- Laboratory for Biosignal Analysis and Perioperative Outcome Research, Biomedical Engineering Center, Asan Institute of Lifesciences, Asan Medical Center, Seoul, Korea
| | - Hyun-Seok Kim
- Laboratory for Biosignal Analysis and Perioperative Outcome Research, Biomedical Engineering Center, Asan Institute of Lifesciences, Asan Medical Center, Seoul, Korea
| | - Jae-Man Shin
- Department of Biomedical Engineering, University of Ulsan College of Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, Seoul, Korea
| | - Dong-Kyu Kim
- Laboratory for Biosignal Analysis and Perioperative Outcome Research, Biomedical Engineering Center, Asan Institute of Lifesciences, Asan Medical Center, Seoul, Korea
| | - Yong-Seok Park
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Hoon Kim
- Laboratory for Biosignal Analysis and Perioperative Outcome Research, Biomedical Engineering Center, Asan Institute of Lifesciences, Asan Medical Center, Seoul, Korea; Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Namkug Kim
- Department of Biomedical Engineering, University of Ulsan College of Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, Seoul, Korea; Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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2
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Izzy M, Fortune BE, Serper M, Bhave N, deLemos A, Gallegos-Orozco JF, Guerrero-Miranda C, Hall S, Harinstein ME, Karas MG, Kriss M, Lim N, Palardy M, Sawinski D, Schonfeld E, Seetharam A, Sharma P, Tallaj J, Dadhania DM, VanWagner LB. Management of cardiac diseases in liver transplant recipients: Comprehensive review and multidisciplinary practice-based recommendations. Am J Transplant 2022; 22:2740-2758. [PMID: 35359027 PMCID: PMC9522925 DOI: 10.1111/ajt.17049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/10/2022] [Accepted: 03/27/2022] [Indexed: 01/25/2023]
Abstract
Cardiac diseases are one of the most common causes of morbidity and mortality following liver transplantation (LT). Prior studies have shown that cardiac diseases affect close to one-third of liver transplant recipients (LTRs) long term and that their incidence has been on the rise. This rise is expected to continue as more patients with advanced age and/or non-alcoholic steatohepatitis undergo LT. In view of the increasing disease burden, a multidisciplinary initiative was developed to critically review the existing literature (between January 1, 1990 and March 17, 2021) surrounding epidemiology, risk assessment, and risk mitigation of coronary heart disease, arrhythmia, heart failure, and valvular heart disease and formulate practice-based recommendations accordingly. In this review, the expert panel emphasizes the importance of optimizing management of metabolic syndrome and its components in LTRs and highlights the cardioprotective potential for the newer diabetes medications (e.g., sodium glucose transporter-2 inhibitors) in this high-risk population. Tailoring the multidisciplinary management of cardiac diseases in LTRs to the cardiometabolic risk profile of the individual patient is critical. The review also outlines numerous knowledge gaps to pave the road for future research in this sphere with the ultimate goal of improving clinical outcomes.
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Affiliation(s)
- Manhal Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN, USA
| | - Brett E Fortune
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole Bhave
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andrew deLemos
- Department of Medicine, Division of Hepatology, Atrium Health, Charlotte, NC, USA
| | - Juan F. Gallegos-Orozco
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Utah School, Salt Lake City, UT, USA
| | - Cesar Guerrero-Miranda
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Shelley Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Matthew E Harinstein
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria G. Karas
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Michael Kriss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO, USA
| | - Nicholas Lim
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Maryse Palardy
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Deirdre Sawinski
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Emily Schonfeld
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Anil Seetharam
- Department of Medicine, Division of Gastroenterology and Hepatology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Pratima Sharma
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Darshana M Dadhania
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, and Department of Preventive Medicine, Division of Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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3
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Kim D, Han S, Kim YS, Choi GS, Kim JM, Lee KW, Ko JH, Yoo IY, Ko JS, Gwak MS, Joh JW, Kim GS. Bile duct anastomosis does not promote bacterial contamination of autologous blood salvaged during living donor liver transplantation. Liver Transpl 2022; 28:1747-1755. [PMID: 35687652 DOI: 10.1002/lt.26525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 01/13/2023]
Abstract
Bile duct surgeries are conventionally considered to promote bacterial contamination of the surgical field. However, liver transplantation recipients' bile produced by the newly implanted liver graft from healthy living donors may be sterile. We tested bacterial contamination of autologous blood salvaged before and after bile duct anastomosis (BDA) during living donor liver transplantation (LDLT). In 29 patients undergoing LDLT, bacterial culture was performed for four blood samples and one bile sample: two from autologous blood salvaged before BDA (one was nonleukoreduced and another was leukoreduced), two from autologous blood salvaged after BDA (one was nonleukoreduced and another was leukoreduced), and one from bile produced in the newly implanted liver graft. The primary outcome was bacterial contamination. The risk of bacterial contamination was not significantly different between nonleukoreduced autologous blood salvaged before BDA and nonleukoreduced autologous blood salvaged after BDA (44.8% and 31.0%; odds ratio 0.33, 95% confidence interval 0.03-1.86; p = 0.228). No bacteria were found after leukoreduction in all 58 autologous blood samples. All bile samples were negative for bacteria. None of the 29 patients, including 13 patients who received salvaged autologous blood positive for bacteria, developed postoperative bacteremia. We found that bile from the newly implanted liver graft is sterile in LDLT and BDA does not increase the risk of bacterial contamination of salvaged blood, supporting the use of blood salvage during LDLT even after BDA. Leukoreduction converted all autologous blood samples positive for bacteria to negative. The clinical benefit of leukoreduction for salvaged autologous blood on post-LDLT bacteremia needs further research.
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - You Sang Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Gyu-Sung Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Jae-Hoon Ko
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - In Young Yoo
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of South Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
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Suphathamwit A, Mahawithitwong P. Persistent Severe Bradycardia During Liver Transplantation. J Cardiothorac Vasc Anesth 2020; 34:1881-1884. [PMID: 31899143 DOI: 10.1053/j.jvca.2019.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Aphichat Suphathamwit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Prawej Mahawithitwong
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Moon YJ, Moon HS, Kim DS, Kim JM, Lee JK, Shim WH, Kim SH, Hwang GS, Choi JS. Deep Learning-Based Stroke Volume Estimation Outperforms Conventional Arterial Contour Method in Patients with Hemodynamic Instability. J Clin Med 2019; 8:jcm8091419. [PMID: 31505848 PMCID: PMC6780281 DOI: 10.3390/jcm8091419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Although the stroke volume (SV) estimation by arterial blood pressure has been widely used in clinical practice, its accuracy is questionable, especially during periods of hemodynamic instability. We aimed to create novel SV estimating model based on deep-learning (DL) method. A convolutional neural network was applied to estimate SV from arterial blood pressure waveform data recorded from liver transplantation (LT) surgeries. The model was trained using a gold standard referential SV measured via pulmonary artery thermodilution method. Merging a gold standard SV and corresponding 10.24 seconds of arterial blood pressure waveform as an input/output data set with 2-senconds of sliding overlap, 484,384 data sets from 34 LT surgeries were used for training and validation of DL model. The performance of DL model was evaluated by correlation and concordance analyses in another 491,353 data sets from 31 LT surgeries. We also evaluated the performance of pre-existing commercialized model (EV1000), and the performance results of DL model and EV1000 were compared. The DL model provided an acceptable performance throughout the surgery (r = 0.813, concordance rate = 74.15%). During the reperfusion phase, where the most severe hemodynamic instability occurred, DL model showed superior correlation (0.861; 95% Confidence Interval, (CI), 0.855-0.866 vs. 0.570; 95% CI, 0.556-0.584, P < 0.001) and higher concordance rate (90.6% vs. 75.8%) over EV1000. In conclusion, the DL-based model was superior for estimating intraoperative SV and thus might guide physicians to precise intraoperative hemodynamic management. Moreover, the DL model seems to be particularly promising because it outperformed EV1000 in circumstance of rapid hemodynamic changes where physicians need most help.
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Affiliation(s)
- Young-Jin Moon
- Biosignal Analysis and Perioperative Outcome Research Laboratory, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Hyun S Moon
- Health Innovation Bigdata Center, Asan Institute for Lifesciences, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Dong-Sub Kim
- Health Innovation Bigdata Center, Asan Institute for Lifesciences, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Jae-Man Kim
- Biosignal Analysis and Perioperative Outcome Research Laboratory, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Joon-Kyu Lee
- Health Innovation Bigdata Center, Asan Institute for Lifesciences, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Woo-Hyun Shim
- Health Innovation Bigdata Center, Asan Institute for Lifesciences, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Sung-Hoon Kim
- Biosignal Analysis and Perioperative Outcome Research Laboratory, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Gyu-Sam Hwang
- Biosignal Analysis and Perioperative Outcome Research Laboratory, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Jae-Soon Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
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Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis. J Clin Monit Comput 2019; 34:763-770. [PMID: 31327100 DOI: 10.1007/s10877-019-00359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
The accumulation of tracheobronchial secretions may contribute to a deterioration in pulmonary function and its early detection is important. In this study, we analyzed the respiratory sound spectrum in patients with intratracheal secretion, and compared acoustic characteristics before and after therapeutic endotracheal suctioning. After review of anesthetic records of liver transplant recipients, we included recipients with identified intratracheal secretion during surgery. Intraoperative breath sounds recorded through esophageal stethoscope were sampled in 20 s-period before and after suctioning of secretion and analyzed using fast Fourier transform. We also analyzed normal breath sounds from recipients without any respiratory problem as control group. The maximal power (dBmMax), total power from whole frequency range of 80-500 Hz (Pt), total power of each frequency range (80-200 Hz, P80-200; 200-300 Hz, P200-300; 300-400 Hz, P300-400; 400-500 Hz, P400-500), and their ratio (P80-200/Pt, P200-300/Pt, P300-400/Pt, P400-500/Pt) were compared. Breath sounds were obtained from 20 recipients; 9 pairs of breath sound before and after suctioning of secretion and 11 normal breath sounds. Patients with intratracheal secretion showed significantly higher P80-200, P200-300, P300-400, P400-500 when compared to the those of normal control patients (P = 0.003, P = 0.002, and P = 0.009, respectively), while dBmMax did not differ. Elimination of secretions attenuated P80-200, P200-300, P300-400, and P400-500 by 22.4%, 25.7%, 48.5%, and 15.3%, respectively (P = 0.002, 0.024, 0.009, and 0.016, respectively). Identifying the presence of intratracheal secretions with power ratio at 80-200 Hz and 300-400 Hz showed the highest area under the curve of 0.955 in receiver operating characteristic curve analysis. We suggest that spectral analysis of breath sounds obtained from the esophageal stethoscope might be a useful non-invasive respiratory monitor for accumulation of intratracheal secretion. Further prospective studies to evaluate the utility of acoustic analysis in surgical patients are warranted.
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Quantitative Analysis of an Intraoperative Digitalized Esophageal Heart Sound Signal to Speculate on Perturbed Cardiovascular Function. J Clin Med 2019; 8:jcm8050715. [PMID: 31137509 PMCID: PMC6572513 DOI: 10.3390/jcm8050715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 12/21/2022] Open
Abstract
Although visualization of heart sounds, known as phonocardiography, provides valuable information on cardiovascular hemodynamics, its use has not been widely encouraged due to the scarcity of information on its interpretation. In the present study, using the intraoperative phonocardiogram recorded by an esophageal stethoscope, we quantitatively evaluated the time and frequency domains of modulation of the heart sounds components and their association with left ventricular contractility and systemic vascular resistance under the effects of various cardiovascular drugs. We analyzed 29 pairs of intraoperative digitalized phonocardiographic signals and their corresponding hemodynamic data before and after cardiovascular drug administration (ephedrine, esmolol, phenylephrine, and/or nicardipine) in 17 patients who underwent liver transplantation. The S1 and S2 components of the heart sounds (the first and second heart sounds, respectively) were identified and their modulation in time and frequency domains was analyzed. As an index of cardiovascular function, systolic tissue Doppler wave velocity (TDI S'), maximal dP/dt from the arterial waveform, and systemic vascular resistance were simultaneously evaluated. Ephedrine/esmolol and phenylephrine/nicardipine primarily affected the S1 and S2 components of the heart sounds, respectively. This result implies that the intraoperative phonocardiogram may have the potential to be useful in detecting the changes in contractility and afterload that commonly occur in patients receiving anesthesia. In an era of constant need for noninvasive hemodynamic assessment, phonocardiography has the potential for use as a novel and informative tool for monitoring of hemodynamic function.
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Park HS, Kim SH, Park YS, Thiele RH, Shin WJ, Hwang GS. Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation. J Clin Med 2019; 8:jcm8050717. [PMID: 31137521 PMCID: PMC6572700 DOI: 10.3390/jcm8050717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 12/05/2022] Open
Abstract
The aim of this study was to analyze whether the respiratory variation in electrocardiogram (ECG) standard lead II R-wave amplitude (ΔRDII) could be used to assess intravascular volume status following inferior vena cava (IVC) clamping. This clamping causes an acute decrease in cardiac output during liver transplantation (LT). We retrospectively compared ΔRDII and related variables before and after IVC clamping in 34 recipients. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to derive a cutoff value of ΔRDII for predicting pulse pressure variation (PPV). After IVC clamping, cardiac output significantly decreased while ΔRDII significantly increased (p = 0.002). The cutoff value of ΔRDII for predicting a PPV >13% was 16.9% (AUC: 0.685) with a sensitivity of 57.9% and specificity of 77.6% (95% confidence interval 0.561 – 0.793, p = 0.015). Frequency analysis of ECG also significantly increased in the respiratory frequency band (p = 0.016). Although significant changes in ΔRDII during vena cava clamping were found at norepinephrine doses <0.1 µg/kg/min (p = 0.032), such changes were not significant at norepinephrine doses >0.1 µg/kg/min (p = 0.093). ΔRDII could be a noninvasive dynamic parameter in LT recipients presenting with hemodynamic fluctuation. Based on our data, we recommended cautious interpretation of ΔRDII may be requisite according to vasopressor administration status.
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Affiliation(s)
- Hee-Sun Park
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Yong-Seok Park
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Robert H Thiele
- Departments of Anesthesiology and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA 22903, USA.
| | - Won-Jung Shin
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
| | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea.
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Fu H, Sun K, Li J, Gong W, Agopian V, Yan M, Busuttil RW, Steadman RH, Xia VW. Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation. Clin Transplant 2018; 32:e13422. [PMID: 30312516 DOI: 10.1111/ctr.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/07/2018] [Accepted: 10/07/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Hong Fu
- Department of Anesthesiology; Chongqing Traditional Chinese Medicine Hospital; Chongqing China
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Kai Sun
- Department of Anesthesiology; Second Affiliated Hospital of Zhejiang University of School of Medicine; Hangzhou Zhejiang China
| | - Jun Li
- Department of Anesthesiology; Mianyang Central Hospital; Mianyang City Sichuan Province China
| | - Weiyi Gong
- Department of Anesthesiology; Baoan District People’s Hospital; Shenzhen China
| | - Vatche Agopian
- Department of Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Min Yan
- Department of Anesthesiology; Second Affiliated Hospital of Zhejiang University of School of Medicine; Hangzhou Zhejiang China
| | - Ronald W. Busuttil
- Department of Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Randolph H. Steadman
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Victor W. Xia
- Department of Anesthesiology and Perioperative Medicine; David Geffen School of Medicine at UCLA; Los Angeles California
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10
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Moon YJ, Kwon HM, Park YS, Kim SH, Hwang GS. Brief Episodes of Newly Developed Intraoperative Atrial Fibrillation Predicts Worse Outcomes in Adult Liver Transplantation. Transplant Proc 2018; 50:1142-1146. [PMID: 29731082 DOI: 10.1016/j.transproceed.2018.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although patients undergoing liver transplantation (LT) are frequently exposed to predisposing factors of atrial fibrillation (AF) such as autonomic imbalance, surgical stress, and elevated catecholamine levels, the occurrence of intraoperative AF (IOAF) has not been fully examined in LT candidates. METHODS Data from 1059 patients who underwent adult LT from 2006 to 2010 were analyzed. Among patients with preoperative normal sinus rhythm, the incidence, prognosis, and detailed characteristics of newly developed IOAF were assessed. Their risk factors and clinical implication, including hepatic graft survival and mortality, were also examined. RESULTS Thirteen (1.2%) cases of AF newly developed intraoperatively. A higher Model for End-Stage Liver Disease score (adjusted odds ratio, 1.077 [95% confidence interval, 1.015-1.143]; P = .015) and fulminant hepatic failure (adjusted odds ratio, 6.844 [95% CI, 1.944-24.096]; P = .003) were associated with its occurrence. Eight cases of newly developed AF occurred immediately after hepatic graft reperfusion; the other 3 cases occurred during the pre-anhepatic or anhepatic phase. The majority of patients (9 cases) experienced only brief episodes of AF lasting <1 hour. Despite all patients with newly developed AF eventually converting to sinus rhythm within 1 week after surgery, the episode of IOAF was independently associated with mortality (adjusted hazard ratio, 5.097 [95% confidence interval, 2.189-11.868]; P < .001) after adjustment for Model for End-Stage Liver Disease score. CONCLUSIONS For LT recipients, even a brief episode of newly developed IOAF seems to be an important prognosticator, regardless of AF duration.
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Affiliation(s)
- Y-J Moon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H-M Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y-S Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - G-S Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Prediction of Fluid Responsiveness by a Non-invasive Respiratory Systolic Time Interval Variation Using Heart Sound Signals in Recipients Undergoing Liver Transplantation. Transplant Proc 2018; 49:1082-1086. [PMID: 28583532 DOI: 10.1016/j.transproceed.2017.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The fluid management of cirrhotic patients undergoing liver transplantation (LT) is challenging. Phonocardiography, a graphic recording of heart sounds, provides valuable information concerning heart function and hemodynamic condition. We assessed whether the systolic time interval (STI) and its respiratory variation could predict fluid responsiveness in cirrhotic patients undergoing LT. METHODS Thirty LT recipients who needed volume expansion were included. The fluid challenge consisted of 500 mL 5% albumin administered over a period of 10 minutes. STI was measured as the time interval between the maximal amplitude of each heart sound corrected with the corresponding RR interval (cSTI). The respiratory variation in STI (STV) induced by mechanical ventilation was calculated. Responders were defined as those showing a ≥10% increase in stroke volume index after volume expansion. RESULTS In all, 14 of the 30 patients were responders. Significant increases in cSTI were observed after volume expansion in both responders (P < .001) and non-responders (P = .008). Responders showed significant decreases in STV (11.1% ± 4.3% vs 6.1% ± 2.6%, P < .001) after fluid loading, whereas STV in non-responders remained unchanged (6.4% ± 2.6% vs 6.4% ± 4.2%, P = .86). A cut-off value of ≥7.5% STV from baseline could predict fluid responsiveness with an area under the receiver operating characteristic curve of 0.804 (95% confidence interval, 0.618-0.925). CONCLUSIONS Intra-operative STV can predict fluid responsiveness in patients undergoing LT. Beat-to-beat monitoring of STI and STV may be useful as a non-invasive hemodynamic index and for fluid management.
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