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Grinberg T, Aviv Y, Vaturi M, Perl L, Wiessman M, Vaknin-Assa H, Codner P, Shapira Y, Kornowski R, Orvin K. Noninvasive Hemodynamic Evaluation Following TAVI for Severe Aortic Stenosis. J Am Heart Assoc 2023; 12:e028479. [PMID: 36942754 PMCID: PMC10122892 DOI: 10.1161/jaha.122.028479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background Various hemodynamic changes occur following transcatheter aortic valve implantation (TAVI) that may impact therapeutic decisions. NICaS is a noninvasive bioimpedance monitoring system aimed at hemodynamic assessment. We used the NICaS system in patients with severe aortic stenosis (AS) to evaluate short-term hemodynamic changes after TAVI. Methods and Results We performed hemodynamic analysis using NICaS on 97 patients with severe AS who underwent TAVI using either self-expandable (68%) or balloon-expandable (32%) valves. Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), coronary artery disease (46%), and diabetes (37%). NICaS was performed at several time points-before TAVI, soon after TAVI, at hospital discharge, and during follow-up. Compared with baseline NICaS measurements, we observed a significant increase in systolic blood pressure and total peripheral resistance (systolic blood pressure 132±21 mm Hg at baseline versus 147±23 mm Hg after TAVI, P<0.001; total peripheral resistance 1751±512 versus 2084±762 dynes*s/cm5, respectively, P<0.001) concurrent with a decrease in cardiac output and stroke volume (cardiac output 4.2±1.5 versus 3.9±1.3 L/min, P=0.037; stroke volume 61.4±14.8 versus 56.2±15.9 mL, P=0.001) in the immediate post-TAVI period. At follow-up (median 59 days [interquartile range, 40.5-91]) these measurements returned to values that were not different from the baseline. A significant improvement in echocardiography-based left ventricular ejection fraction was observed from baseline to follow-up (55.6%±11.6% to 59.4%±9.4%, P<0.001). Conclusions Unique short-term adaptive hemodynamic changes were observed using NICaS in patients with AS soon after TAVI. Noninvasive hemodynamic evaluation immediately following TAVI may contribute to the understanding of complex hemodynamic changes and merits favorable consideration.
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Affiliation(s)
- Tzlil Grinberg
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Aviv
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Mordehay Vaturi
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Leor Perl
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maya Wiessman
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hanna Vaknin-Assa
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Pablo Codner
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Shapira
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ran Kornowski
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Katia Orvin
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Nachman D, Rahamim E, Kolben Y, Mengesha B, Elbaz-Greener G, Amir O, Asleh R. In Search of Clinical Impact: Advanced Monitoring Technologies in Daily Heart Failure Care. J Clin Med 2021; 10:jcm10204692. [PMID: 34682813 PMCID: PMC8537939 DOI: 10.3390/jcm10204692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
Despite significant advances in the management of heart failure (HF), further improvement in the outcome of this chronic and progressive disease is still considered a major unmet need. Recurrent hospitalizations due to decompensated HF frequently occur, resulting in increased morbidity and mortality rates. Past attempts at early detection of clinical deterioration were mainly based on monitoring of signs and symptoms of HF exacerbation, which have mostly given disappointing results. Extensive research of the pathophysiology of HF decompensation has indicated that hemodynamic alterations start days prior to clinical manifestation. Novel technologies aim to monitor these minute hemodynamic changes, allowing time for therapeutic interventions to prevent hemodynamic derangement and HF exacerbation. The latest noticeable advancements include assessment of lung fluid volume, wearable devices with integrated sensors, and microelectromechanical systems-based implantable devices for continuous measurement of cardiac filling pressures. This manuscript will review the rationale for monitoring HF patients and discuss previous and ongoing attempts to develop clinically meaningful monitoring devices to improve daily HF health care, with particular emphasis on the recent advances and clinical trials relevant to this evolving field.
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Affiliation(s)
- Dean Nachman
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
- Correspondence: (D.N.); (R.A.); Tel.: +972-2-6757657 (D.N.); +972-2-6775266 (R.A.)
| | - Eldad Rahamim
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
| | - Yotam Kolben
- Hadassah Medical Center, Department of Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel;
| | - Bethlehem Mengesha
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
| | - Gabby Elbaz-Greener
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
| | - Offer Amir
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Rabea Asleh
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
- Correspondence: (D.N.); (R.A.); Tel.: +972-2-6757657 (D.N.); +972-2-6775266 (R.A.)
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Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis. Crit Care Med 2021; 50:126-137. [PMID: 34325447 DOI: 10.1097/ccm.0000000000005144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze the validity of electrical bioimpedance-based noninvasive cardiac output monitoring in pediatrics compared with standard methods such as thermodilution and echocardiography. DATA SOURCES Systematic searches were conducted in MEDLINE and EMBASE (2000-2019). STUDY SELECTION Method-comparison studies of transthoracic electrical velocimetry or whole body electrical bioimpedance versus standard cardiac output monitoring methods in children (0-18 yr old) were included. DATA EXTRACTION Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Mean differences of cardiac output, stroke volume, or cardiac index measurements were pooled using a random-effects model (R Core Team, R Foundation for Statistical Computing, Vienna, Austria, 2019). Bland-Altman statistics assessing agreement between devices and author conclusions about inferiority/noninferiority were extracted. DATA SYNTHESIS Twenty-nine of 649 identified studies were included in the qualitative analysis, and 25 studies in the meta-analyses. No significant difference was found between means of cardiac output, stroke volume, and cardiac index measurements, except in exclusively neonatal/infant studies reporting stroke volume (mean difference, 1.00 mL; 95% CI, 0.23-1.77). Median percentage error in child/adolescent studies approached acceptability (percentage error less than or equal to 30%) for cardiac output in L/min (31%; range, 13-158%) and stroke volume in mL (26%; range, 14-27%), but not in neonatal/infant studies (45%; range, 29-53% and 45%; range, 28-70%, respectively). Twenty of 29 studies concluded that transthoracic electrical velocimetry/whole body electrical bioimpedance was noninferior. Transthoracic electrical velocimetry was considered inferior in six of nine studies with heterogeneous congenital heart disease populations. CONCLUSIONS The meta-analyses demonstrated no significant difference between means of compared devices (except in neonatal stroke volume studies). The wide range of percentage error reported may be due to heterogeneity of study designs, devices, and populations included. Transthoracic electrical velocimetry/whole body electrical bioimpedance may be acceptable for use in child/adolescent populations, but validity in neonates and congenital heart disease patients remains uncertain. Larger studies in specific clinical contexts with standardized methodologies are required.
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Rafaeli Rabin R, Rosin I, Matitiau A, Simpson Y, Flidel-Rimon O. Assessing Patent Ductus Arteriosus (PDA) Significance on Cardiac Output by Whole-Body Bio-impedance. Pediatr Cardiol 2020; 41:1386-1390. [PMID: 32524206 DOI: 10.1007/s00246-020-02380-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
We evaluated the effectiveness of a whole-body bioimpedance device (NICaS®, NI Medical, Petach Tikva, Israel) to predict the presence of a hemodynamically significant patent ductus arteriosus (PDA) in premature infants. A total of 36 infants less than 35 week's gestation age and birth weights of less than 1750 g were included in the study. Using the NICaS® device, we obtained whole-body bioimpedance measurements of stroke volume index (SI), cardiac output index (CI) and total peripheral resistance index. A total of 61 measurements were taken together with echocardiograph imaging. The study population was divided into three groups according to the echocardiograph results: group 1-small PDA, group 2-moderate PDA, and group 3-large PDA. Both SI and CI significantly increased from a median value of 22.6 ml/m2 and 3.4 l/min/m2 to 23.8 and 3.7, to 39.8 and 5.4 between groups 1, 2 and 3 respectively. The difference was statistically significant between groups 1 and 3 (P = 0.005 for SI and P = 0.002 for CI) and between groups 2 and 3 (P = 0.037 for SI and P = 0.05 for CI). We found statistically significant differences in SI and CI between infants with large PDAs and infants with no or small and medium PDAs. We suggest that these differences can be used in real time, in addition to echocardiography, in assessing the presence of significant PDAs.
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Affiliation(s)
| | - Ilya Rosin
- Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel
| | - Avraham Matitiau
- Unit of Pediatric Cardiology, Hebrew University, Jerusalem, Israel
| | - Yael Simpson
- Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel
| | - Orna Flidel-Rimon
- Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel.
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A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study. Shock 2020; 55:230-235. [PMID: 32769818 DOI: 10.1097/shk.0000000000001621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Alternation in traditional vital signs can only be observed during advanced stages of hypovolemia and shortly before the hemodynamic collapse. However, even minimal blood loss induces a decrease in the cardiac preload which translates to a decrease in stroke volume, but these indices are not readily monitored. We aimed to determine whether minor hemodynamic alternations induced by controlled and standardized hypovolemia can be detected by a whole-body bio-impedance technology. METHODS This was a non-randomized controlled trial that enrolled healthy blood donors. Vital signs, as well as shock index and stroke volume (SV), were recorded using noninvasive cardiac system, a noninvasive whole-body impedance-based hemodynamic analysis system, during phlebotomy. RESULTS Sixty subjects were included in the study group and 20 in the control group. Blood loss of 450 mL resulted in a significant decrease in systolic blood pressure (5 mm Hg; 95% CI 3, 6) and SV (5.07 mL; 95% CI 3.21, 6.92), and increase in shock index (0.03 bpm/mm Hg; 95% CI 0.01, 0.05). Clinically detectable changes (≥10%) in blood pressure and shock index were detectable in 15% and 5%, respectively. SV decreased by more than 10% in 40% of blood donors. No significant changes occurred in the control group. CONCLUSION Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.
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Goldkorn R, Naimushin A, Rozen E, Freimark D. Early post-stress decrease in cardiac performance by impedance cardiography and its relationship to the severity and extent of ischemia by myocardial perfusion imaging. BMC Cardiovasc Disord 2020; 20:354. [PMID: 32736524 PMCID: PMC7394672 DOI: 10.1186/s12872-020-01639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background While single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established noninvasive procedure for the evaluation of patients with coronary artery disease (CAD), it is unable to detect the presence of, or underestimates the extent of CAD in certain patients. We aimed to show that a bio-impedance device can detect early post-stress changes in several hemodynamic parameters, thereby serving as a potential marker for the presence of significant ischemia. Methods Prospectively enrolled patients, referred to our Medical Center for clinically-indicated MPI, underwent testing using a Non-Invasive Cardiac System (NICaS) before and immediately after exercise. The differences between rest and stress hemodynamic parameters were compared with the severity and extent of myocardial ischemia by MPI. The study included 198 patients; mean age was 62 years, 26% were women, 54% had hypertension, and 29% diabetes mellitus. Of them, 188 patients had ≤10%, and 10 had > 10% of myocardial ischemia. Results In the first group, there was a significantly greater increase in post-exercise stroke index, stroke work index, cardiac index and cardiac power index (19.2, 29.1, 90.5 and 107%, respectively) compared with the second group (− 2.7, 3.8, 43.7 and 53.5%, respectively), as well as a significantly greater decrease in total peripheral resistance index (− 38.7% compared with − 16.3%), with corresponding p values of 0.015, 0.017, 0.040, 0.016, and < 0.001, respectively. Conclusions Our data suggest that immediate post-stress changes in several hemodynamic parameters, detected by the NICaS, can be used as an important adjunct to SPECT MPI for the early detection of myocardial ischemia.
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Affiliation(s)
- Ronen Goldkorn
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alexey Naimushin
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Eli Rozen
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Dov Freimark
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Naranjo J, Dodd S, Martin YN. Perioperative Management of Pheochromocytoma. J Cardiothorac Vasc Anesth 2017; 31:1427-1439. [PMID: 28392094 DOI: 10.1053/j.jvca.2017.02.023] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 12/12/2022]
Abstract
Pheochromocytomas are rare neuroendocrine tumors that produce and store catecholamines. Without adequate preparation, the release of excessive amounts of catecholamines, especially during anesthetic induction or during surgical removal, can produce life-threatening cardiovascular complications. This review focuses on the perioperative management of pheochromocytoma/paragangliomas, initially summarizing the clinical aspects of the disease and then highlighting the current evidence available for preoperative, intraoperative, and postoperative anesthetic management.
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Affiliation(s)
- Julian Naranjo
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Sarah Dodd
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Yvette N Martin
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Boos CJ, Holdsworth DA, Hall DP, Mellor A, O'Hara J, Woods DR. Comparison of two methods of assessing total body water at sea level and increasing high altitude. Clin Physiol Funct Imaging 2014; 34:478-84. [DOI: 10.1111/cpf.12121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- C. J. Boos
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Cardiology; Poole Hospital NHS Foundation Trust; Dorset UK
- Centre of Postgraduate Medical Research & Education; Bournemouth University; Bournemouth UK
- Department of Cardiology; Royal Berkshire Hospital; Reading UK
| | - D. A. Holdsworth
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Cardiology; Poole Hospital NHS Foundation Trust; Dorset UK
| | - D. P. Hall
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Anaesthesia; Western General Hospital; Edinburgh UK
| | - A. Mellor
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- James Cook University Hospital; Middlesborough UK
- Leeds Metropolitan University; 104 Carnegie Research Institute (CRI); Leeds UK
| | - J. O'Hara
- Leeds Metropolitan University; 104 Carnegie Research Institute (CRI); Leeds UK
| | - D. R. Woods
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Medicine; Royal Victoria Infirmary and Northumbria NHS Foundation Trust; Newcastle upon Tyne UK
- University of Newcastle; Newcastle upon Tyne UK
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Cambios en el perfil hemodinámico al instaurar la ventilación mecánica en pacientes con cardiopatía isquémica y enfermedad coronaria. Medición con biorreactancia torácica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2013.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rodríguez IJ, Echeverry JC, Abello M, Cruz LE. Changes in the hemodynamic profile when establishing mechanical ventilation in patients with ischemic heart disease and coronary disease: Measurement with thoracic bioreactance. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Changes in the hemodynamic profile when establishing mechanical ventilation in patients with ischemic heart disease and coronary disease: Measurement with thoracic bioreactance☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442020-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wang JJ, Hu WC, Kao T, Liu CP, Lin SK. Development of forearm impedance plethysmography for the minimally invasive monitoring of cardiac pumping function. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jbise.2011.42018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tanino Y, Shite J, Paredes OL, Shinke T, Ogasawara D, Sawada T, Kawamori H, Miyoshi N, Kato H, Yoshino N, Hirata KI. Whole Body Bioimpedance Monitoring for Outpatient Chronic Heart Failure Follow up. Circ J 2009; 73:1074-9. [DOI: 10.1253/circj.cj-08-0847] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yusuke Tanino
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Junya Shite
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Oscar L Paredes
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Daisuke Ogasawara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takahiro Sawada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Naoki Miyoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroki Kato
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Naoki Yoshino
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Wang JJ, Wang PW, Liu CP, Lin SK, Hu WC, Kao T. Evaluation of changes in cardiac output from the electrical impedance waveform in the forearm. Physiol Meas 2007; 28:989-99. [PMID: 17827648 DOI: 10.1088/0967-3334/28/9/002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We tested the validity of regional impedance cardiography (RIC) for measuring changes in both cardiac output and stroke volume by comparing the values with a 2D ultrasound technique in response to the breath-hold manipulation. Among 13 subjects, changes in the maximum amplitude of the regional impedance waveform from the forearm conformed to those in stroke volume (r = 0.86, p < 0.001) and cardiac output (r = 0.76, p < 0.003) measured with the ultrasound technique in baseline and immediately after a 30 s breath-hold maneuver. We also found that the per cent change in cardiac output (r = 0.73, p < 0.005) and the per cent change in stroke volume (r = 0.84, p < 0.0003) by the echocardiography were both positively correlated with the per cent change in the peak impedance amplitude. In addition, both the change and the per cent change in the mean area under the impedance curve were consistent with those in the stroke volume, respectively. Accordingly, the regional electrical impedance waveform from lower limbs may be helpful in providing a non-invasive and continuous assessment of left ventricular output, especially during cardiac procedures.
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Affiliation(s)
- Jia-Jung Wang
- Department of Biomedical Engineering, I-Shou University, Taiwan, Republic of China.
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Abstract
UNLABELLED Previously reported comparisons between cardiac output (CO) results in patients with cardiac conditions measured by thoracic impedance cardiography (TIC) versus thermodilution (TD) reveal upper and lower limits of agreement with two standard deviations (2SD) of approximately +/-2.2 l min(-1), a 44% disparity between the two technologies. We show here that if the electrodes are placed on one wrist and on a contralateral ankle instead of on the chest, a configuration designated as regional impedance cardiography (RIC), the 2SD limit of agreement between RIC and TD is +/-1.0 l min(-1), approximately 20% disparity between the two methods. To compare the performances of the TIC and RIC algorithms, the raw data of peripheral impedance changes yielded by RIC in 43 cardiac patients were used here for software processing and calculating the CO with the TIC algorithm. The 2SD between the TIC and TD was +/-1.7 l min(-1), and after annexing the correcting factors of the RIC formula to the TIC formula, the disparity between TIC and TD further declined to +/-1.25 l min(-1). CONCLUSIONS (1) in cardiac conditions, the RIC technology is twice as accurate as TIC; (2) the advantage of RIC is the use of peripheral rather than thoracic impedance signals, supported by correcting factors.
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Affiliation(s)
- G Cotter
- Division of Clinical Pharmacology, Duke University Medical Center, Durham, NC, USA.
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Leitman M, Sucher E, Kaluski E, Wolf R, Peleg E, Moshkovitz Y, Milo-Cotter O, Vered Z, Cotter G. Non-invasive measurement of cardiac output by whole-body bio-impedance during dobutamine stress echocardiography: Clinical implications in patients with left ventricular dysfunction and ischaemia. Eur J Heart Fail 2006; 8:136-40. [PMID: 16199201 DOI: 10.1016/j.ejheart.2005.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 06/30/2005] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To compare non-invasive determination of cardiac index (CI) by whole body electrical bioimpedance using the NICaS apparatus and Doppler echocardiography, and the role of cardiac power index (Cpi) and total peripheral resistance index (TPRi) calculation during dobutamine stress echocardiography (DSE). SUBJECTS AND METHODS We enrolled 60 consecutive patients undergoing DSE. Patients were prospectively divided into 3 groups: Group 1 (n = 20): normal DSE (control). Group 2 (n = 20): EF<40% without significant ischaemia. Group 3 (n = 20): patients with significant ischaemia on DSE. Measurements of CI were performed at the end of each stage of DSE by both echocardiographic left ventricular outflow track flow and the NICaS apparatus, using whole-body bio-impedance. MAP was measured simultaneously and TPRi and Cpi were calculated. RESULTS The correlation between non-invasive CI as determined by NICaS and echocardiography was 0.81, although Echocardiographic readings of CI were higher during administration of higher doses of dobutamine. Lower EF correlated with lower Cpi, especially stress induced Cpi. Hence, patients with reduced EF (group 2) had a blunted increase in Cpi during stress. Patients with ischaemia (group 3) had a blunted increase in Cpi as well as a decrease in Cpi and increase in TPRi during the last stages of DSE. CONCLUSION Measurement of CI by NICaS correlated well with Doppler derived CI. The calculation of Cpi and TPRi changes during dobutamine stress may provide important clinical information.
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Affiliation(s)
- Marina Leitman
- Cardiology Department, Assaf-Harofeh Medical Center, Israel
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Moshkovitz Y, Kaluski E, Milo O, Vered Z, Cotter G. Recent developments in cardiac output determination by bioimpedance: comparison with invasive cardiac output and potential cardiovascular applications. Curr Opin Cardiol 2004; 19:229-37. [PMID: 15096956 DOI: 10.1097/00001573-200405000-00008] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent developments in bioimpedance technique and its application in cardiovascular diseases. Cardiac output determination has been used selectively during recent years because of the need for invasive right heart catheterization. Hence, experience with its application in patients with cardiovascular diseases and especially heart failure is limited. Bioimpedance is a novel noninvasive technique determining changes in instantaneous (during one heartbeat) conductance of a small electrical current transferred through the body. By using different algorithms correcting for various body composition constants, it calculates the change in instantaneous arterial blood volume (that is, stroke volume) and cardiac output. Traditionally, bioimpedance cardiac output is determined using either thoracic or whole body techniques according to the location of the electrodes transmitting and receiving the small electrical current. RECENT FINDINGS Significant progress was achieved in recent years in cardiac output determination by bioimpedance. Newer algorithms using thoracic and whole body bioimpedance have demonstrated better correlation with invasive cardiac output determination. In a few preliminary studies bioimpedance-determined cardiac output was found useful in the diagnosis, risk stratification, and treatment titration of some cardiovascular conditions. Further, larger prospective studies are required to determine the true independent value of cardiac output measurement by bioimpedance for the evaluation of cardiovascular diseases and especially heart failure. SUMMARY Recently, significant improvement was achieved in cardiac output measurement by bioimpedance with both newer thoracic and whole body techniques. Preliminary studies imply that this measure may be of value in managing some cardiovascular disorders.
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Affiliation(s)
- Yaron Moshkovitz
- Cardiac Surgery Department, Ramat Marpe Hospital, Petah Tikva, Israel
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Cotter G, Moshkovitz Y, Kaluski E, Cohen AJ, Miller H, Goor D, Vered Z. Accurate, Noninvasive Continuous Monitoring of Cardiac Output by Whole-Body Electrical Bioimpedance. Chest 2004; 125:1431-40. [PMID: 15078756 DOI: 10.1378/chest.125.4.1431] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Cardiac output (CO) is measured but sparingly due to limitations in its measurement technique (ie, right-heart catheterization). Yet, in recent years it has been suggested that CO may be of value in the diagnosis, risk stratification, and treatment titration of cardiac patients, especially those with congestive heart failure (CHF). We examine the use of a new noninvasive, continuous whole-body bioimpedance system (NICaS; NI Medical; Hod-Hasharon, Israel) for measuring CO. The aim of the present study was to test the validity of this noninvasive cardiac output system/monitor (NICO) in a cohort of cardiac patients. DESIGN Prospective, double-blind comparison of the NICO and thermodilution CO determinations. PATIENTS We enrolled 122 patients in three different groups: during cardiac catheterization (n = 40); before, during, and after coronary bypass surgery (n = 51); and while being treated for acute congestive heart failure (CHF) exacerbation (n = 31). MEASUREMENTS AND INTERVENTION: In all patients, CO measurements were obtained by two independent blinded operators. CO was measured by both techniques three times, and an average was determined for each time point. CO was measured at one time point in patients undergoing coronary catheterization; before, during, and after bypass surgery in patients undergoing coronary bypass surgery; and before and during vasodilator treatment in patients treated for acute heart failure. RESULTS Overall, 418 paired CO measurements were obtained. The overall correlation between the NICO cardiac index (CI) and the thermodilution CI was r = 0.886, with a small bias (0.0009 +/- 0.684 L) [mean +/- 2 SD], and this finding was consistent within each group of patients. Thermodilution readings were 15% higher than NICO when CI was < 1.5 L/min/m(2), and 5% lower than NICO when CI was > 3 L/min/m(2). The NICO has also accurately detected CI changes during coronary bypass operation and vasodilator administration for acute CHF. CONCLUSION The results of the present study indicate that whole-body bioimpedance CO measurements obtained by the NICO are accurate in rapid, noninvasive measurement and the follow-up of CO in a wide range of cardiac clinical situations.
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Affiliation(s)
- Gad Cotter
- Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, Israel.
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Cotter G, Moshkovitz Y, Kaluski E, Milo O, Nobikov Y, Schneeweiss A, Krakover R, Vered Z. The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure. Eur J Heart Fail 2003; 5:443-51. [PMID: 12921805 DOI: 10.1016/s1388-9842(03)00100-4] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Conventional hemodynamic indexes (cardiac index (CI), and pulmonary capillary wedge pressure) are of limited value in the diagnosis and treatment of patients with acute congestive heart failure (CHF). PATIENTS AND METHODS We measured CI, wedge pressure, right atrial pressure (RAP) and mean arterial blood pressure (MAP) in 89 consecutive patients admitted due to acute CHF (exacerbated systolic CHF, n=56; hypertensive crisis, n=5; pulmonary edema, n=11; and cardiogenic shock, n=17) and in two control groups. The two control groups were 11 patients with septic shock and 20 healthy volunteers. Systemic vascular resistance index (SVRi) was calculated as SVRi=(MAP-RAP)/CI. Cardiac contractility was estimated by the cardiac power index (Cpi), calculated as CIxMAP. RESULTS AND DISCUSSION We found that CI<2.7 l/min/m(2) and wedge pressure >12 mmHg are found consistently in patients with acute CHF. However, these measures often overlapped in patients with different acute CHF syndromes, while Cpi and SVRi permitted more accurate differentiation. Cpi was low in patients with exacerbated systolic CHF and extremely low in patients with cardiogenic shock, while SVRi was increased in patients with exacerbated systolic CHF and extremely high in patients with pulmonary edema. By using a two-dimensional presentation of Cpi vs. SVRi we found that these clinical syndromes can be accurately characterized hemodynamically. The paired measurements of each clinical group segregated into a specific region on the Cpi/SVRi diagnostic graph, that could be mathematically defined by a statistically significant line (Lambda=0.95). Therefore, measurement of SVRi and Cpi and their two-dimensional graphic representation enables accurate hemodynamic diagnosis and follow-up of individual patients with acute CHF.
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Affiliation(s)
- Gad Cotter
- Cardiology Department, Assaf-Harofeh Medical Center, 70300, Zerifin, Israel.
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Kauppinen PK, Kööbi T, Hyttinen J, Malmivuo J. Segmental composition of whole-body impedance cardiogram estimated by computer simulations and clinical experiments. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 2000; 20:106-13. [PMID: 10735977 DOI: 10.1046/j.1365-2281.2000.00234.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Whole-body impedance cardiography (ICGWB) has been proposed as a feasible means of measuring cardiac output (CO). However, the source distribution of heart-related impedance variations in the whole body is not known. To establish how much of a signal originates in each segment of the body and what the contribution of each is to stroke volume (SV) in ICGWB, impedance in the extremities and trunk were investigated in 15 healthy volunteers. In addition, the theoretical measurement properties of ICGWB were studied using a computer model of the whole-body anatomy as a volume conductor. The model confirmed the expected result that most of the basal impedance originates from the extremities. Clinical experiments revealed that the heart-related amplitude variations in the ICGWB signal originate more evenly from various body segments, the trunk slightly more than the arms or legs. The heart-related ICGWB signal represents a weighted sum of segmental pulsatile events in the body yielding physiologically meaningful data on almost the whole circulatory system.
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Affiliation(s)
- P K Kauppinen
- Tampere University of Technology, Ragnar Granit Institute, FIN-33101 Tampere, Finland
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