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Zhou Z, Peng H, Li J, Chen Z, Huo J, Zhou T. Real-time monitoring of the contractile properties of H9C2 cardiomyocytes by double resonator piezoelectric cytometry. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 15:2839-2852. [PMID: 37272335 DOI: 10.1039/d3ay00254c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Testing the mechanical properties of cardiomyocytes plays an important role in the study of the physiological and pathological processes of constant contraction and diastole of the cardiovascular system. However, there is currently no satisfactory and dynamic technology to measure the mechanical properties of cardiomyocytes in a sustained manner, greatly affecting their practical application in clinical diagnosis and treatment evaluation. Herein, a double resonator piezoelectric cytometry (DRPC) technique was employed for dynamic monitoring of H9C2 cardiomyocyte adhesion and the effects of two cardiovascular drugs on the contractile properties of H9C2 cardiomyocytes, i.e., isoprenaline (ISO, a positive inotropic agent) and verapamil (VRP, a negative inotropic agent). Specifically, we used 9 MHz AT and BT-cut bare gold and transparent ITO electrodes and compared their dynamic adhesion to the two electrodes modified with RGD and gelatin respectively versus unmodified to measure the cell generated stress (ΔS) exerted on the quartz crystal surface by a population of cells and the cell viscoelastic index (CVI). We found that the DRPC technique can quantitatively measure the magnitude and direction of the generated forces during the adhesion process of the cells and under the effect of drugs. In conclusion, the technique presented in this study can be used for the simultaneous measurement of cell adhesion, traction force and viscoelasticity of living cells in a noninvasive, dynamic and continuous way, making it an ideal tool for assessing the population contractility of cardiomyocytes and evaluating the efficacy and toxicity of cardiovascular drugs.
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Affiliation(s)
- Zhen Zhou
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China.
- Hunan Provincial Engineering Technology Research Center for Cell Mechanics and Function Analysis, Changsha 410128, China
| | - Hange Peng
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China.
- Hunan Provincial Engineering Technology Research Center for Cell Mechanics and Function Analysis, Changsha 410128, China
| | - Jiali Li
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China.
- Hunan Provincial Engineering Technology Research Center for Cell Mechanics and Function Analysis, Changsha 410128, China
| | - Zhihui Chen
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China.
- Hunan Provincial Engineering Technology Research Center for Cell Mechanics and Function Analysis, Changsha 410128, China
| | - Jingyi Huo
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China.
- Hunan Provincial Engineering Technology Research Center for Cell Mechanics and Function Analysis, Changsha 410128, China
| | - Tiean Zhou
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha 410128, China.
- Hunan Provincial Engineering Technology Research Center for Cell Mechanics and Function Analysis, Changsha 410128, China
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Cottrell J, Cummings K, Jude D, Chaffin D. The effect of impedance cardiography directed antihypertensive therapy on fetal growth restriction rates and perinatal mortality in women with chronic hypertension. Pregnancy Hypertens 2022; 28:123-127. [PMID: 35339775 DOI: 10.1016/j.preghy.2022.03.006] [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: 08/02/2021] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We sought to determine the effect of impedance cardiography directed medical antihypertensive therapy on fetal growth restriction and perinatal mortality in women with chronic hypertension. STUDY DESIGN A retrospective study was conducted on 958 women referred to the Maternal Hypertension Center at Cabell Huntington Hospital between 2005 and 2014 for the indication of chronic hypertension. MAIN OUTCOME MEASURES Serial assessments of maternal hemodynamics were obtained using non-invasive impedance cardiography. Vasodilators were initiated for increased systemic vascular resistance. Elevated cardiac output was treated with beta blockade. RESULTS Blood pressure at initial visit was used to stratify patients into five groups. Initial blood pressure of <130 systolic or <80 diastolic had 24 cases of growth restriction (6.8%) and 6 perinatal deaths (1.7%), 130-139 systolic or 80-89 diastolic resulted in 29 cases of growth restriction (9.3%) and 9 perinatal deaths (2.9%), 140-149 systolic or 90-99 diastolic 14 cases of growth restriction (6.5%) and 3 perinatal deaths (1.4%), 150-159 systolic or 100-109 diastolic had 5 cases of growth restriction (8.6%) and 4 perinatal deaths (6.89%), and >160 systolic or >110 diastolic 3 cases of growth restriction (13%) with no perinatal deaths. There were no differences in growth restriction (p = .59) or perinatal death (p = .15) between the groups. CONCLUSION The rates of IUGR and perinatal mortality did not increase even with increasing severity of maternal hypertension. This low cost and non-invasive test should be considered for optimizing rates of growth restriction and perinatal mortality in pregnancies complicated by chronic hypertension.
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Affiliation(s)
- Jesse Cottrell
- Marshall University, Joan C. Edwards School of Medicine, Department of Obstetrics and Gynecology, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - Kelly Cummings
- Marshall University, Joan C. Edwards School of Medicine, Department of Obstetrics and Gynecology, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - David Jude
- Marshall University, Joan C. Edwards School of Medicine, Department of Obstetrics and Gynecology, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - David Chaffin
- Marshall University, Joan C. Edwards School of Medicine, Department of Obstetrics and Gynecology, 1600 Medical Center Drive, Huntington, WV 25701, USA
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Chabchoub S, Mansouri S, Ben Salah R. Signal processing techniques applied to impedance cardiography ICG signals - a review. J Med Eng Technol 2022; 46:243-260. [PMID: 35040738 DOI: 10.1080/03091902.2022.2026508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Over the last decade, Computer-Aided Diagnosis (CAD) systems have been provided significant research focus by researchers. CAD systems have been developed in order to minimise visual errors, to compensate manual interpretation, and to help medical staff to take decisions swiftly. These systems have been considered as powerful tools for a reliable, automatic, and low-cost monitoring and diagnosis. CAD systems are based on analysis and classification of several physiological signals for detecting and assessing different diseases related to the corresponding organ. The implementation of these systems requires the application of several advanced signal processing techniques. Specifically, in cardiology, CAD systems have achieved promising results in providing an accurate and rapid detection of cardiovascular diseases (CVDs). Particularly, the number of works on signal processing field for impedance cardiography (ICG) signals starts to grow slowly in recent years. This paper presents a review study of signal processing techniques applied to the ICG signal for the denoising, the analysis, the classification and the characterisation purposes. This review is intended to provide researchers with a broad overview of the currently used signal processing techniques for ICG signal analysis, as well as to improve future research by applying other recent advanced methods.
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Affiliation(s)
- Souhir Chabchoub
- Laboratory of Biophysics and Medical Technologies, University of Tunis El-Manar, ISTMT, Tunis, Tunisia
| | - Sofienne Mansouri
- Laboratory of Biophysics and Medical Technologies, University of Tunis El-Manar, ISTMT, Tunis, Tunisia.,Department of Medical Equipment Technology, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
| | - Ridha Ben Salah
- Laboratory of Biophysics and Medical Technologies, University of Tunis El-Manar, ISTMT, Tunis, Tunisia
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Dehkordi P, Khosrow-Khavar F, Di Rienzo M, Inan OT, Schmidt SE, Blaber AP, Sørensen K, Struijk JJ, Zakeri V, Lombardi P, Shandhi MMH, Borairi M, Zanetti JM, Tavakolian K. Comparison of Different Methods for Estimating Cardiac Timings: A Comprehensive Multimodal Echocardiography Investigation. Front Physiol 2019; 10:1057. [PMID: 31507437 PMCID: PMC6713915 DOI: 10.3389/fphys.2019.01057] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
Cardiac time intervals are important hemodynamic indices and provide information about left ventricular performance. Phonocardiography (PCG), impedance cardiography (ICG), and recently, seismocardiography (SCG) have been unobtrusive methods of choice for detection of cardiac time intervals and have potentials to be integrated into wearable devices. The main purpose of this study was to investigate the accuracy and precision of beat-to-beat extraction of cardiac timings from the PCG, ICG and SCG recordings in comparison to multimodal echocardiography (Doppler, TDI, and M-mode) as the gold clinical standard. Recordings were obtained from 86 healthy adults and in total 2,120 cardiac cycles were analyzed. For estimation of the pre-ejection period (PEP), 43% of ICG annotations fell in the corresponding echocardiography ranges while this was 86% for SCG. For estimation of the total systolic time (TST), these numbers were 43, 80, and 90% for ICG, PCG, and SCG, respectively. In summary, SCG and PCG signals provided an acceptable accuracy and precision in estimating cardiac timings, as compared to ICG.
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Affiliation(s)
- Parastoo Dehkordi
- Electrical and Computer Engineering Department, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Samuel E Schmidt
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Andrew P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Kasper Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Johannes J Struijk
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Md Mobashir H Shandhi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | | | | | - Kouhyar Tavakolian
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.,Electrical Engineering Department, University of North Dakota, Grand Forks, ND, United States
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Bijl RC, Valensise H, Novelli GP, Vasapollo B, Wilkinson I, Thilaganathan B, Stöhr EJ, Lees C, van der Marel CD, Cornette JMJ. Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:35-50. [PMID: 30737852 DOI: 10.1002/uog.20231] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R C Bijl
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - G P Novelli
- Department of Cardiology, San Sebastiano Martire Hospital, Frascati, Italy
| | - B Vasapollo
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - I Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E J Stöhr
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - C Lees
- Department of Obstetrics, Imperial College, London, UK
| | - C D van der Marel
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J M J Cornette
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
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Orabona R, Prefumo F, Zanardini C, Magri R, Loardi C, Cappa V, Calza S, Frusca T, Acharya G. Maternal functional hemodynamics in uncomplicated twin pregnancies: A longitudinal study using impedance cardiography. Acta Obstet Gynecol Scand 2018; 98:188-195. [PMID: 30289562 DOI: 10.1111/aogs.13479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Longitudinal studies of maternal hemodynamics in twin pregnancy are scarce and preload reserve in twin pregnancies has not been studied. Thus, we aimed to investigate serial changes in maternal systemic hemodynamics from the first to third trimester, and cardiovascular response to passive leg raising to evaluate preload reserve using impedance cardiography in a cohort of uncomplicated twin pregnancies. MATERIAL AND METHODS This was a prospective longitudinal study of 50 twin pregnancies. Maternal hemodynamics was assessed at baseline and 120 seconds after passive leg raising using impedance cardiography, at five time points during gestation. Women were excluded from the analysis if there were pregnancy complications or fewer than three of five planned assessments were available. RESULTS Data from 37 uncomplicated twin pregnancies were available for analysis. Mean arterial pressure slightly decreased until 17 weeks' gestation, then increased. Systemic vascular resistance was constant in the first half of pregnancy before rising steadily thereafter, whereas the cardiac output increased from the first trimester, peaked by the end of the second trimester and then decreased in the third trimester. The change in stroke volume and cardiac output following passive leg raising during pregnancy ranged from -2.2% to 1.6% and from -3.7% to 3.2%, respectively. Although passive leg raising caused no significant changes in systemic vascular resistance, cardiac output or heart rate, mean arterial pressure decreased in the first and second trimesters. CONCLUSIONS In uncomplicated twin pregnancies, maternal cardiovascular adaptation is evident from the first trimester. Twin pregnancies show a reduced preload reserve in the second half of gestation.
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Affiliation(s)
- Rossana Orabona
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Cristina Zanardini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Roberta Magri
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Chiara Loardi
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Veronica Cappa
- Unit of Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Unit of Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.,Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Ganesh Acharya
- Department of Clinical Science, Intervention & Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway and University Hospital of North Norway, Tromsø, Norway
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7
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Agreement between preload reserve measured by impedance cardiography and echocardiography during pregnancy. Arch Gynecol Obstet 2018; 298:59-66. [PMID: 29623416 PMCID: PMC5995996 DOI: 10.1007/s00404-018-4773-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/03/2018] [Indexed: 11/17/2022]
Abstract
Purpose Accurate assessment of cardiac function is important during pregnancy. Echocardiography and impedance cardiography (ICG) are commonly used noninvasive methods to measure stroke volume (SV) and cardiac output (CO). The difference in stroke volume (ΔSV) or cardiac output (ΔCO) measured at baseline and after passive leg raising (PLR) is a measure of preload reserve that predicts volume responsiveness. However, the agreement between these two methods in measuring preload reserve during pregnancy is unclear. The aim of our study was to investigate the correlation and the agreement between Doppler echocardiography and ICG in assessing preload reserve in pregnant women. Methods In this prospective observational cross-sectional study, preload reserve was assessed by measuring the SV and CO during baseline and 90 s after PLR simultaneously by Doppler echocardiography and ICG in healthy pregnant women during the second and third trimesters. Bland–Altman analysis was used to determine the agreement between the two methods. Bias was calculated as the mean difference between two methods and precision as 1.96 SD of the difference. Results A total of 53 pregnant women were included. We found a statistically significant correlation between ΔSV (R = 0.56, p < 0.0001) and ΔCO (R = 0.39, p = 0.004) measured by ICG and Doppler echocardiography. The mean bias for ΔSV was 2.52 ml, with a precision of 18.19 ml. The mean bias for ΔCO was 0.21 l/min, with a precision of 1.51 l/min. Conclusion There was a good agreement and a statistically significant correlation between ICG and Doppler echocardiography for measuring preload reserve.
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D’Ambrosio A, Cotoia A, Beck R, Salatto P, Zibar L, Cinnella G. Impedance cardiography as tool for continuous hemodynamic monitoring during cesarean section: randomized, prospective double blind study. BMC Anesthesiol 2018; 18:32. [PMID: 29587655 PMCID: PMC5870261 DOI: 10.1186/s12871-018-0498-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia. METHODS Sixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups. Mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate (HR), stroke volume index (SVI) were recorded from Tbaseline to 31 min after CSE by ICG. Sensory and motor blocks, patients and surgeons satisfaction, neonatal data were also recorded. RESULTS Fifteen of 32 patients in GL6 and 15 of 30 patients in GL8 experienced hypotension at T2 vs Tbaseline (P < .001) and SVRI reduction (P = .035 and P < .001 respectively). MAP, CI and SVRI were always slightly higher in GL6 vs GL8. HR and SVI remained stable until the end of surgery in all patients. Total ephedrine requirements was higher in GL8 (P = .010). The onset and offset time of sensory and motor block were similar in both groups, but the number of patients with motor block was lower in GL6 vs GL8 (P = .001). Patients and surgeon satisfaction scores, the number of patients needed systemic rescue doses, neonatal data were similar in both groups. CONCLUSIONS ICG is a useful noninvasive tool to monitor continuously hemodynamics during cesarean section. The hemodynamic stability, the satisfying sensory block and rapid mobilization provided by low levobupivacaine dose may be particularly advantageous in obstetric patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT03170427 . Retrospectively Registered (Date of registration: May 2017).
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Affiliation(s)
- Alessandro D’Ambrosio
- Department of Anesthesia, Intensive Care and Pain Therapy, University of Foggia, University Hospital Foggia, Foggia, Italy
| | - Antonella Cotoia
- Department of Anesthesia, Intensive Care and Pain Therapy, University of Foggia, University Hospital Foggia, Foggia, Italy
| | - Renata Beck
- Department of Anesthesia, Intensive Care and Pain Therapy, University of Foggia, University Hospital Foggia, Foggia, Italy
| | - Potito Salatto
- Department of Anesthesia, Intensive Care and Pain Therapy, University of Foggia, University Hospital Foggia, Foggia, Italy
| | - Lada Zibar
- Department of Pathophysiology, Faculty of Medicine, University of Osijek, Osijek, Croatia
- Institute for Nephrology, Osijek University Hospital, Osijek, Croatia
| | - Gilda Cinnella
- Department of Anesthesia, Intensive Care and Pain Therapy, University of Foggia, University Hospital Foggia, Foggia, Italy
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KROHOVA J, CZIPPELOVA B, TURIANIKOVA Z, LAZAROVA Z, TONHAJZEROVA I, JAVORKA M. Preejection Period as a Sympathetic Activity Index: a Role of Confounding Factors. Physiol Res 2017; 66:S265-S275. [DOI: 10.33549/physiolres.933682] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In previous studies, one of the systolic time intervals – preejection period (PEP) – was used as an index of sympathetic activity reflecting the cardiac contractility. However, PEP could be also influenced by several other cardiovascular variables including preload, afterload and diastolic blood pressure (DBP). The aim of this study was to assess the behavior of the PEP together with other potentially confounding cardiovascular system characteristics in healthy humans during mental and orthostatic stress (head-up tilt test – HUT). Forty-nine healthy volunteers (28 females, 21 males, mean age 18.6 years (SD=1.8 years)) participated in the study. We recorded finger arterial blood pressure by volume-clamp method (Finometer Pro, FMS, Netherlands), PEP, thoracic fluid content (TFC) – a measure of preload, and cardiac output (CO) by impedance cardiography (CardioScreen® 2000, Medis, Germany). Systemic vascular resistance (SVR) – a measure of afterload – was calculated as a ratio of mean arterial pressure and CO. We observed that during HUT, an expected decrease in TFC was accompanied by an increase of PEP, an increase of SVR and no significant change in DBP. During mental stress, we observed a decrease of PEP and an increase of TFC, SVR and DBP. Correlating a change in assessed measures (delta values) between mental stress and previous supine rest, we found that ΔPEP correlated negatively with ΔCO and positively with ΔSVR. In orthostasis, no significant correlation between ΔPEP and ΔDBP, ΔTFC, ΔCO, ΔMBP or ΔSVR was found. We conclude that despite an expected increase of sympathetic activity during both challenges, PEP behaved differently indicating an effect of other confounding factors. To interpret PEP values properly, we recommend simultaneously to measure other variables influencing this cardiovascular measure.
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Affiliation(s)
- J. KROHOVA
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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11
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Vårtun Å, Flo K, Widnes C, Acharya G. Static and Functional Hemodynamic Profiles of Women with Abnormal Uterine Artery Doppler at 22-24 Weeks of Gestation. PLoS One 2016; 11:e0157916. [PMID: 27308858 PMCID: PMC4911143 DOI: 10.1371/journal.pone.0157916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/07/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To compare cardiac function, systemic hemodynamics and preload reserve of women with increased (cases) and normal (controls) uterine artery (UtA) pulsatility index (PI) at 22–24 weeks of gestation. Materials and Methods A prospective cross-sectional study of 620 pregnant women. UtA blood flow velocities were measured using Doppler ultrasonography, and PI was calculated. Mean UtA PI ≥ 1.16 (90th percentile) was considered abnormal. Maternal hemodynamics was investigated at baseline and during passive leg raising (PLR) using impedance cardiography (ICG). Preload reserve was defined as percent increase in stroke volume (SV) 90 seconds after passive leg raising compared to baseline. Results Mean UtA PI was 1.49 among cases (n = 63) and 0.76 among controls (n = 557) (p < 0.0001). Eighteen (28.6%) cases and 53 (9.5%) controls developed pregnancy complications (p <0.0001). The mean arterial pressure and systemic vascular resistance were 83 mmHg and 1098.89±293.87 dyne s/cm5 among cases and 79 mmHg and 1023.95±213.83 dyne s/cm5 among controls (p = 0.007 and p = 0.012, respectively). Heart rate, SV and cardiac output were not different between the groups. Both cases and controls responded with a small (4–5%) increase in SV in response to PLR, but the cardiac output remained unchanged. The preload reserve was not significantly different between two groups. Conclusion Pregnant women with abnormal UtA PI had higher blood pressure and systemic vascular resistance, but similar functional hemodynamic profile at 22–24 weeks compared to controls. Further studies are needed to clarify whether functional hemodynamic assessment using ICG can be useful in predicting pregnancy complications.
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Affiliation(s)
- Åse Vårtun
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
- * E-mail:
| | - Kari Flo
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
| | - Christian Widnes
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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Staelens AS, Vonck S, Mesens T, Tomsin K, Molenberghs G, Gyselaers W. Type-specific orthostatic hemodynamic response of hypertensive diseases in pregnancy. Clin Exp Pharmacol Physiol 2016; 42:1036-44. [PMID: 26192080 DOI: 10.1111/1440-1681.12463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/26/2022]
Abstract
Posture changes may differ between types of hypertensive disease. The aim is to evaluate the orthostatic response of impedance cardiography (ICG) measurements in uncomplicated and hypertensive pregnancies. Measurements were performed in supine and standing position in 202 women: 41 uncomplicated pregnancies (UP), 59 gestational hypertension (GH), 35 early-onset (EPE, < 34 weeks) and 67 late-onset (LPE, ≥ 34 weeks) preeclampsia were assessed. Measurements were recorded of heart rate, blood pressure, aortic flow parameters, cardiac output, pre-ejection period and left ventricular ejection time. Overall, orthostatic shifts were different between all groups (P < 0.001). UP was different from the hypertensive complicated gestations in the orthostatic change of the aortic acceleration. In contrast to patients with preeclampsia, those with GH had an increased blood pressure and Heather index, and stable pre-ejection period after posture change. EPE differed from LPE by change in blood pressure and aortic flow parameters. In addition to static ICG-measurements, orthostatic shifts improved group characterization from 57.4% to 65.8%. The orthostatic response is altered in hypertensive pregnancies. ICG measurements in the upright as well as during an orthostatic test might have the potential to improve the discriminative yield between hypertensive diseases in pregnancy.
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Affiliation(s)
- Anneleen S Staelens
- Department Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Sharona Vonck
- Department Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Tinne Mesens
- Department Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Kathleen Tomsin
- Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Molenberghs
- I-BioStat, Hasselt University, Hasselt, Belgium.,I-BioStat, University of Leuven, Leuven, Belgium
| | - Wilfried Gyselaers
- Department Obstetrics & Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
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13
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Yazdanian H, Mahnam A, Edrisi M, Esfahani MA. Design and Implementation of a Portable Impedance Cardiography System for Noninvasive Stroke Volume Monitoring. JOURNAL OF MEDICAL SIGNALS & SENSORS 2016; 6:47-56. [PMID: 27014612 PMCID: PMC4786963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
Measurement of the stroke volume (SV) and its changes over time can be very helpful for diagnosis of dysfunctions in the blood circulatory system and monitoring their treatments. Impedance cardiography (ICG) is a simple method of measuring the SV based on changes in the instantaneous mean impedance of the thorax. This method has received much attention in the last two decades because it is noninvasive, easy to be used, and applicable for continuous monitoring of SV as well as other hemodynamic parameters. The aim of this study was to develop a low-cost portable ICG system with high accuracy for monitoring SV. The proposed wireless system uses a tetrapolar configuration to measure the impedance of the thorax at 50 kHz. The system consists of carefully designed precise voltage-controlled current source, biopotential recorder, and demodulator. The measured impedance was analyzed on a computer to determine SV. After evaluating the system's electronic performance, its accuracy was assessed by comparing its measurements with the values obtained from Doppler echocardiography (DE) on 5 participants. The implemented ICG system can noninvasively provide a continuous measure of SV. The signal to noise ratio of the system was measured above 50 dB. The experiments revealed that a strong correlation (r = 0.89) exists between the measurements by the developed system and DE (P < 0.05). ICG as the sixth vital sign can be measured simply and reliably by the developed system, but more detailed validation studies should be conducted to evaluate the system performance. There is a good promise to upgrade the system to a commercial version domestically for clinical use in the future.
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Affiliation(s)
- Hassan Yazdanian
- Department of Biomedical Engineering, University of Isfahan, Isfahan, Iran
| | - Amin Mahnam
- Department of Biomedical Engineering, University of Isfahan, Isfahan, Iran
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Edrisi
- Department of Electrical Engineering, University of Isfahan, Isfahan, Iran
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14
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Abstract
The year 2015 marked the 200th anniversary of the birth of Ignaz Semmelweis, the Hungarian physician who identified unhygienic practices of physicians as a major cause of childbed fever or puerperal sepsis. Although such practices have largely disappeared as a factor in the development of chorioamnionitis and postpartum or puerperal endometritis, it is appropriate that this article on sepsis in pregnancy acknowledges his contributions to maternal health. This review describes the incidence and mortality of sepsis in pregnancy, methods to identify and define sepsis in this population, including scoring systems, causes, and sites of infection during pregnancy and parturition and management guidelines.
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Affiliation(s)
- Ahmad Chebbo
- Department of Medicine, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, USA
| | - Susanna Tan
- Department of Medicine, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, USA
| | - Christelle Kassis
- Department of Medicine, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, USA
| | - Leslie Tamura
- Department of Medicine, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, USA; Department of Medicine, Advocate Lutheran General Hospital, 1775 Dempster Street, 6 South, Park Ridge, IL 60068, USA
| | - Richard W Carlson
- Department of Medicine, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, USA; Department of Medicine, Colleges of Medicine, University of Arizona, Phoenix, AZ, USA; Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
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15
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Martin E, Anyikam A, Ballas J, Buono K, Mantell K, Huynh-Covey T, Archer T. A validation study of electrical cardiometry in pregnant patients using transthoracic echocardiography as the reference standard. J Clin Monit Comput 2015; 30:679-86. [DOI: 10.1007/s10877-015-9771-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
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16
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Vårtun Å, Flo K, Wilsgaard T, Acharya G. Maternal functional hemodynamics in the second half of pregnancy: a longitudinal study. PLoS One 2015; 10:e0135300. [PMID: 26258418 PMCID: PMC4530890 DOI: 10.1371/journal.pone.0135300] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 07/20/2015] [Indexed: 01/04/2023] Open
Abstract
Objective Cardiovascular response to passive leg raising (PLR) is useful in assessing preload reserve, but it has not been studied longitudinally during pregnancy. We aimed to investigate gestational age associated serial changes in maternal functional hemodynamics and establish longitudinal reference ranges for the second half of pregnancy. Materials and Methods This was a prospective longitudinal study on 98 healthy pregnant women who were examined 3–5 times during 20–40 weeks of gestation (a total of 441 observations). Maternal cardiac function and systemic hemodynamics were assessed at baseline and 90 seconds after PLR using impedance cardiography (ICG). The main outcome measures were gestational age specific changes in ICG-derived variables of maternal cardiovascular function and functional hemodynamic response to PLR. Results Hemodynamic response to PLR varied during pregnancy. PLR led to an insignificant increase in stroke volume during 20+0 to 31+6 weeks, but later in gestation the stroke volume was slightly lower at PLR compared to baseline. PLR caused no significant change in cardiac output between 20+0 and 23+6 weeks and a significant decrease after 24+0 weeks. A decrease in heart rate, mean arterial pressure, and cardiac contractility was observed during PLR throughout the second half of pregnancy. Systemic vascular resistance was reduced by PLR up to 32+0 weeks, but increased slightly thereafter. Conclusion Healthy pregnant women appear to have limited preload reserve and reduced cardiac contractility, especially in the third trimester, which makes them vulnerable to fluid overload and cardiac failure.
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Affiliation(s)
- Åse Vårtun
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
- * E-mail:
| | - Kari Flo
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT- The Arctic University of Norway and Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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17
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McIntyre JPR, Ellyett KM, Mitchell EA, Quill GM, Thompson JM, Stewart AW, Doughty RN, Stone PR. Validation of thoracic impedance cardiography by echocardiography in healthy late pregnancy. BMC Pregnancy Childbirth 2015; 15:70. [PMID: 25886289 PMCID: PMC4389339 DOI: 10.1186/s12884-015-0504-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Assessment of stroke volume (SV) is often necessary in clinical and research settings. The clinically established method for SV assessment in pregnancy is echocardiography, but given its limitations, it is not always an appropriate measurement tool. Thoracic impedance cardiography (ICG) allows continuous, non-invasive SV assessment. However, SV determination relies on assumptions regarding the thoracic shape that may mean the algorithm is not valid in pregnancy. The available data regarding the validity of ICG against an established reference standard using modern SV algorithms are both limited and conflicting. We aimed to test the validity of ICG in a clinically realistic setting in late pregnancy using echocardiography. Methods Twenty-nine women in late pregnancy underwent standard echocardiography assessments with simultaneous ICG measurement. Agreement between devices was tested using Bland-Altman analysis. Results Bland-Altman analysis of the relationship between ICG and echocardiography demonstrated that the 95% limits of agreement exceeded acceptable or expected ranges. Measures of maternal and fetal anthropometry do not account for the lack of agreement. Conclusions Absolute values of SV as determined by ICG are not valid in pregnancy. Further work is required to examine the ability of ICG to assess relative changes in maternal haemodynamics in late pregnancy.
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Affiliation(s)
- Jordan P R McIntyre
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Level 12, Support Building, Auckland City Hospital, Private Bag 92019, Auckland, New Zealand. .,New Zealand Respiratory and Sleep Institute, Auckland, New Zealand.
| | - Kevin M Ellyett
- Respiratory Measurement Laboratory, Auckland District Health Board, Auckland, New Zealand.
| | - Edwin A Mitchell
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.
| | - Gina M Quill
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - John Md Thompson
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.
| | - Alistair W Stewart
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Level 12, Support Building, Auckland City Hospital, Private Bag 92019, Auckland, New Zealand.
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18
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Morris R, Sunesara I, Darby M, Novotny S, Kiprono L, Bautista L, Sawardecker S, Bofill J, Anderson B, Martin JN. Impedance cardiography assessed treatment of acute severe pregnancy hypertension: a randomized trial. J Matern Fetal Neonatal Med 2014; 29:171-6. [DOI: 10.3109/14767058.2014.995081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rachael Morris
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Imran Sunesara
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Marie Darby
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Sarah Novotny
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Luissa Kiprono
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Leody Bautista
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Sandip Sawardecker
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - James Bofill
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - Belinda Anderson
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
| | - James N. Martin
- Divisions of Maternal-Fetal Medicine and Biostatistics, Department of Obstetrics and Gynecology, University of Mississippi Medical Center (UMMC), Jackson, MS, USA
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19
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Sachs A, Aaronson J, Smiley R. The role of the anesthesiologist in the care of the parturient with cardiac disease. Semin Perinatol 2014; 38:252-9. [PMID: 25037515 DOI: 10.1053/j.semperi.2014.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Women with cardiac disease constitute a growing percentage of parturients, and in many series cardiac disease is the leading cause of maternal mortality. Involvement of anesthesiologists in the planning for and management of delivery in these women can improve the experience and potentially the outcome of these patients. Communication with the anesthesiology team about particularly complex cases is essential to avoid both medical complications and inter-disciplinary disagreements. The specific role and contributions of the anesthesiology team will depend significantly on the nature of the institution and the organization of the (obstetric) anesthesiology service.
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Affiliation(s)
- Adam Sachs
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 630 West 168th St, New York, NY 10032
| | - Jaime Aaronson
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 630 West 168th St, New York, NY 10032
| | - Richard Smiley
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 630 West 168th St, New York, NY 10032.
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20
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Vårtun Å, Flo K, Acharya G. Effect of passive leg raising on systemic hemodynamics of pregnant women: a dynamic assessment of maternal cardiovascular function at 22-24 weeks of gestation. PLoS One 2014; 9:e94629. [PMID: 24732308 PMCID: PMC3986105 DOI: 10.1371/journal.pone.0094629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/19/2014] [Indexed: 12/22/2022] Open
Abstract
Objective To investigate functional hemodynamic response to passive leg raising in healthy pregnant women and compare it with non-pregnant controls. Materials and Methods This was a prospective cross-sectional study with a case-control design. A total of 108 healthy pregnant women at 22–24 weeks of gestation and 54 non-pregnant women were included. Cardiac function and systemic hemodynamics were studied at baseline and 90 seconds after passive leg raising using non-invasive impedance cardiography. Main outcome measures Trends and magnitudes of changes in impedance cardiography derived parameters of cardiac function and systemic hemodynamics caused by passive leg raising, and preload responsiveness defined as >10% increase in stroke volume or cardiac output after passive leg raising compared to baseline. Results The hemodynamic parameters in both pregnant and non-pregnant women changed significantly during passive leg raising compared to baseline, but the magnitude and trend of change was similar in both groups. The stroke volume increased both in pregnant (p = 0.042) and non-pregnant (p = 0.018) women, whereas the blood pressure and systemic vascular resistance decreased (p<0.001) following passive leg raising in both groups. Only 14.8% of pregnant women and 18.5% of non-pregnant women were preload responsive and the difference between groups was not significant (p = 0.705). Conclusion Static measures of cardiovascular status are different between healthy pregnant and non-pregnant women, but the physiological response to passive leg raising is similar and not modified by pregnancy at 22–24 weeks of gestation. Whether physiological response to passive leg raising is different in earlier and later stages of pregnancy merit further investigation.
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Affiliation(s)
- Åse Vårtun
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
- * E-mail:
| | - Kari Flo
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø and Department of Obstetrics and Gynaecology University Hospital of Northern Norway, Tromsø, Norway
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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21
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Maternal Hemodynamics by Thoracic Impedance Cardiography for Normal Pregnancy and the Postpartum Period. Obstet Gynecol 2014; 123:318-324. [DOI: 10.1097/aog.0000000000000104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Staelens A, Tomsin K, Grieten L, Oben J, Mesens T, Spaanderman M, Jacquemyn Y, Gyselaers W. Non-invasive assessment of gestational hemodynamics: benefits and limitations of impedance cardiography versus other techniques. Expert Rev Med Devices 2014; 10:765-79. [DOI: 10.1586/17434440.2013.853466] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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