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Lai CJ, Shih CC, Huang HH, Chien MH, Wu MS, Cheng YJ. Detecting Volemic, Cardiac, and Autonomic Responses From Hypervolemia to Normovolemia via Non-Invasive ClearSight Hemodynamic Monitoring During Hemodialysis: An Observational Investigation. Front Physiol 2022; 13:775631. [PMID: 35574491 PMCID: PMC9095841 DOI: 10.3389/fphys.2022.775631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Unstable hemodynamics are not uncommon during hemodialysis (HD), which involves a rapid volume depletion, taking the patient from hypervolemia toward euvolemia. Since uremic patients commonly have cardiovascular comorbidities, hemodynamic changes during HD may reflect interactions among the volemic, cardiac, and autonomic responses to gradual volume depletion during ultrafiltration. Accurate identification of inappropriate responses helps with precisely managing intradialytic hypotension. Recently, the non-invasive ClearSight was reported to be able to detect causes of intraoperative hypotension. In this prospective observational study, we aimed to determine whether ClearSight could be used to detect patterns in stroke volemic, cardiac, and vasoreactive responses during HD. Methods: ClearSight was used to monitor chronic stable patients receiving maintenance HD. Data of mean arterial blood pressure (MAP), heart rate (HR), stroke volume index (SVI), cardiac index (CI), and calculated systemic vascular resistance index (SVRI) were obtained and analyzed to examine patterns in volemic, cardiac, and vasoreactive changes from T0 (before HD) until T8 in 30-min intervals (total 4 h). Results: A total of 56 patients with a mean age of 60.5 years were recruited, of which 40 of them were men. The average ultrafiltration volume at T8 was 2.1 ± 0.8 L. The changes in MAP and HR from T0 to T8 were non-significant. SVI at T7 was significantly lower than that at T1, T2, and T3. CI at T4 to T8 was significantly lower than that at T0. SVRI was significantly higher at T3 to T8 than at T0. Pearson's correlation coefficients between SVI and CI and between SVRI and MAP were positive at all time points. The correlation coefficients between SVRI and SVI and between CI and SVRI were significant and negative for all time points. Conclusion: ClearSight was able to detect patterns in hypervolemia during HD and was well tolerated for 4 h. CI decreased significantly after T4, with slightly decreased SVI. Ultrafiltration volume was not correlated with changes in SVI or CI. The vascular tone increased significantly, and this counteracted the reduced cardiac output after T4. With simultaneous monitoring on SVI, CI, and SVRI during HD, therefore, hypotension could be detected and managed by reducing the filtration rate or administering inotrope or vasopressors. Trial Registration: clinicaltrials.gov, ID: NCT03901794.
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Affiliation(s)
- Chih-Jun Lai
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.,Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chih Shih
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsing-Hao Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hung Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiou Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
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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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Wu HK, Chang MY, Cheng HM, Hsu PC, Lo LC, Chen LC, Lin KP, Chang HH. Low central blood pressure and sympathetic activity predispose for the development of intradialytic hypotension. Medicine (Baltimore) 2021; 100:e25299. [PMID: 33832099 PMCID: PMC8036036 DOI: 10.1097/md.0000000000025299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
Intradialytic hypotension (IDH) may lead to a poor life quality and was associated with cardiovascular mortality in patients under hemodialysis. This study investigated the autonomic nerve and cardiovascular function in the IDH episodes.In this case-control study, 70 end stage renal disease patients (198 visits) were recruited. Pulse wave analysis and heart rate variability were evaluated before hemodialysis. Two definitions of IDH were confirmed by medical records. IDH-f indicated a drop of systolic blood pressure or mean arterial pressure, accompanied with symptoms; IDH-n indicated a low nadir systolic pressure during the hemodialysis. All parameters were evaluated for the possible predisposing factors under each definition.A total of 24 IDH-f and 37 IDH-n were noted in 177 visits. For both definitions, central pulse pressure seemed to be a consistent predisposing factor. Furthermore, lower sympathetic activity (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.35-0.87), lower pulse pressure (OR 0.95; 95% CI 0.92-0.98), and higher augmentation index (OR 17.36; 95% CI 1.48-204.10) were the possible predisposing factors for IDH-f. On the contrary, lower mean arterial pressure (OR 0.87; 95% CI 0.78-0.98) was identified as the possible factor for IDH-n.It was suggested that the lower central pulse pressure and sympathetic activity might be involved in the development of IDH.
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Affiliation(s)
- Han-Kuei Wu
- School of Post-Baccalaureate Chinese Medicine, China Medical University
- Department of Traditional Chinese Medicine, Kuang Tien General Hospital, Taichung
- Department of Chinese Medicine, China Medical University Hospital Taipei Branch, Taipei
| | - Ming-Yang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University, Taoyuan
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital
- Faculty of Medicine, and Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Po-Chi Hsu
- Department of Chinese Medicine, China Medical University Hospital Taipei Branch, Taipei
- School of Chinese Medicine, China Medical University
- Department of Chinese Medicine, China Medical University Hospital, Taichung
| | - Lun-Chien Lo
- School of Chinese Medicine, China Medical University
- Department of Chinese Medicine, China Medical University Hospital, Taichung
| | - Li-Chuan Chen
- Division of Translational Medicine, Department of Biomedical Sciences and Engineering, National Central University, Taoyuan
| | - Kang-Ping Lin
- Department of Electrical Engineering
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan
| | - Hen-Hong Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Traditional Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
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Matsuo M, Kojima S, Arisato T, Matsubara M, Koezuka R, Kishida M, Ogawa K, Inoue H, Yoshihara F. Hypocholesterolemia is a risk factor for reduced systemic vascular resistance reactivity during hemodialysis. Hypertens Res 2021; 44:988-995. [PMID: 33707756 DOI: 10.1038/s41440-021-00640-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/04/2023]
Abstract
Intradialytic hypotension (IDH) is associated with high mortality. Peripheral vascular resistance and circulating blood volume are important factors in IDH; however, the effects of hemodialysis (HD) on vascular resistance in IDH remain unclear. We herein performed a retrospective observational cohort study to investigate changes in and factors related to vascular resistance during HD. A total of 101 HD patients were divided into two groups (Decreased blood pressure (BP) during HD group: N = 19, Nondecreased BP group: N = 82), and cardiac output was measured with electrical velocimetry (AESCLON) for 3 h. The systemic vascular resistance index (SVRI) was significantly decreased in the Decreased BP group, while the cardiac index was similar in both groups. A multivariate regression analysis identified hypocholesterolemia as a predictor of reduced vascular resistance reactivity during HD. Furthermore, a correlation was found between changes in the SVRI and cholesterol levels in patients with a higher Geriatric Nutritional Risk Index (GNRI) but not in those with a lower GNRI. The present results suggest that hypocholesterolemia contributes to reducing systematic vascular resistance reactivity during HD, which is an important predictor of a reduction in BP during HD. The relationship between hypocholesterolemia and vascular resistance may involve mechanisms other than malnutrition.
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Affiliation(s)
- Miki Matsuo
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shiori Kojima
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Arisato
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaki Matsubara
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryo Koezuka
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masatsugu Kishida
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Ogawa
- Clinical Engineering Department, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Inoue
- Clinical Engineering Department, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Fumiki Yoshihara
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan.
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Lin YK, Kao CC, Tseng CH, Hsu CE, Lin YJ, Chen YC, Lin C, Huang CY. Noninvasive Hemodynamic Profiles during Hemodialysis in Patients with and without Heart Failure. Cardiorenal Med 2020; 10:243-256. [PMID: 32268337 DOI: 10.1159/000506470] [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] [Received: 08/05/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although the dynamics of blood pressure (BP) during dialysis provide information related to the control system, the prognosis and relationships between temporal changes in intradialytic hemodynamic regulation, BP, and decreased cardiac function remain largely unclear. METHODS Hemodynamic parameters, including heart rate (HR), stroke volume (SV), cardiac index, and systemic vascular resistance index, were recorded using a noninvasive hemodynamic device on a beat-by-beat basis in 40 patients on dialysis who were divided into three groups, i.e., those with and without BP lability and those with heart failure (HF). Statistical measurements, including mean, standard deviation, coefficient of variation (CV), and index of nonrandomness of each hemodynamic parameter were derived from the three different phases divided equally during dialysis and compared using 3×3 two-way mixed-model analysis of variance to determine the effects of the different stages of hemodialysis (HD), cardiac function, and intradialytic changes in BP on the hemodynamic parameters. In addition, multivariate Cox regression was performed to determine the association between the changes in the derived parameters and BP lability. RESULTS The average SV tended to decrease during HD in all groups (p = 0.041). A significant decrease was observed in the CV of SV between the first two stages of HD in patients with labile BP and HF when compared to those without labile BP (p = 0.037). Significant interactions between group and stage of the index of nonrandomness for HR were also noted; this index was significantly higher in patients without labile BP than in those with labile BP or HF (p = 0.048). A higher difference between the early and middle stages of HD for nonrandomness indexes of HR was an independent predictor of reduced BP lability during HD (HR = 0.844, 95% confidence interval 0.722-0.987, p = 0.034). CONCLUSIONS Increases in the CV of SV and the index of nonrandomness for HR during early-stage HD in response to decreased SV may be associated with better BP control during HD. This finding suggests that patients with more structurally meaningful hemodynamic control have a more favorable cardiovascular outcome.
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Affiliation(s)
- Ying-Kuang Lin
- Division of Nephrology, Department of Medicine, Taiwan Landseed International Hospital, Taoyuan City, Taiwan.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan.,Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan City, Taiwan
| | - Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi-Ho Tseng
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan.,Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan City, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ching-En Hsu
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan
| | - Yi-Je Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan
| | - You-Chuan Chen
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan, .,Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan City, Taiwan,
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
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Kao CC, Tseng CH, Lo MT, Lin YK, Hsu CY, Wu YL, Chen HH, Lin FY, Lin C, Huang CY. Alteration autonomic control of cardiac function during hemodialysis predict cardiovascular outcomes in end stage renal disease patients. Sci Rep 2019; 9:18783. [PMID: 31827106 PMCID: PMC6906395 DOI: 10.1038/s41598-019-55001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/20/2019] [Indexed: 11/09/2022] Open
Abstract
Dialysis-induced hemodynamic instability has been associated with increased risk of cardiovascular (CV) mortality. However, the control mechanisms beneath the dynamic BP changes and cardiac function during hemodialysis and subsequent CV events are not known. We hypothesize that the impaired hemodynamic control can be prognostic indicators for subsequent CV events in end stage renal diseaes (ESRD) patients. To explore the association of hemodynamic parameters and CV events in hemodialysis patients, we enrolled ESRD patients who received chronic hemodialysis without documented atherosclerotic cardiovascular disease and hemodynamic parameters were continuously obtained from the impedance cardiography during hemodialysis. A total of 35 patients were enrolled. 16 patients developed hospitalized CV events. The statistical properties [coefficient of variance (standard deviation / mean value; CoV)] of hourly beat-to-beat dynamics of hemodynamic parameters were calculated. The CoV of stroke volume (SV) and cardiac index (CI) between the 1st and 2nd hour of dialysis were significantly increased in patients without CV events compared to those with CV events. Higher CoV of SVdiff and CIdiff were significantly correlated with longer CV event-free survival, and the area under the receiver operating characteristic (ROC) curve showed fair overall discriminative power (0.783 and 0.796, respectively). The responses of hemodynamic control mechanisms can be independent predictive indexes for lower hospitalized CV events, which implies that these patients who have better autonomic control systems may have better CV outcomes.
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Affiliation(s)
- Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ho Tseng
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan.,Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan city, Taiwan
| | - Ying-Kuang Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan.,Division of Nephrology, Department of Medicine, Landseed International Hospital, Taoyuan city, Taiwan
| | - Chien-Yi Hsu
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yueh-Lin Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Feng-Yen Lin
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan. .,Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan city, Taiwan.
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan. .,Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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