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Billig S, Zayat R, Ebeling A, Steffen H, Nix C, Hatam N, Schnöring H, Derwall M. Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work. Int J Cardiovasc Imaging 2021; 37:835-846. [PMID: 33048268 PMCID: PMC7969559 DOI: 10.1007/s10554-020-02053-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281-2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72-88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.
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Affiliation(s)
- Sebastian Billig
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Rashad Zayat
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Andreas Ebeling
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Henning Steffen
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Christoph Nix
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, 52074, Germany
| | - Nima Hatam
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Heike Schnöring
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Matthias Derwall
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany.
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Miyazaki E, Maeda T, Ito S, Oi A, Hotta N, Tsukinaga A, Kanazawa H, Ohnishi Y. Accuracy and Trending Ability of Cardiac Index Measured by the CNAP System in Patients Undergoing Abdominal Aortic Aneurysm Surgery. J Cardiothorac Vasc Anesth 2020; 35:1439-1446. [PMID: 32888805 DOI: 10.1053/j.jvca.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The CNAP system is a noninvasive monitor that provides a continuous arterial pressure waveform using an inflatable finger cuff. The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of noninvasive pulse contour monitors. The aim of this study was to evaluate the accuracy and trending ability of cardiac index derived by the CNAP system (CICN) in patients undergoing AAA surgery. DESIGN Prospective clinical study. SETTING Cardiac surgery operating room in a single cardiovascular center. PARTICIPANTS Twenty patients who underwent elective AAA surgery. INTERVENTIONS CICN and cardiac index measured using 3-dimensional images (CI3D) were determined simultaneously at 8 points during the surgery. At aortic clamping and unclamping, the authors tested the trending ability of CICN using 4-quadrant plot analysis and polar plot analysis. MEASUREMENTS AND MAIN RESULTS The authors found a wide limit of agreement between CICN and CI3D (percentage error: 85.0%). The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CICN-CI3D)/CI3D], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CICN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. CONCLUSIONS CICN is not interchangeable with CI3D in patients undergoing AAA surgery. The trending ability for CICN at aortic clamping and unclamping was below the acceptable limit. These inaccuracies might be secondary to the high systemic vascular resistance index during AAA surgery.
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Affiliation(s)
- Erika Miyazaki
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuma Maeda
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA.
| | - Shinya Ito
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ayako Oi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naoshi Hotta
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akito Tsukinaga
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroko Kanazawa
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Sumiyoshi M, Maeda T, Miyazaki E, Hotta N, Sato H, Hamaguchi E, Kanazawa H, Ohnishi Y, Kamei M. Accuracy of the ClearSight™ system in patients undergoing abdominal aortic aneurysm surgery. J Anesth 2019; 33:364-371. [DOI: 10.1007/s00540-019-02632-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/16/2019] [Indexed: 11/28/2022]
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Alruwaili F, Cluff K, Griffith J, Farhoud H. Passive Self Resonant Skin Patch Sensor to Monitor Cardiac Intraventricular Stroke Volume Using Electromagnetic Properties of Blood. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:1900709. [PMID: 30416893 PMCID: PMC6214405 DOI: 10.1109/jtehm.2018.2870589] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/29/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022]
Abstract
This paper focuses on the development of a passive, lightweight skin patch sensor that can measure fluid volume changes in the heart in a non-invasive, point-of-care setting. The wearable sensor is an electromagnetic, self-resonant sensor configured into a specific pattern to formulate its three passive elements (resistance, capacitance, and inductance). In an animal model, a bladder was inserted into the left ventricle (LV) of a bovine heart, and fluid was injected using a syringe to simulate stoke volume (SV). In a human study, to assess the dynamic fluid volume changes of the heart in real time, the sensor frequency response was obtained from a participant in a 30° head-up tilt (HUT), 10° HUT, supine, and 10° head-down tilt positions over time. In the animal model, an 80-mL fluid volume change in the LV resulted in a downward frequency shift of 80.16 kHz. In the human study, there was a patterned frequency shift over time which correlated with ventricular volume changes in the heart during the cardiac cycle. Statistical analysis showed a linear correlation \documentclass[12pt]{minimal}
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\end{document} and 0.87 between the frequency shifts and fluid volume changes in the LV of the bovine heart and human participant, respectively. In addition, the patch sensor detected heart rate in a continuous manner with a 0.179% relative error compared to electrocardiography. These results provide promising data regarding the ability of the patch sensor to be a potential technology for SV monitoring in a non-invasive, continuous, and non-clinical setting.
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Affiliation(s)
- Fayez Alruwaili
- Biomedical Engineering DepartmentWichita State UniversityWichitaKS67260USA
| | - Kim Cluff
- Biomedical Engineering DepartmentWichita State UniversityWichitaKS67260USA
| | - Jacob Griffith
- Biomedical Engineering DepartmentWichita State UniversityWichitaKS67260USA
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Maeda T, Hattori K, Sumiyoshi M, Kanazawa H, Ohnishi Y. Accuracy and trending ability of the fourth-generation FloTrac/Vigileo System™ in patients undergoing abdominal aortic aneurysm surgery. J Anesth 2018; 32:387-393. [DOI: 10.1007/s00540-018-2491-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
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Watanabe S, Fish K, Kovacic JC, Bikou O, Leonardson L, Nomoto K, Aguero J, Kapur NK, Hajjar RJ, Ishikawa K. Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure. J Am Heart Assoc 2018. [PMID: 29514806 PMCID: PMC5907535 DOI: 10.1161/jaha.117.006462] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Delivering therapeutic materials, like stem cells or gene vectors, to the myocardium is difficult in the setting of ischemic heart failure because of decreased coronary flow and impaired microvascular perfusion (MP). The aim of this study was to determine if mechanical left ventricular (LV) unloading with the Impella increases coronary flow and MP in a subacute myocardial infarction. Methods and Results Anterior transmural myocardial infarction (infarct size, 26.0±3.4%) was induced in Yorkshire pigs. At 2 weeks after myocardial infarction, 6 animals underwent mechanical LV unloading by Impella, whereas 4 animals underwent pharmacological LV unloading using sodium nitroprusside for 2 hours. LV unloading with Impella significantly reduced end‐diastolic volume (−16±11mL, P=0.02) and end‐diastolic pressure (EDP; −32±23 mm Hg, P=0.03), resulting in a significant decrease in LV end‐diastolic wall stress (EDWS) (infarct: 71.6±14.7 to 43.3±10.8 kdynes/cm2 [P=0.02]; remote: 66.6±20.9 to 40.6±13.3 kdynes/cm2 [P=0.02]). Coronary flow increased immediately and remained elevated after 2 hours in Impella‐treated pigs. Compared with the baseline, MP measured by fluorescent microspheres significantly increased within the infarct zone (109±81%, P=0.003), but not in the remote zone. Although sodium nitroprusside effectively reduced LV‐EDWS, 2 (50%) of sodium nitroprusside–treated pigs developed profound systemic hypotension. A significant correlation was observed between the infarct MP and EDWS (r2=0.43, P=0.03), suggesting an important role of EDWS in regulating MP during LV unloading in the infarcted myocardium. Conclusions LV unloading using an Impella decreased EDWS and increased infarct MP without hemodynamic decompensation. Mechanical LV unloading is a novel and efficient approach to increase infarct MP in patients with subacute myocardial infarction.
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Affiliation(s)
- Shin Watanabe
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth Fish
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jason C Kovacic
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olympia Bikou
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lauren Leonardson
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Koichi Nomoto
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaume Aguero
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY.,Hospital Universitari i Politecnic La Fe, Valencia, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | | | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY
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Hattori K, Maeda T, Masubuchi T, Yoshikawa A, Ebuchi K, Morishima K, Kamei M, Yoshitani K, Ohnishi Y. Accuracy and Trending Ability of the Fourth-Generation FloTrac/Vigileo System in Patients With Low Cardiac Index. J Cardiothorac Vasc Anesth 2017; 31:99-104. [DOI: 10.1053/j.jvca.2016.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Indexed: 11/11/2022]
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Maeda T, Sakurai R, Nakagawa K, Morishima K, Maekawa M, Furumoto K, Kono T, Egawa A, Kubota Y, Kato S, Okamura H, Yoshitani K, Ohnishi Y. Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured by Three-Dimensional Echocardiography Can Predict Decreases in Brain Natriuretic Peptide. J Cardiothorac Vasc Anesth 2016; 30:599-605. [DOI: 10.1053/j.jvca.2015.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 11/11/2022]
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Maeda T, Yoshitani K, Inatomi Y, Ohnishi Y. Inaccuracy of the FloTrac/Vigileo™ System in Patients With Low Cardiac Index. J Cardiothorac Vasc Anesth 2014; 28:1521-6. [DOI: 10.1053/j.jvca.2014.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Indexed: 11/11/2022]
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van Hout GPJ, de Jong R, Vrijenhoek JEP, Timmers L, Duckers HJ, Hoefer IE. Admittance-based pressure-volume loop measurements in a porcine model of chronic myocardial infarction. Exp Physiol 2013; 98:1565-75. [DOI: 10.1113/expphysiol.2013.074179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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