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Bhatia A, Hanna J, Stuart T, Kasper KA, Clausen DM, Gutruf P. Wireless Battery-free and Fully Implantable Organ Interfaces. Chem Rev 2024; 124:2205-2280. [PMID: 38382030 DOI: 10.1021/acs.chemrev.3c00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Advances in soft materials, miniaturized electronics, sensors, stimulators, radios, and battery-free power supplies are resulting in a new generation of fully implantable organ interfaces that leverage volumetric reduction and soft mechanics by eliminating electrochemical power storage. This device class offers the ability to provide high-fidelity readouts of physiological processes, enables stimulation, and allows control over organs to realize new therapeutic and diagnostic paradigms. Driven by seamless integration with connected infrastructure, these devices enable personalized digital medicine. Key to advances are carefully designed material, electrophysical, electrochemical, and electromagnetic systems that form implantables with mechanical properties closely matched to the target organ to deliver functionality that supports high-fidelity sensors and stimulators. The elimination of electrochemical power supplies enables control over device operation, anywhere from acute, to lifetimes matching the target subject with physical dimensions that supports imperceptible operation. This review provides a comprehensive overview of the basic building blocks of battery-free organ interfaces and related topics such as implantation, delivery, sterilization, and user acceptance. State of the art examples categorized by organ system and an outlook of interconnection and advanced strategies for computation leveraging the consistent power influx to elevate functionality of this device class over current battery-powered strategies is highlighted.
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Affiliation(s)
- Aman Bhatia
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
| | - Jessica Hanna
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
| | - Tucker Stuart
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
| | - Kevin Albert Kasper
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
| | - David Marshall Clausen
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
| | - Philipp Gutruf
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
- Department of Electrical and Computer Engineering, The University of Arizona, Tucson, Arizona 85721, United States
- Bio5 Institute, The University of Arizona, Tucson, Arizona 85721, United States
- Neuroscience Graduate Interdisciplinary Program (GIDP), The University of Arizona, Tucson, Arizona 85721, United States
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Kong MG, Moon I, Seo HS, Suh J, Choi JY, Na JO, Kim EJ. Home Bioelectrical Impedance Analysis Management System in Patients With Heart Failure: Rationale and Study Design. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:22-27. [PMID: 38303915 PMCID: PMC10827698 DOI: 10.36628/ijhf.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 02/03/2024]
Abstract
Body fluid monitoring and management are essential to control dyspnea and prevent re-hospitalization in patients with chronic heart failure (HF). There are several methods to estimate and monitor patient's volume status, such as symptoms, signs, body weight, and implantable devices. However, these methods might be difficult to use for reasons that are slow to reflect body water change, inaccurate in specific patients' condition, or invasive. Bioelectrical impedance analysis (BIA) is a novel method for body water monitoring in patients with HF, and the value in prognosis has been proven in previous studies. We aim to determine the efficacy and safety of home BIA body water monitoring-guided HF treatment in patients with chronic HF. This multi-center, open-label, randomized control trial will enroll patients with HF who are taking loop diuretics. The home BIA group patients will be monitored for body water using a home BIA device and receive messages regarding their edema status and direction of additional diuretics usage or behavioral changes through the linked application system once weekly. The control group patients will receive the usual HF management. The primary endpoint is the change in N-terminal prohormone of brain natriuretic peptide levels from baseline after 12 weeks. This trial will provide crucial evidence for patient management with a novel home BIA body water monitoring system in patients with HF.
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Affiliation(s)
- Min Gyu Kong
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Inki Moon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jah Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Oh Na
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Jurek A, Krzesiński P, Uziębło-Życzkowska B, Witek P, Zieliński G, Kazimierczak A, Wierzbowski R, Banak M, Gielerak G. The patient's sex determines the hemodynamic profile in patients with Cushing disease. Front Endocrinol (Lausanne) 2023; 14:1270455. [PMID: 37886640 PMCID: PMC10598757 DOI: 10.3389/fendo.2023.1270455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Background Cushing disease (CD) may lead to accelerated cardiovascular remodeling and increased mortality. There are suspected differences in the mechanism of cardiovascular dysfunction between males and females with CD. The purpose of this study was to assess the effect of patient sex on the hemodynamic profile assessed via impedance cardiography and echocardiography in patients newly diagnosed with CD. Material and methods The 54 patients newly diagnosed with CD (mean age 41 years; 77.8% of females) who were included in this prospective clinical study underwent impedance cardiography to assess specific parameters (including systemic vascular resistance index [SVRI], total arterial compliance index [TACI], Heather index [HI], stroke index [SI], cardiac index [CI], velocity index [VI], and acceleration index [ACI]) and transthoracic echocardiography to assess heart chamber diameters and left ventricular systolic and diastolic function. Results Males with CD exhibited higher afterload, with higher SVRI (3,169.3 ± 731.8 vs. 2,339.3 ± 640.8 dyn*s*cm-5*m² in males and females, respectively; p=0.002), lower TACI (0.80 ± 0.30 vs. 1.09 ± 0.30 mL/mmHg*m2; p=0.008), and lower hemodynamic parameters of left ventricular function, with lower HI (9.46 ± 2.86 vs. 14.1 ± 5.06 Ohm/s2; p=0.0007), lower VI (35.1 ± 11.9 vs. 44.9 ± 13.1 1*1000-1*s-1; p=0.009), lower SI (36.5 ± 11.7 vs. 43.6 ± 9.57 mL/m2; p=0.04), lower CI (2.36 ± 0.46 vs. 3.17 ± 0.76 mL*m-2*min-1; p=0.0009), and lower ACI (50.4 ± 19.8 vs. 73.6 ± 25.0 1/100/s2; p=0.006). There were no significant differences between the sexes in left ventricular systolic or diastolic function assessed by echocardiography. Conclusion In comparison with females with CD, males with CD have a less favorable hemodynamic profile, with higher afterload and worse left ventricular function. Sex differences in cardiovascular system function should be taken into consideration in designing personalized diagnostic and therapeutic management of patients with CD.
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Affiliation(s)
- Agnieszka Jurek
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology, and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Zieliński
- Department of Neurosurgery, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Anna Kazimierczak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Robert Wierzbowski
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Małgorzata Banak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Medicine, Military Institute of Medicine – National Research Institute, Warsaw, Poland
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Pranskunas A, Gulbinaite E, Navickaite A, Pranskuniene Z. Differences in Hemodynamic Response to Passive Leg Raising Tests during the Day in Healthy Individuals: The Question of Normovolemia. Life (Basel) 2023; 13:1606. [PMID: 37511981 PMCID: PMC10381249 DOI: 10.3390/life13071606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The passive leg-raising (PLR) test was developed to predict fluid responsiveness and reduce fluid overload. However, the hemodynamic response of healthy individuals to the PLR test and how it changes during the day, between the morning and evening, after individuals have consumed food and fluids, has not been profoundly explored. This study aimed to compare the systemic hemodynamic changes in healthy individuals between morning and evening PLR tests. METHODS In this study, the PLR test was performed twice a day. The first PLR test was performed between 08h00 and 09h00 in the morning, while the second PLR test was performed between 20h00 and 21h00 in the evening. Hemodynamic parameters were measured using an impedance cardiography monitor, and a cutoff value of a 10% increase in stroke volume (SV) during the PLR test was used to differentiate between preload responders and non-responders. RESULTS We included 50 healthy volunteers in this study. When comparing the morning and evening PLR test results, we found no PLR-induced differences in heart rate (-3 [-8-2] vs. -2 [-8-4] beats/min, p = 0.870), SV (11 [5-22] vs. 12 [4-20] mL, p = 0.853) or cardiac output (0.7 [0.2-1.3] vs. 0.8 [0.1-1.4] L/min, p = 0.639). We also observed no differences in the proportion of preload responders during the PLR test between the morning and evening (64% vs. 66%, p = 0.99). However, there was a moderate agreement between the two PLR tests (morning and evening) (kappa = 0.429, p = 0.012). There was a moderate correlation between the changes in SV between the two PLR tests (rs = 0.50, p < 0.001). CONCLUSION In young, healthy individuals, we observed no change in the systemic hemodynamic responsiveness to the PLR test between the morning and evening, without restriction of fluid and food intake.
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Affiliation(s)
- Andrius Pranskunas
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu g. 2, 50161 Kaunas, Lithuania
| | - Egle Gulbinaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307 Kaunas, Lithuania
| | - Aiste Navickaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307 Kaunas, Lithuania
| | - Zivile Pranskuniene
- Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, Sukileliu pr. 13, 50166 Kaunas, Lithuania
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Sukileliu pr. 13, 50166 Kaunas, Lithuania
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Benouar S, Kedir-Talha M, Seoane F. Time-series NARX feedback neural network for forecasting impedance cardiography ICG missing points: a predictive model. Front Physiol 2023; 14:1181745. [PMID: 37346485 PMCID: PMC10280448 DOI: 10.3389/fphys.2023.1181745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
One of the crucial steps in assessing hemodynamic parameters using impedance cardiography (ICG) is the detection of the characteristic points in the dZ/dt ICG complex, especially the X point. The most often estimated parameters from the ICG complex are stroke volume and cardiac output, for which is required the left ventricular pre-ejection time. Unfortunately, for beat-to-beat calculations, the accuracy of detection is affected by the variability of the ICG complex subtypes. Thus, in this work, we aim to create a predictive model that can predict the missing points and decrease the previous work percentages of missing points to support the detection of ICG characteristic points and the extraction of hemodynamic parameters according to several existing subtypes. Thus, a time-series non-linear autoregressive model with exogenous inputs (NARX) feedback neural network approach was implemented to forecast the missing ICG points according to the different existing subtypes. The NARX was trained on two different datasets with an open-loop mode to ensure that the network is fed with correct feedback inputs. Once the training is satisfactory, the loop can be closed for multi-step prediction tests and simulation. The results show that we can predict the missing characteristic points in all the complexes with a success rate ranging between 75% and 88% in the evaluated datasets. Previously, without the NARX predictive model, the successful detection rate was 21%-30% for the same datasets. Thus, this work indicates a promising method and an accuracy increase in the detection of X, Y, O, and Z points for both datasets.
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Affiliation(s)
- Sara Benouar
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Instrumentation, Department of Instrumentation and Automatics, Institute of Electrical Engineering, University of Sciences and Technology Houari Boumediene, Bab Ezzouar, Algeria
| | - Malika Kedir-Talha
- Laboratory of Instrumentation, Department of Instrumentation and Automatics, Institute of Electrical Engineering, University of Sciences and Technology Houari Boumediene, Bab Ezzouar, Algeria
| | - Fernando Seoane
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Technology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Textile Technology, University of Borås, Borås, Sweden
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Gill J. Implantable Cardiovascular Devices: Current and Emerging Technologies for Remote Heart Failure Monitoring. Cardiol Rev 2023; 31:128-138. [PMID: 35349243 DOI: 10.1097/crd.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Heart failure remains a substantial socioeconomic burden to our health care system. With the aging of the population, the incidence is expected to rise in the ensuing years. Standard heart failure management strategies have failed to reduce hospitalizations and mortality. In patients with heart failure, remote hemodynamic monitoring with implantable devices provides essential data, which can be used in unison with standard patient management to reduce heart failure hospitalizations. This review will chronicle the important clinical trials of various implantable devices and describe the emerging technologies in remote heart failure management. Cardiovascular implantable electronic devices, namely implanted cardioverter-defibrillator and cardiac resynchronization therapy devices with defibrillator, have evolved beyond sole resynchronization and currently can deliver real-time cardiac hemodynamics. Clinical data regarding hemodynamic monitoring with implanted cardioverter-defibrillator and cardiac resynchronization therapy devices with defibrillator have not consistently demonstrated a reduction in heart failure or mortality benefit. However, there is promise in the future with the application of multiparameter diagnostic algorithms with these devices. The most efficacious implantable device has been the pulmonary artery pressure sensor, CardioMEMS. This device has been proven to be safe and shown to reduce heart failure hospitalizations. Moreover, multiple newly developed devices are currently under investigation after successful first-in-man studies.
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Affiliation(s)
- Jashan Gill
- From the Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Medicine, Northwestern McHenry Hospital, McHenry, IL
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Showkat I, Khanday FA, Beigh MR. A review of bio-impedance devices. Med Biol Eng Comput 2023; 61:927-950. [PMID: 36637716 DOI: 10.1007/s11517-022-02763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Abstract
Bio-impedance measurement analysis primarily refers to a safe and a non-invasive technique to analyze the electrical changes in living tissues on the application of low-value alternating current. It finds applications both in the biomedical and the agricultural fields. This paper concisely reviews the origin and measurement approaches for concepts and fundamentals of bio-impedance followed by a critical review on bio-impedance portable devices with main emphasis on the embedded system approach which is in demand due to its miniature size and present lifestyle preference of monitoring health in real time. The paper also provides a comprehensive review of various bio-impedance circuits with emphasis on the measurement and calibration techniques.
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Affiliation(s)
- Insha Showkat
- Department of Electronics and Instrumentation Technology, University of Kashmir, Hazratbal, Srinagar, Jammu and Kashmir, India
| | - Farooq A Khanday
- Department of Electronics and Instrumentation Technology, University of Kashmir, Hazratbal, Srinagar, Jammu and Kashmir, India.
| | - M Rafiq Beigh
- Department of Electronics, Govt. Degree College Sumbal, Sumbal, J&K, India
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Trybek P, Sobotnicka E, Wawrzkiewicz-Jałowiecka A, Machura Ł, Feige D, Sobotnicki A, Richter-Laskowska M. A New Method of Identifying Characteristic Points in the Impedance Cardiography Signal Based on Empirical Mode Decomposition. SENSORS (BASEL, SWITZERLAND) 2023; 23:675. [PMID: 36679466 PMCID: PMC9861967 DOI: 10.3390/s23020675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The accurate detection of fiducial points in the impedance cardiography signal (ICG) has a decisive impact on the proper estimation of diagnostic parameters such as stroke volume or cardiac output. It is, therefore, necessary to find an algorithm that is able to assess their positions with great precision. The solution to this problem is, however, quite challenging with regard to the high sensitivity of the ICG technique to the noise and varying morphology of the acquired signals. The aim of this study is to propose a novel method that allows us to overcome these limitations. The developed algorithm is based on Empirical Mode Decomposition (EMD)-an effective technique for processing and analyzing various types of non-stationary signals. We find high correlations between the results obtained from the algorithm and annotated by an expert. This, in turn, implies that the difference in estimation of the diagnostic-relevant parameters is small, which suggests that the method can automatically provide precise clinical information.
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Affiliation(s)
- Paulina Trybek
- Institute of Physics, Faculty of Science and Technology, University of Silesia in Katowice, 41-500 Chorzow, Poland
| | - Ewelina Sobotnicka
- Łukasiewicz Research Network—Krakow Institute of Technology, The Centre for Biomedical Engineering, Zakopianska Str. 73, 30-418 Krakow, Poland
| | - Agata Wawrzkiewicz-Jałowiecka
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Łukasz Machura
- Institute of Physics, Faculty of Science and Technology, University of Silesia in Katowice, 41-500 Chorzow, Poland
| | - Daniel Feige
- Łukasiewicz Research Network—Krakow Institute of Technology, The Centre for Biomedical Engineering, Zakopianska Str. 73, 30-418 Krakow, Poland
- PhD School, Silesian University of Technology, 2A Akademicka, 44-100 Gliwice, Poland
| | - Aleksander Sobotnicki
- Łukasiewicz Research Network—Krakow Institute of Technology, The Centre for Biomedical Engineering, Zakopianska Str. 73, 30-418 Krakow, Poland
| | - Monika Richter-Laskowska
- Institute of Physics, Faculty of Science and Technology, University of Silesia in Katowice, 41-500 Chorzow, Poland
- Łukasiewicz Research Network—Krakow Institute of Technology, The Centre for Biomedical Engineering, Zakopianska Str. 73, 30-418 Krakow, Poland
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Karpiel I, Richter-Laskowska M, Feige D, Gacek A, Sobotnicki A. An Effective Method of Detecting Characteristic Points of Impedance Cardiogram Verified in the Clinical Pilot Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22249872. [PMID: 36560238 PMCID: PMC9782651 DOI: 10.3390/s22249872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 05/12/2023]
Abstract
Accurate and reliable determination of the characteristic points of the impedance cardiogram (ICG) is an important research problem with a growing range of applications in the cardiological diagnostics of patients with heart failure (HF). The shapes of the characteristic waves of the ICG signal and the temporal location of the characteristic points B, C, and X provide significant diagnostic information. On this basis, essential diagnostic cardiological parameters can be determined, such as, e.g., cardiac output (CO) or stroke volume (SV). Although the importance of this problem is obvious, we face many challenges, including noisy signals and the big variability in the morphology, which altogether make the accurate identification of the characteristic points quite difficult. The paper presents an effective method of ICG points identification intended for conducting experimental research in the field of impedance cardiography. Its effectiveness is confirmed in clinical pilot studies.
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Affiliation(s)
- Ilona Karpiel
- Łukasiewicz Research Network, Institute of Medical Technology and Equipment, Roosevelt 118, 41-800 Zabrze, Poland
- Correspondence: ; Tel.: +48-(32)271-60-13
| | - Monika Richter-Laskowska
- Łukasiewicz Research Network, Institute of Medical Technology and Equipment, Roosevelt 118, 41-800 Zabrze, Poland
- Institute of Physics, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Daniel Feige
- Łukasiewicz Research Network, Institute of Medical Technology and Equipment, Roosevelt 118, 41-800 Zabrze, Poland
- PhD School, Silesian University of Technology, 2A Akademicka, 44-100 Gliwice, Poland
| | - Adam Gacek
- Łukasiewicz Research Network, Institute of Medical Technology and Equipment, Roosevelt 118, 41-800 Zabrze, Poland
| | - Aleksander Sobotnicki
- Łukasiewicz Research Network, Institute of Medical Technology and Equipment, Roosevelt 118, 41-800 Zabrze, Poland
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Wang Y, Xiao Y, Tang J, Liu Y, Li H, Peng Z, Xu D, Shen L. Effects of early phase 1 cardiac rehabilitation on cardiac function evaluated by impedance cardiography in patients with coronary heart disease and acute heart failure. Front Cardiovasc Med 2022; 9:958895. [PMID: 36093175 PMCID: PMC9449118 DOI: 10.3389/fcvm.2022.958895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of the study was to access the impact of phase 1 cardiac rehabilitation (CR) on cardiac function and hemodynamic changes in patients with coronary heart disease (CHD) and acute heart failure (AHF). Materials and methods A total of 98 patients with CHD and AHF were recruited and randomized into two groups. Control group received standard pharmacotherapy and CR group received standard pharmacotherapy combined phase 1 CR. NT-proBNP and hemodynamic parameters measured by impedance cardiography (ICG) were estimated at baseline and at the end of treatment period. Results Phase 1 CR combined routine medical treatment could lower NT-proBNP levels. The percentage of high-risk patients was significantly decreased in CR group, although the post-treatment NT-proBNP level between control group and CR group showed no significant differences. Similarly, most hemodynamic parameters improved in the CR group, but not in the control group, suggesting that phase 1 CR in combination with the standard pharmacotherapy improved hemodynamic characteristics by elevating cardiac output, ameliorating preload, improving systolic and diastolic function, and relieving afterload, although the post-treatment hemodynamic parameters showed no statistically significant differences between the control group and the CR group. Conclusion Phase 1 CR combined routine medication can improve cardiac function and hemodynamic characteristics in patients with CHD and AHF. Thus, recommendation of phase 1 CR to stable patients is necessary.
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Affiliation(s)
- Yishu Wang
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanchao Xiao
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jianjun Tang
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yutao Liu
- The First People’s Hospital of Xiangtan City, Xiangtan, China
| | - Hui Li
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zengjin Peng
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Danyan Xu
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Shen
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Li Shen,
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11
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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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12
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Spindelböck T, Ranftl S, von der Linden W. Cross-Entropy Learning for Aortic Pathology Classification of Artificial Multi-Sensor Impedance Cardiography Signals. ENTROPY 2021; 23:e23121661. [PMID: 34945967 PMCID: PMC8700029 DOI: 10.3390/e23121661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
An aortic dissection, a particular aortic pathology, occurs when blood pushes through a tear between the layers of the aorta and forms a so-called false lumen. Aortic dissection has a low incidence compared to other diseases, but a relatively high mortality that increases with disease progression. An early identification and treatment increases patients’ chances of survival. State-of-the-art medical imaging techniques have several disadvantages; therefore, we propose the detection of aortic dissections through their signatures in impedance cardiography signals. These signatures arise due to pathological blood flow characteristics and a blood conductivity that strongly depends on the flow field, i.e., the proposed method is, in principle, applicable to any aortic pathology that changes the blood flow characteristics. For the signal classification, we trained a convolutional neural network (CNN) with artificial impedance cardiography data based on a simulation model for a healthy virtual patient and a virtual patient with an aortic dissection. The network architecture was tailored to a multi-sensor, multi-channel time-series classification with a categorical cross-entropy loss function as the training objective. The trained network typically yielded a specificity of (93.9±0.1)% and a sensitivity of (97.5±0.1)%. A study of the accuracy as a function of the size of an aortic dissection yielded better results for a small false lumen with larger noise, which emphasizes the question of the feasibility of detecting aortic dissections in an early state.
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Affiliation(s)
- Tobias Spindelböck
- Institute of Theoretical and Computational Physics, Graz University of Technology, Petersgasse 16, 8010 Graz, Austria; (T.S.); (W.v.d.L.)
| | - Sascha Ranftl
- Institute of Theoretical and Computational Physics, Graz University of Technology, Petersgasse 16, 8010 Graz, Austria; (T.S.); (W.v.d.L.)
- Graz Center of Computational Engineering, Graz University of Technology, Krenngasse 37, 8010 Graz, Austria
- Correspondence:
| | - Wolfgang von der Linden
- Institute of Theoretical and Computational Physics, Graz University of Technology, Petersgasse 16, 8010 Graz, Austria; (T.S.); (W.v.d.L.)
- Graz Center of Computational Engineering, Graz University of Technology, Krenngasse 37, 8010 Graz, Austria
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13
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Xu SH, Zhang J, Zhang Y, Zhang P, Cheng GQ. Non-invasive cardiac output measurement by electrical cardiometry and M-mode echocardiography in the neonate: a prospective observational study of 136 neonatal infants. Transl Pediatr 2021; 10:1757-1764. [PMID: 34430424 PMCID: PMC8349957 DOI: 10.21037/tp-21-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Electrical cardiometry (EC) is a continuous, non-invasive method for measuring cardiac output (CO). This study investigates the correlation and consistency of CO values in newborns obtained by using EC and M-mode echocardiography (Teichholz formula). METHODS In this prospective observational study, simultaneous measurement of CO was implemented with EC (COec) and M-mode echocardiography (COm) in neonates. The absolute values of CO measured by the two methods were converted to Z-scores. Following that, Pears's correlation analyses and the Bland-Altman index were employed to analyze the correlation and consistency of COec Z-scores and COm Z-scores. RESULTS A total of 136 neonates (93 preterm infants) were enrolled in this study, and EC and M-mode echocardiography comparative studies were conducted 155 times. The mean value of COec and COm demonstrated significant statistical differences (P<0.001). A moderate correlation (r=0.601; P<0.001) was found between the two methods. The Bland-Altman index value was 3.2%, which remained less than 5% in the low birth weight (LBW) (2.1%), non-LBW (3.4%), spontaneous respiration (3.1%), nasal continuous positive airway pressure (nCPAP) (4.0%), mechanical ventilation (2.9%), hemodynamic significance of the patent ductus arteriosus (hsPDA) (4.3%), and non-hsPDA (3.7%) groups, respectively. CONCLUSIONS Although the absolute values of CO measured by EC and M-mode echocardiography were not interchangeable, the distribution of CO in EC and M-mode echocardiography was similar.
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Affiliation(s)
- Su-Hua Xu
- Neonatology Department, Children's Hospital of Fudan University, Shanghai, China
| | - Jing Zhang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Peng Zhang
- Neonatology Department, Children's Hospital of Fudan University, Shanghai, China
| | - Guo-Qiang Cheng
- Neonatology Department, Children's Hospital of Fudan University, Shanghai, China
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Benouar S, Hafid A, Kedir-Talha M, Seoane F. Classification of impedance cardiography dZ/dt complex subtypes using pattern recognition artificial neural networks. ACTA ACUST UNITED AC 2021; 66:515-527. [PMID: 34162027 DOI: 10.1515/bmt-2020-0267] [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: 10/09/2020] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
In impedance cardiography (ICG), the detection of dZ/dt signal (ICG) characteristic points, especially the X point, is a crucial step for the calculation of hemodynamic parameters such as stroke volume (SV) and cardiac output (CO). Unfortunately, for beat-to-beat calculations, the accuracy of the detection is affected by the variability of the ICG complex subtypes. Thus, in this work, automated classification of ICG complexes is proposed to support the detection of ICG characteristic points and the extraction of hemodynamic parameters according to several existing subtypes. A novel pattern recognition artificial neural network (PRANN) approach was implemented, and a divide-and-conquer strategy was used to identify the five different waveforms of the ICG complex waveform with output nodes no greater than 3. The PRANN was trained, tested and validated using a dataset from four volunteers from a measurement of eight electrodes. Once the training was satisfactory, the deployed network was validated on two other datasets that were completely different from the training dataset. As an additional performance validation of the PRANN, each dataset included four volunteers for a total of eight volunteers. The results show an average accuracy of 96% in classifying ICG complex subtypes with only a decrease in the accuracy to 83 and 80% on the validation datasets. This work indicates that the PRANN is a promising method for automated classification of ICG subtypes, facilitating the investigation of the extraction of hemodynamic parameters from beat-to-beat dZ/dt complexes.
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Affiliation(s)
- Sara Benouar
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria.,Department of Textile Technology, University of Borås, Borås, Sweden
| | - Abdelakram Hafid
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria.,Department of Textile Technology, University of Borås, Borås, Sweden
| | - Malika Kedir-Talha
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria
| | - Fernando Seoane
- Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,The Department of Medical Technology, Karolinska University Hospital, Stockholm,Sweden.,The Swedish School of Textiles, University of Borås, Borås, Sweden
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15
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Lander MM, Aldweib N, Abraham WT. Wireless Hemodynamic Monitoring in Patients with Heart Failure. Curr Heart Fail Rep 2021; 18:12-22. [PMID: 33420917 PMCID: PMC7796686 DOI: 10.1007/s11897-020-00498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/13/2022]
Abstract
Purpose of Review Wireless hemodynamic monitoring in heart failure patients allows for volume assessment without the need for physical exam. Data obtained from these devices is used to assist patient management and avoid heart failure hospitalizations. In this review, we outline the various devices, mechanisms they utilize, and effects on heart failure patients. Recent Findings New applications of these devices to specific populations may expand the pool of patients that may benefit. In the COVID-19 pandemic with a growing emphasis on virtual visits, remote monitoring can add vital ancillary data. Summary Wireless hemodynamic monitoring with a pulmonary artery pressure sensor is a highly effective and safe method to assess for worsening intracardiac pressures that may predict heart failure events, giving lead time that is valuable to keep patients optimized. Implantation of this device has been found to improve outcomes in heart failure patients regardless of preserved or reduced ejection fraction.
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Affiliation(s)
- Matthew M Lander
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, USA.
| | - Nael Aldweib
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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16
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Patra A, Thakkar PS, Makhoul M, Bada HS. Objective Assessment of Physiologic Alterations Associated With Hemodynamically Significant Patent Ductus Arteriosus in Extremely Premature Neonates. Front Pediatr 2021; 9:648584. [PMID: 33718311 PMCID: PMC7946992 DOI: 10.3389/fped.2021.648584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
Delay in closure of ductus arteriosus in postnatal life may lead to serious consequences and complications in an extremely premature neonate secondary to hemodynamic alterations in regional blood flow pattern in various organs. Despite the widespread recognition amongst neonatologists to identify a hemodynamically significant patent ductus arteriosus (hsPDA) early in the postnatal course, there is lack of consensus in its definition and thus the threshold to initiate treatment. Echocardiographic assessment of PDA shunt size and volume combined with neonatologists' impression of clinical significance is most frequently used to determine the need for treatment of PDA. Common clinical signs of hsPDA utilized as surrogate for decreased tissue perfusion may lag behind early echocardiographic signs. Although echocardiogram allows direct assessment of PDA shunt and hemodynamic alterations in the heart, it is limited by dependence on pediatric cardiologist availability, interobserver variation and isolated time point assessment. Electrical cardiometry (EC) is a non-invasive continuous real time measurement of cardiac output by applying changes in thoracic electrical impedance. EC has been validated in preterm newborns by concomitant transthoracic echocardiogram assessments and may be beneficial in studying changes in cardiac output in premature newborns with hsPDA. Alterations in perfusion index derived from continuous pulse oximetry monitoring has been used to study changes in cardiac performance and tissue perfusion in infants with PDA. Near infrared spectroscopy (NIRS) has been used to objectively and continuously assess variations in renal, mesenteric, and cerebral oxygen saturation and thus perfusion changes due to diastolic vascular steal from hsPDA in preterm neonates. Doppler ultrasound studies measuring resistive indices in cerebral circulation indicate disturbance in cerebral perfusion secondary to ductal steal. With recent trends of change in practice toward less intervention in care of preterm newborn, treatment strategy needs to be targeted for select preterm population most vulnerable to adverse hemodynamic effects of PDA. Integration of these novel ways of hemodynamic and tissue perfusion assessment in routine clinical care may help mitigate the challenges in defining and targeting treatment of hsPDA thereby improving outcomes in extremely premature neonates.
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Affiliation(s)
- Aparna Patra
- Division of Neonatology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Pratibha S Thakkar
- Division of Neonatology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Majd Makhoul
- Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Henrietta S Bada
- Division of Neonatology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
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17
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Sumbel L, Annamalai MR, Wats A, Salameh M, Agarwal A, Bhalala U. Noninvasive Cardiac Output Monitoring Using Electrical Cardiometry and Outcomes in Critically Ill Children. J Pediatr Intensive Care 2020; 11:114-119. [DOI: 10.1055/s-0040-1718867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023] Open
Abstract
AbstractCardiac output (CO) measurement is an important element of hemodynamic assessment in critically ill children and existing methods are difficult and/or inaccurate. There is insufficient literature regarding CO as measured by noninvasive electrical cardiometry (EC) as a predictor of outcomes in critically ill children. We conducted a retrospective chart review in children <21 years, admitted to our pediatric intensive care unit (PICU) between July 2018 and November 2018 with acute respiratory failure and/or shock and who were monitored with EC (ICON monitor). We collected demographic information, data on CO measurements with EC and with transthoracic echocardiography (TTE), and data on ventilator days, PICU and hospital days, inotrope score, and mortality. We analyzed the data using Chi-square and multiple linear regression analysis. Among 327 recordings of CO as measured by EC in 61 critically ill children, the initial, nadir, and median CO (L/min; median [interquartile range (IQR)]) were 3.4 (1.15, 5.6), 2.39 (0.63, 4.4), and 2.74 (1.03, 5.2), respectively. Low CO as measured with EC did not correlate well with TTE (p = 0.9). Both nadir and mean CO predicted ventilator days (p = 0.05 and 0.01, respectively), and nadir CO was correlated with peak inotrope score (correlation coefficient of –0.3). In our cohort of critically ill children with respiratory failure and/or shock, CO measured with EC did not correlate with TTE. Both nadir and median CO measured with EC predicted outcomes in critically ill children.
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Affiliation(s)
- Lydia Sumbel
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - Muthiah R. Annamalai
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, Texas, United States
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas, United States
| | - Aanchal Wats
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, Texas, United States
| | - Mohammed Salameh
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, Texas, United States
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas, United States
| | - Arpit Agarwal
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, Texas, United States
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas, United States
| | - Utpal Bhalala
- Department of Pediatrics, The Children's Hospital of San Antonio, San Antonio, Texas, United States
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas, United States
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18
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Jeong IC, Bychkov D, Searson PC. Wearable Devices for Precision Medicine and Health State Monitoring. IEEE Trans Biomed Eng 2020; 66:1242-1258. [PMID: 31021744 DOI: 10.1109/tbme.2018.2871638] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Wearable technologies will play an important role in advancing precision medicine by enabling measurement of clinically-relevant parameters describing an individual's health state. The lifestyle and fitness markets have provided the driving force for the development of a broad range of wearable technologies that can be adapted for use in healthcare. Here we review existing technologies currently used for measurement of the four primary vital signs: temperature, heart rate, respiration rate, and blood pressure, along with physical activity, sweat, and emotion. We review the relevant physiology that defines the measurement needs and evaluate the different methods of signal transduction and measurement modalities for the use of wearables in healthcare.
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19
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Bonora BM, Vigili de Kreutzenberg S, Avogaro A, Fadini GP. Effects of the SGLT2 inhibitor dapagliflozin on cardiac function evaluated by impedance cardiography in patients with type 2 diabetes. Secondary analysis of a randomized placebo-controlled trial. Cardiovasc Diabetol 2019; 18:106. [PMID: 31412874 PMCID: PMC6694690 DOI: 10.1186/s12933-019-0910-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIMS Cardiovascular outcome trials have documented a strong benefit of sodium glucose cotransporter-2 inhibitors (SGLT2i) on the risk of hospitalization for heart failure (HF) in patients with type 2 diabetes (T2D) with or without established cardiovascular disease or prior history of HF. The mechanisms, however, are not entirely clear. We aimed to evaluate whether treatment with SGLT2i affected cardiac function using impedance cardiography (ICG) in a randomized placebo-controlled trial. MATERIALS AND METHODS Thirty-three patients with T2D were randomized to receive blind dapagliflozin 10 mg or matching placebo for 12-week on top of their ongoing glucose lowering medication regimen. Cardiac function was evaluated by resting ICG at baseline and at the end of the 12-week treatment period. ICG is a non-invasive technology based on the continuous measurement of thoracic electrical conductivity to process a cardiodynamic parameters related to fluid content, blood flow, cardiac function, and circulatory function. We also evaluated changes in glycaemic control, blood pressure, and body weight. RESULTS Thirty-one patients completed the study, 1 was excluded because ICG data was missing. Patients included in the final analysis were on average 63.4-year-old, with a known diabetes duration of 14.1 years and a baseline HbA1c of 8.2% (66 mmol/mol). 63.3% of patients had established cardiovascular disease (symptomatic or asymptomatic) and 36.7% had microangiopathy, but none had a prior history of HF. After 12 weeks, patients randomized to dapagliflozin, as compared to those randomized to placebo, showed improvements in HbA1c (- 1.2%; 13 mmol/mol), systolic blood pressure (- 3.7 mmHg), and body weight (- 3.3 kg). Based on ICG, in both groups, we detected no significant change in parameters of blood flow (stroke volume, cardiac output, cardiac index), systolic function (ejection fraction, acceleration and velocity indexes, systolic time ratio), circulatory function (systemic vascular resistance index), and fluid status (thoracic fluid content) after treatment. CONCLUSION This is the first study exploring cardiac effects of SGLT2i using ICG in T2D. We observed no change in cardiac function parameters estimated by ICG in T2D patients who received dapagliflozin versus placebo for 12 weeks. Trial registration ClinicalTrial.gov NCT02327039. Registered 30 December 2014.
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Affiliation(s)
| | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
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20
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Chabin X, Taghli-Lamallem O, Mulliez A, Bordachar P, Jean F, Futier E, Massoullié G, Andonache M, Souteyrand G, Ploux S, Boirie Y, Richard R, Citron B, Lusson JR, Godet T, Pereira B, Motreff P, Clerfond G, Eschalier R. Bioimpedance analysis is safe in patients with implanted cardiac electronic devices. Clin Nutr 2018. [PMID: 29525512 DOI: 10.1016/j.clnu.2018.02.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS There is an increase in the number of patients worldwide with cardiac implantable electronic devices (CIEDs). Current medical practice guidelines warn against performing bioimpedance analysis (BIA) in this group of patients in order to avoid any electromagnetic interference. These recommendations restrict using the BIA in patients undergoing heart failure or with nutrition disorders in whom BIA could be of major interest in detecting peripheral congestion and to help guide treatment. The present study was conducted to evaluate whether BIA caused electromagnetic interference in patients having CIEDs. METHODS Patient enrollment was conducted during routine face-to-face consultations for scheduled CIEDs interrogations. Device battery voltage, lead impedance, pacing thresholds and device electrograms were recorded before and after each BIA measurement to detect any electromagnetic interference or oversensing. RESULTS A total of 200 patients were enrolled. During BIA, no significant changes in battery voltage, lead impedance or pacing thresholds were detected, nor were there any inappropriate over- or undersensing observed in intracardiac electrograms. Furthermore, 6- and 12-month follow-up did not reveal any changes in CIEDs. CONCLUSIONS This study shows no interference in patients equipped with CIEDs and suggests that BIA can be securely performed in these patients. Trial registered under the identifier NCT03045822.
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Affiliation(s)
- Xavier Chabin
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Ouarda Taghli-Lamallem
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Direction), F-63000 Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Frédéric Jean
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Perioperative Medicine, Anesthesiology and Critical Care Medicine, Estaing Hospital, University Hospital of Clermont-Ferrand and CNRS, Inserm U1103, GreD, Clermont-Ferrand, France
| | - Grégoire Massoullié
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Marius Andonache
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Géraud Souteyrand
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Yves Boirie
- Nutrition Department, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Ruddy Richard
- Nutrition Department, CHU Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Bernard Citron
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Jean-R Lusson
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Thomas Godet
- Department of Perioperative Medicine, Anesthesiology and Critical Care Medicine, Estaing Hospital, University Hospital of Clermont-Ferrand and CNRS, Inserm U1103, GreD, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics Unit (Clinical Research and Innovation Direction), F-63000 Clermont-Ferrand, France
| | - Pascal Motreff
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Guillaume Clerfond
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France
| | - Romain Eschalier
- Université Clermont Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France.
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21
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Karakitsos DN, Patrianakos AP, Paraskevopoulos A, Parthenakis FI, Tzenakis N, Fourtounas C, Daphnis EK, Vardas PE. Impedance Cardiography Derived Cardiac Output in Hemodialysis Patients: A Study of Reproducibility and Comparison with Echocardiography. Int J Artif Organs 2018; 29:564-72. [PMID: 16841284 DOI: 10.1177/039139880602900604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hemodialysis patients experience a variety of hemodynamic abnormalities that contribute to cardiovascular disease mortality which is the leading cause of death in these patients. Impedance cardiography has been utilized in order to monitor cardiac hemodynamics with lower cost and inconvenience, but it has not been appropriately validated in the hemodialysis population. Aim We repeatedly used impedance cardiography to assess short- (48 hours) and long-term (15 days) reproducibility of cardiac output measurements and we compared baseline impedance cardiography measurements with echocardiographic measurements. Patients and Methods We studied 109 stable hemodialysis patients, aged 59.70 ± 11.97 years being on hemodialysis for 67.59 ± 40.15 months, on a non-dialysis day. Cardiac output was obtained with the BioZ impedance cardiography system (Cardiodynamics, San Diego, Ca, USA). Baseline echocardiography was performed using a Hewlett-Packard Sonos 2500 (Andover, Mass., USA). Results The values of impedance cardiography derived cardiac output were 5.28 ± 0.79, 5.27 ± 0.75 and 5.25 ± 0.74 l/min at baseline (107 patients), 48 hours (107 patients) and 15 days (98 patients) respectively, showing high reproducibility. Bland and Altman analysis estimated that bias at 48 hours and at 15 days were: −0.013 (95% confidence intervals = −0.045 to 0.019) and 0.028, (95% confidence intervals = −0.044 to 0.101), respectively. In addition baseline impedance cardiography derived cardiac output was significantly correlated with the echocardiographic derived cardiac output (r = 0.9, p < 0.0001). Conclusion Impedance cardiography is a simple non invasive technique for cardiac output estimation in hemodialysis patients which has high reproducibility when performed under controlled conditions, and is closely correlated with echocardiographic measurements of cardiac output.
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Affiliation(s)
- D N Karakitsos
- Department of Nephrology, Heraklion University Hospital, Crete - Greece
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22
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Benouar S, Hafid A, Attari M, Kedir-Talha M, Seoane F. Systematic Variability in ICG Recordings Results in ICG Complex Subtypes - Steps Towards the Enhancement of ICG Characterization. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2018; 9:72-82. [PMID: 33584923 PMCID: PMC7852018 DOI: 10.2478/joeb-2018-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 06/12/2023]
Abstract
The quality of an impedance cardiography (ICG) signal critically impacts the calculation of hemodynamic parameters. These calculations depend solely on the identification of ICG characteristic points on the ABEXYOZ complex. Unfortunately, contrary to the relatively constant morphology of the PQRST complex in electrocardiography, the waveform morphology of ICG data is far from stationary, which causes difficulties in the accuracy of the automated detection of characteristic ICG points. This study evaluated ICG recordings obtained from 10 volunteers. The results indicate that there are several different waveforms for the ABEXYOZ complex; there are up to five clearly distinct waveforms for the ABEXYOZ complex in addition to those that are typically reported. The differences between waveform types increased the difficulty of detecting ICG points. To accurately detect all ICG points, the ABEXYOZ complex should be analyzed according to the corresponding waveform type.
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Affiliation(s)
- Sara Benouar
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria
- Department of Textile Technology, University of Borås, 50190, Borås, Sweden
| | - Abdelakram Hafid
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria
- Department of Textile Technology, University of Borås, 50190, Borås, Sweden
| | - Mokhtar Attari
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria
| | - Malika Kedir-Talha
- Laboratory of Instrumentation, University of Sciences and Technology Houari Boumediene, Algiers, Algeria
| | - Fernando Seoane
- Department of Textile Technology, University of Borås, 50190, Borås, Sweden
- Dept. for Clinical Science, Intervention and Technology, Karolinska Institute, 14186Stockholm, Sweden
- Dept. Biomedical Engineering, Karolinska University Hospital, 14186Stockholm, Sweden
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Bagal UR, Pandey PC, Naidu SMM, Hardas SP. Detection of opening and closing of the aortic valve using impedance cardiography and its validation by echocardiography. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa8bf5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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24
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Beat-to-beat estimation of stroke volume using impedance cardiography and artificial neural network. Med Biol Eng Comput 2017; 56:1077-1089. [DOI: 10.1007/s11517-017-1752-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
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Nederend I, Ten Harkel ADJ, Blom NA, Berntson GG, de Geus EJC. Impedance cardiography in healthy children and children with congenital heart disease: Improving stroke volume assessment. Int J Psychophysiol 2017; 120:136-147. [PMID: 28778397 DOI: 10.1016/j.ijpsycho.2017.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Stroke volume (SV) and cardiac output are important measures in the clinical evaluation of cardiac patients and are also frequently used in research applications. This study was aimed to improve SV scoring derived from spot-electrode based impedance cardiography (ICG) in a pediatric population of healthy volunteers and patients with a corrected congenital heart defect. METHODS 128 healthy volunteers and 66 patients participated. First, scoring methods for ambiguous ICG signals were optimized to improve agreement of B- and X-points with aortic valve opening/closure in simultaneously recorded transthoracic echocardiography (TTE). Building on the improved scoring of B- and X-points, the Kubicek equation for SV estimation was optimized by testing the agreement with the simultaneously recorded SV by TTE. Both steps were initially done in a subset of the sample of healthy children and then validated in the remaining subset of healthy children and in a sample of patients. RESULTS SV assessment by ICG in healthy children strongly improved (intra class correlation increased from 0.26 to 0.72) after replacing baseline thorax impedance (Z0) in the Kubicek equation by an equation (7.337-6.208∗dZ/dtmax), where dZ/dtmax is the amplitude of the ICG signal at the C-point. Reliable SV assessment remained more difficult in patients compared to healthy controls. CONCLUSIONS After proper adjustment of the Kubicek equation, SV assessed by the use of spot-electrode based ICG is comparable to that obtained from TTE. This approach is highly feasible in a pediatric population and can be used in an ambulatory setting.
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Affiliation(s)
- Ineke Nederend
- Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Nico A Blom
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Gary G Berntson
- Ohio State University, Department of Psychology, 1835 Neil Avenue, Columbus OH 43210, United States.
| | - Eco J C de Geus
- Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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Non-invasive cardiac output monitor validation study in pediatric cardiac surgery patients. J Clin Anesth 2017; 38:129-132. [DOI: 10.1016/j.jclinane.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 11/30/2022]
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Elwan MH, Hue J, Green SJ, Eltahan SM, Sims MR, Coats TJ. Thoracic electrical bioimpedance versus suprasternal Doppler in emergency care. Emerg Med Australas 2017; 29:391-393. [PMID: 28320068 DOI: 10.1111/1742-6723.12765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There are a number of cardiac output (CO) monitors that could potentially be used in the ED. Two of the most promising methods, thoracic electrical bioimpedance and suprasternal Doppler, have not been directly compared. The aim of this study was to investigate the feasibility of CO monitoring using suprasternal Doppler and bioimpedance in emergency care and compare haemodynamic data obtained from both monitors. METHODS Haemodynamic measurements were made on the same group of patients using bioimpedance (Niccomo, Medis, Germany) and suprasternal Doppler (USCOM, Sydney, Australia). RESULTS Usable CO data were obtained in 97% of patients by suprasternal Doppler and 87% by bioimpedance. The median CO obtained by Doppler was 3.4 L/min lower than bioimpedance. The stroke volume median was lower by 51 mL in Doppler. CONCLUSIONS These two methods of non-invasive cardiac monitoring are not interchangeable. The results suggest that the choice of non-invasive cardiac monitor is important, but the grounds on which to make this choice are not currently clear.
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Affiliation(s)
- Mohammed H Elwan
- Department of Emergency Medicine, Alexandria University, Alexandria, Egypt.,Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jeremy Hue
- Department of Physics, University of Leicester, Leicester, UK
| | - Samira J Green
- Emergency Department, Homerton University Hospital, London, UK
| | - Salah M Eltahan
- Department of Emergency Medicine, Alexandria University, Alexandria, Egypt
| | - Mark R Sims
- Department of Physics, University of Leicester, Leicester, UK
| | - Timothy J Coats
- Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Huygh J, Peeters Y, Bernards J, Malbrain MLNG. Hemodynamic monitoring in the critically ill: an overview of current cardiac output monitoring methods. F1000Res 2016; 5. [PMID: 28003877 PMCID: PMC5166586 DOI: 10.12688/f1000research.8991.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 01/12/2023] Open
Abstract
Critically ill patients are often hemodynamically unstable (or at risk of becoming unstable) owing to hypovolemia, cardiac dysfunction, or alterations of vasomotor function, leading to organ dysfunction, deterioration into multi-organ failure, and eventually death. With hemodynamic monitoring, we aim to guide our medical management so as to prevent or treat organ failure and improve the outcomes of our patients. Therapeutic measures may include fluid resuscitation, vasopressors, or inotropic agents. Both resuscitation and de-resuscitation phases can be guided using hemodynamic monitoring. This monitoring itself includes several different techniques, each with its own advantages and disadvantages, and may range from invasive to less- and even non-invasive techniques, calibrated or non-calibrated. This article will discuss the indications and basics of monitoring, further elaborating on the different techniques of monitoring.
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Affiliation(s)
- Johan Huygh
- ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium
| | - Yannick Peeters
- ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium
| | - Jelle Bernards
- ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium
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Shen H, Zhu Y, Qin KR. A theoretical computerized study for the electrical conductivity of arterial pulsatile blood flow by an elastic tube model. Med Eng Phys 2016; 38:1439-1448. [DOI: 10.1016/j.medengphy.2016.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/25/2016] [Accepted: 09/23/2016] [Indexed: 11/15/2022]
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Daralammouri Y, Ayoub K, Badrieh N, Lauer B. A hybrid approach for quantifying aortic valve stenosis using impedance cardiography and echocardiography. BMC Cardiovasc Disord 2016; 16:19. [PMID: 26800673 PMCID: PMC4722721 DOI: 10.1186/s12872-015-0155-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusion
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Effect of dancing and nutrition education on hemodynamic and autonomic status in adults with metabolic syndrome: a randomized controlled clinical trial. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hsu KH, Wu TW, Wang YC, Lim WH, Lee CC, Lien R. Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry. J Perinatol 2016; 36:481-5. [PMID: 26890553 DOI: 10.1038/jp.2016.2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/27/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Electrical cardiometry (EC) is an impedance-based monitor that provides noninvasive, real-time hemodynamic assessment. However, the reference values for neonates have not been established. STUDY DESIGN EC (Aesculon) was applied to hemodynamically stable preterm and term infants. Hemodynamic variables included cardiac output (CO), cardiac index (CI), stroke volume (SV) and heart rate (HR). Their gestational age (GA), weight and body surface area (BSA) were recorded. RESULTS A total of 280 neonates were studied. Their GA ranged from 26(5/7) to 41(4/7) weeks, weight 800 to 4420 g and BSA 0.07 to 0.26 m(2). CO was positively correlated to GA, weight and BSA (r=0.681, 0.822, 0.830, respectively; all P<0.001). Using regression analysis, CO was most significantly correlated to BSA. Mean CI was 2.55±0.37 l min(-1) per m(2). CONCLUSION Hemodynamic reference by EC is notably distinct among neonates of diverse maturity. CO is most closely correlated to BSA.
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Affiliation(s)
- K-H Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - T-W Wu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-C Wang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - W-H Lim
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - C-C Lee
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - R Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Edema index measured by bioelectrical impedance analysis as a predictor of fluid reduction needed to remove clinical congestion in acute heart failure. Int J Cardiol 2015; 201:190-2. [DOI: 10.1016/j.ijcard.2015.07.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/29/2015] [Indexed: 11/22/2022]
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Blohm ME, Obrecht D, Hartwich J, Mueller GC, Kersten JF, Weil J, Singer D. Impedance cardiography (electrical velocimetry) and transthoracic echocardiography for non-invasive cardiac output monitoring in pediatric intensive care patients: a prospective single-center observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:603. [PMID: 25407329 PMCID: PMC4261789 DOI: 10.1186/s13054-014-0603-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 10/20/2014] [Indexed: 11/23/2022]
Abstract
Introduction Electrical velocimetry (EV) is a type of impedance cardiography, and is a non-invasive and continuously applicable method of cardiac output monitoring. Transthoracic echocardiography (TTE) is non-invasive but discontinuous. Methods We compared EV with TTE in pediatric intensive care patients in a prospective single-center observational study. Simultaneous, coupled, left ventricular stroke volume measurements were performed by EV using an Aesculon® monitor and TTE (either via trans-aortic valve flow velocity time integral [EVVTI], or via M-mode [EVMM]). H0: bias was less than 10% and the mean percentage error (MPE) was less than 30% in Bland–Altman analysis between EV and TTE. If appropriate, data were logarithmically transformed prior to Bland–Altman analysis. Results A total of 72 patients (age: 2 days to 17 years; weight: 0.8 to 86 kg) were analyzed. Patients were divided into subgroups: organ transplantation (OTX, n =28), sepsis or organ failure (SEPSIS, n =16), neurological patients (NEURO, n =9), and preterm infants (PREM, n =26); Bias/MPE for EVVTI was 7.81%/26.16%. In the EVVTI subgroup analysis for OTX, NEURO, and SEPSIS, bias and MPE were within the limits of H0, whereas the PREM subgroup had a bias/MPE of 39.00%/46.27%. Bias/MPE for EVMM was 8.07%/37.26% where the OTX and NEURO subgroups were within the range of H0, but the PREM and SEPSIS subgroups were outside the range. Mechanical ventilation, non-invasive continuous positive airway pressure ventilation, body weight, and secondary abdominal closure were factors that significantly affected comparison of the methods. Conclusions This study shows that EV is comparable with aortic flow-based TTE for pediatric patients.
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Affiliation(s)
- Martin Ernst Blohm
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Denise Obrecht
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Jana Hartwich
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany. .,Current address: Department of Neurology, Elbe Kliniken Stade, Bremervörder Str. 111, Stade, 21682, Germany.
| | - Goetz Christoph Mueller
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Jan Felix Kersten
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Jochen Weil
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | - Dominique Singer
- Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
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Abstract
Heart failure is a complex clinical syndrome responsible for high morbidity and mortality in the world. Despite advances in the management of heart failure, the prognosis of these patients remains poor and there is a critical need for new treatment strategies improving the clinical outcomes. New approaches in heart failure therapies target cellular mechanisms, as well as mechanical and structural aspects of heart failure that are not addressed by recent therapies. These include abnormalities in molecular mechanisms, electrical conduction and ventricular remodeling. This review presents the pathophysiological basis, mechanisms of action and available clinical efficacy and safety data of drugs and mechanical therapies that are currently under development.
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Clinical utility of central venous saturation for the calculation of cardiac index in cardiac patients. J Card Fail 2014; 20:716-722. [PMID: 25038264 DOI: 10.1016/j.cardfail.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 04/17/2014] [Accepted: 07/10/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mixed venous saturation (MVS) obtained from the distal pulmonary artery (PA) during Swan-Ganz catheterization is the criterion standard for calculating cardiac output (CO) and cardiac index (CI) with the use of the Fick method. We think that calculating CI with the use of central venous saturation (CVS) instead of PA-MVS is both feasible and accurate. Earlier studies were small, enrolled heterogeneous patient populations, and resulted in inconsistent findings. METHODS All patients undergoing right heart catheterization from January 2011 to January 2012 in our catheterization lab with simultaneous measurements of MVS obtained from the distal PA and CVS obtained from the superior vena cava (SVC) or right atrium (RA) were included. Out of the 902 patients enrolled, we excluded patients (n = 50) who had known cardiac shunt or dialysis fistula, had duplicate medical records, or were septic. We calculated the CI with the use of the assumed Fick method using both MVS (criterion standard) and CVS (SVC or RA saturations) in the remaining 852 patients. We measured the correlation and the agreement between the 2 methods with the use of the Pearson correlation coefficient and Bland-Altman analysis. RESULTS Totals of 112 patients with simultaneous PA and RA saturation measurements (group I) and 740 patients with simultaneous PA and SVC saturation measurements (group II) were included. We found an excellent linear correlation between SVC and PA saturation (r = 0.928) and between RA and PA saturation (r = 0.95). There was also an excellent correlation between CI calculated with the use of PA saturation and CI calculated with the use of SVC (r = 0.87) or RA (r = 0.93) saturation. The mean bias of CVS-derived CI compared with MVS-derived CI (criterion standard) was -0.1 (95% limits of agreement [LOA] -1 to +0.77) in the SVC group and -0.006 (LOA -0.68 to +0.69) in the RA group. Patients with low CI had stronger correlation and smaller bias between the 2 methods compared with those with normal or high CI. The presence of baseline hypoxemia, valvular heart disease, or acute coronary syndrome had no significant effect on the correlation or the bias between the 2 methods. CONCLUSIONS In cardiac patients, CVS can be used as a surrogate to true MVS in the calculation of CI. This method is readily available in patients who have central venous access, and may aid in early goal-directed treatment when cardiogenic shock is suspected.
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Ulbrich M, Mühlsteff J, Leonhardt S, Walter M. Influence of physiological sources on the impedance cardiogram analyzed using 4D FEM simulations. Physiol Meas 2014; 35:1451-68. [DOI: 10.1088/0967-3334/35/7/1451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ulbrich M, Mühlsteff J, Sipilä A, Kamppi M, Koskela A, Myry M, Wan T, Leonhardt S, Walter M. The IMPACT shirt: textile integrated and portable impedance cardiography. Physiol Meas 2014; 35:1181-96. [PMID: 24846072 DOI: 10.1088/0967-3334/35/6/1181] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Measurement of hemodynamic parameters such as stroke volume (SV) via impedance cardiography (ICG) is an easy, non-invasive and inexpensive way to assess the health status of the heart. We present a possibility to use this technology for monitoring risk patients at home. The IMPACT Shirt (IMPedAnce Cardiography Textile) has been developed with integrated textile electrodes and textile wiring, as well as with portable miniaturized hardware. Several textile materials were characterized in vitro and in vivo to analyze their performance with regard to washability, and electrical characteristics such as skin-electrode impedance, capacitive coupling and subjective tactile feeling. The small lightweight hardware measures ECG and ICG continuously and transmits wireless data via Bluetooth to a mobile phone (Android) or PC for further analysis. A lithium polymer battery supplies the circuit and can be charged via a micro-USB. Results of a proof-of-concept trial show excellent agreement between SV assessed by a commercial device and the developed system. The IMPACT Shirt allows monitoring of SV and ECG on a daily basis at the patient's home.
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Affiliation(s)
- Mark Ulbrich
- RWTH Aachen University, Philips Chair for Medical Information Technology, Pauwelsstrasse 20, D-52074 Aachen, Germany
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Malik V, Subramanian A, Chauhan S, Hote M. Correlation of Electric Cardiometry and Continuous Thermodilution Cardiac Output Monitoring Systems. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjcs.2014.47016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matsuda Y, Kawate H, Shimada S, Matsuzaki C, Nagata H, Adachi M, Ohnaka K, Nomura M, Takayanagi R. Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS). Endocr J 2014; 61:571-5. [PMID: 24621777 DOI: 10.1507/endocrj.ej13-0471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment of pheochromocytoma is associated with a high risk of hemodynamic instability. To reduce the risk of perioperative complications, adequate medical treatment to normalize blood pressure and restore blood volume is required. Accurate evaluation of the circulating blood volume (CBV) in perioperative patients with pheochromocytoma is clinically important. In the present study, we adopted whole-body bioimpedance monitoring technique using the Non-Invasive Cardiac System (NICaS), which can non-invasively measure cardiac output (CO) values. NICaS-derived CO values were evaluated in eight preoperative patients with pheochromocytoma and were compared with simultaneous CBV values measured by a conventional indicator dilution method using (131)I-labeled human serum albumin. In these patients with pheochromocytoma, the NICaS-derived CO values were significantly correlated with the CBV values measured by (131)I-labeled human serum albumin (4.86 ± 1.05 L/min vs 4.79 ± 1.02 L; r = 0.906; P = 0.002). Sequential NICaS-derived CO values confirmed that CBV increased after preoperative treatment with an α-blocker, with or without volume loading. The results of this study indicate that NICaS can be used to accurately and non-invasively evaluate the hemodynamic status. By sequential monitoring of NICaS-derived CO values, we are able to confirm whether adequate CBV in a patient with pheochromocytoma is obtained by preoperative medical treatment with α-blockers or volume loading, to avoid perioperative complications.
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Affiliation(s)
- Yayoi Matsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Cove ME, Pinsky MR. Perioperative hemodynamic monitoring. Best Pract Res Clin Anaesthesiol 2013; 26:453-62. [PMID: 23351232 DOI: 10.1016/j.bpa.2012.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/10/2012] [Indexed: 02/08/2023]
Abstract
Hemodynamic monitoring is the cornerstone of perioperative anesthetic monitoring. In the unconscious patient, hemodynamic monitoring not only provides information relating to cardiac output, volume status and ultimately tissue perfusion, but also indicates depth of anesthesia and adequacy of pain control. In the 21st century the anesthesiologist has an array of devices to choose from. No single device provides a complete assessment of hemodynamic status, and the use of all devices in every situation is neither practical nor appropriate. This article aims to provide the reader with an overview of the devices currently available, and the information they provide, to assist anesthesiologists in the selection of the most appropriate devices for any given situation.
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Affiliation(s)
- Matthew E Cove
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Tomsin K, Mesens T, Molenberghs G, Peeters L, Gyselaers W. Characteristics of heart, arteries, and veins in low and high cardiac output preeclampsia. Eur J Obstet Gynecol Reprod Biol 2013; 169:218-22. [DOI: 10.1016/j.ejogrb.2013.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/09/2013] [Accepted: 03/26/2013] [Indexed: 11/25/2022]
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Tomsin K, Vriens A, Mesens T, Gyselaers W. Non-invasive cardiovascular profiling using combined electrocardiogram-Doppler ultrasonography and impedance cardiography: An experimental approach. Clin Exp Pharmacol Physiol 2013; 40:438-42. [DOI: 10.1111/1440-1681.12105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/27/2013] [Accepted: 04/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Annette Vriens
- Faculty of Medicine and Life Sciences; Hasselt University; Diepenbeek; Belgium
| | - Tinne Mesens
- Department of Obstetrics and Gynaecology; Ziekenhuis Oost-Limburg; Genk; Belgium
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Evolution of bioimpedance: a circuitous journey from estimation of physiological function to assessment of body composition and a return to clinical research. Eur J Clin Nutr 2013; 67 Suppl 1:S2-9. [PMID: 23299867 DOI: 10.1038/ejcn.2012.149] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Bioimpedance is the collective term that describes safe, non-invasive methods to measure the electrical responses to the introduction of a low-level, alternating current into a living organism, and the biophysical models to estimate body composition from bioelectrical measurements. Although bioimpedance techniques have been used for more than 100 years to monitor assorted biological components, the desire to translate bioelectrical measurements into physiological variables advanced the creation of empirical prediction models that produced inconsistent results. SUBJECTS/METHODS This paper succinctly reviews the origin, and critically evaluates the conceptual models and the implementation of bioimpedance in clinical research, including indirect assessment of assorted physiological functions and body composition (fluid volumes and fat-free mass), classification of hydration, regional fluid accumulation, prognosis in disease and wound healing. RESULTS Despite widespread and mounting interest in the use of bioimpedance to characterise body structure and function, most experimental findings reveal the limitations of existing physical models and reliance on multiple regression models for use in assessments of an individual. CONCLUSIONS Contemporary applications of bioimpedance emphasise the value of bioimpedance variables per se in some novel biomedical applications with the objective of identifying opportunities for future outcome-based research.
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Summers RL, Baker SD, Sterling SA, Porter JM, Jones AE. Characterization of the spectrum of hemodynamic profiles in trauma patients with acute neurogenic shock. J Crit Care 2013; 28:531.e1-5. [PMID: 23566731 DOI: 10.1016/j.jcrc.2013.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/19/2013] [Accepted: 02/04/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Neurogenic shock considered a distributive type of shock secondary to loss of sympathetic outflow to the peripheral vasculature. In this study, we examine the hemodynamic profiles of a series of trauma patients with a diagnosis of neurogenic shock. METHODS Hemodynamic data were collected on a series of trauma patients determined to have spinal cord injuries with neurogenic shock. A well-established integrated computer model of human physiology was used to analyze and categorize the hemodynamic profiles from a system analysis perspective. A differentiation between these categories was presented as the percent of total patients. RESULTS Of the 9 patients with traumatic neurogenic shock, the etiology of shock was decrease in peripheral vascular resistance (PVR) in 3 (33%; 95% confidence interval, 12%-65%), loss of vascular capacitance in 2 (22%; 6%-55%) and mixed peripheral resistance and capacitance responsible in 3 (33%; 12%-65%), and purely cardiac in 1 (11%; 3%-48%). The markers of sympathetic outflow had no correlation to any of the elements in the patients' hemodynamic profiles. CONCLUSIONS Results from this study suggest that hypotension of neurogenic shock can have multiple mechanistic etiologies and represents a spectrum of hemodynamic profiles. This understanding is important for the treatment decisions in managing these patients.
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Affiliation(s)
- Richard L Summers
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Moertl MG, Schlembach D, Papousek I, Hinghofer-Szalkay H, Weiss EM, Lang U, Lackner HK. Hemodynamic evaluation in pregnancy: limitations of impedance cardiography. Physiol Meas 2012; 33:1015-26. [DOI: 10.1088/0967-3334/33/6/1015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Porhomayon J, Zadeii G, Congello S, Nader ND. Applications of minimally invasive cardiac output monitors. Int J Emerg Med 2012; 5:18. [PMID: 22531454 PMCID: PMC3353182 DOI: 10.1186/1865-1380-5-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
Because of the increasing age of the population, critical care and emergency medicine physicians have seen an increased number of critically ill patients over the last decade. Moreover, the trend of hospital closures in the United States t imposes a burden of increased efficiency. Hence, the identification of devices that facilitate accurate but rapid assessments of hemodynamic parameters without the added burden of invasiveness becomes tantamount. The purpose of this review is to understand the applications and limitations of these new technologies.
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Affiliation(s)
- Jahan Porhomayon
- VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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Bernstein DP, Henry IC, Banet MJ, Dittrich T. Stroke volume obtained by electrical interrogation of the brachial artery: transbrachial electrical bioimpedance velocimetry. Physiol Meas 2012; 33:629-49. [DOI: 10.1088/0967-3334/33/4/629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Choi SW, Park SM. Analysis of Left Ventricular Impedance in Comparison With Ultrasound Images. Artif Organs 2011; 36:479-86. [DOI: 10.1111/j.1525-1594.2011.01381.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring. Cardiol Res Pract 2011; 2012:531908. [PMID: 21860802 PMCID: PMC3157155 DOI: 10.1155/2012/531908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/13/2011] [Accepted: 05/15/2011] [Indexed: 01/20/2023] Open
Abstract
Clinical assessment and vital signs are poor predictors of the overall hemodynamic state. Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization. Newer noninvasive resuscitation technology offers the hope of more accurately and safely monitoring a broader range of critically ill patients while using fewer resources. Fluid responsiveness, the cardiac response to volume loading, represents a dynamic method of improving upon the assessment of preload when compared to static measures like central venous pressure. Multiple new hemodynamic monitors now exist that can noninvasively report cardiac output and oxygen delivery in a continuous manner. Proper assessment of the potential future role of these techniques in resuscitation requires understanding the underlying physiologic and clinical principles, reviewing the most recent literature examining their clinical validity, and evaluating their respective advantages and limitations.
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