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Çavuş Z, Vahapoğlu A, Türkmen ÜA, Gencer FK, Yıldız E. Comparing elective and emergency caesarean section by using bioimpedance method. Arch Gynecol Obstet 2024; 309:2633-2641. [PMID: 37542664 DOI: 10.1007/s00404-023-07166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND There are limited studies focusing on hemodynamic changes between elective and emergent C/S cases. We considered that a better understanding of the alterations and physiological reactions in both situations with non-invasive novel technologies might be useful in managing maternal and fetal sides. METHODS In this prospective observational study, non-invasive hemodynamic changes were observed by using the whole-body impedance method using the NICaS™ device. CO, cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheric resistance (TPR), and cardiac reserve (GGI) parameters were evaluated with a non-invasive method. Measurements were done initiating before surgery, 9 times of 5 min intervals. RESULTS All 95 patients finished the study. 47 cesarean sections were in the elective group, 48 were in the emergent group. SV in 4.5.6. time intervals were statistically increased in the elective group (p values: SvMl4: 0.025, SvMl5: 0.049, SvMl6: 0.044) (p < 0.05). SI in the second-time interval was statistically increased in the emergent group (p-value SI2: 0.047) (p < 0.05). SI in the 4th time interval was statistically increased in the elective group (p-value SI4: 0.047) (p < 0.05). CO measurements were not statistically different between groups in all time intervals for all comparisons. CI in the second time interval was statistically decreased in the elective group (p-value CI2: 0.012) (p < 0.05). GGI in the 4th time interval was statistically increased in the elective group (p-value GGI4: 0.035) (p < 0.05). TPRI in the second time interval was statistically increased in the elective group (p-value TPRI 2: 0.014) (p < 0.05). CONCLUSIONS Understanding normal hemodynamic values before, during, and after C/S is feasible and might help the clinician assess patients' cardiac performance with a reliable noninvasive technique. NICaS might be a reliable tool to evaluate patients' baseline values and diagnose complications earlier during the surgery.
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Affiliation(s)
- Zuhal Çavuş
- Anesthesiology and Reanimation Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey.
| | - Ayşe Vahapoğlu
- Anesthesiology and Reanimation Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Ülkü Aygen Türkmen
- Anesthesiology and Reanimation Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Fatma Ketenci Gencer
- Gynecology and Obstetrics Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Elif Yıldız
- Gynecology and Obstetrics Department, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
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Maraey A, Chacko P, Moukarbel GV. Thoracic impedance monitoring in heart failure: from theory to practice. Expert Rev Med Devices 2024:1-4. [PMID: 38655906 DOI: 10.1080/17434440.2024.2347412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Ahmed Maraey
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
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Anshory M, Kuan WS, Rohman MS, Waranugraha Y, Kamila PA, Iskandar A, Susianti H, Yau YW, Wei Soh CH, Ali KM, Chua MT, Di Somma S. Can non-invasive cardiac hemodynamics and fluid content system (NICaS) parameters predict Acute Heart Failure outcomes in Caucasian and Asian patients in the emergency department? Adv Med Sci 2024; 69:81-89. [PMID: 38387408 DOI: 10.1016/j.advms.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/29/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Acute heart failure (AHF) is a serious condition that requires prompt diagnosis and management. To optimize patient care, clinicians need a reliable, non-invasive method to assess hemodynamic parameters and total body congestion. Currently, no standardized technology is widely used for this purpose. However, NICaS technology, which measures hemodynamic parameters based on regional bioimpedance, has shown promise in monitoring AHF patients in a non-invasive and reliable manner. In this study, researchers aimed to evaluate the usefulness of NICaS technology in predicting patients' outcome in Caucasian and Asian AHF patients presenting to the emergency department (ED). PATIENTS AND METHODS The study included 40 Caucasian patients from Italy (group A) and 71 Asian patients from Indonesia and Singapore (group B) with a diagnosis of AHF in the ED. The study compared data from NICaS parameters, clinical findings, laboratory, and radiological results with short-term events. RESULTS In group A, NICaS data at ED arrival significantly predicted 30-day cardiovascular mortality and rehospitalization. At discharge, a value of cardiac output obtained using NICaS was a significant predictor for 30-day rehospitalization. In group B, NICaS variables, total peripheral resistance index on admission and during 48-72 h had prominent AUC compared to clinical congestion score and NT-proBNP in predicting mortality and rehospitalization. CONCLUSIONS The results indicate that NICaS technology offers a simple, non-invasive, and reliable method of assessing cardiac hemodynamics and congestion in AHF patients. These measurements may enhance diagnosis, tailor management plans, stratify risk, and predict outcomes in both Caucasian and Asian patients.
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Affiliation(s)
- Muhammad Anshory
- Internal Medicine Department, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Great Network, Global Research on Acute Conditions Team, Rome, 00191, Italy
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - M Saifur Rohman
- Cardiology Department, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Yoga Waranugraha
- Cardiology Department, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Putri Annisa Kamila
- Cardiology Department, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Agustin Iskandar
- Clinical Pathology Department, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Great Network, Global Research on Acute Conditions Team, Rome, 00191, Italy
| | - Hani Susianti
- Clinical Pathology Department, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Great Network, Global Research on Acute Conditions Team, Rome, 00191, Italy
| | - Ying Wei Yau
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Crystal Harn Wei Soh
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Khalid Mohammed Ali
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy; Great Network, Global Research on Acute Conditions Team, Rome, 00191, Italy.
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Cheko J, Patsalis N, Kreutz J, Divchev D, Chatzis G, Schieffer B, Markus B. The Impact of Positive Inotropic Therapy on Hemodynamics and Organ Function in Acute Heart Failure: A Differentiated View. J Pers Med 2023; 14:17. [PMID: 38248718 PMCID: PMC10820131 DOI: 10.3390/jpm14010017] [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: 11/17/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Little is known about the impact of treatment with inotropic drugs on the interaction of hemodynamics, biomarkers, and end-organ function in patients with acute decompensated heart failure (HF) of different origins and heart rhythms. METHODS Fifty patients with different causes of acute decompensated HF (dilated cardiomyopathy DCM, ischemic cardiomyopathy ICM, atrial fibrillation AF, sinus rhythm/pacemaker lead rhythm SR/PM) were treated with dobutamine or levosimendan. Non-invasive hemodynamics, biomarkers, and parameters of renal organ function were evaluated at hospital admission and after myocardial recompensation (day 5 to 7). RESULTS Twenty-seven patients with ICM and twenty-three patients with DCM were included. Thirty-nine patients were treated with dobutamine and eleven with levosimendan. Sixteen were accompanied by persistent AF and thirty-four presented either with SR or PM. In the overall cohort, body weight and biomarkers (NT-proBNP/ST2) significantly decreased. GFR significantly increased during therapy with either dobutamine or levosimendan. However, hemodynamic parameters seem to be only improved in patients with DCM, in the levosimendan sub-group, and in patients with SR/PM. CONCLUSION Patients with acute decompensated HF benefit from positive inotropic therapy during short-term follow-ups. In particular, patients with DCM, those after levosimendan therapy and those with SR/PM, seem to benefit most from inotropic therapy.
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Affiliation(s)
| | | | | | | | | | | | - Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, Hospital of the Phillips University of Marburg, D-35043 Marburg, Germany; (J.C.); (N.P.); (J.K.); (D.D.); (G.C.); (B.S.)
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Grinberg T, Aviv Y, Vaturi M, Perl L, Wiessman M, Vaknin-Assa H, Codner P, Shapira Y, Kornowski R, Orvin K. Noninvasive Hemodynamic Evaluation Following TAVI for Severe Aortic Stenosis. J Am Heart Assoc 2023; 12:e028479. [PMID: 36942754 PMCID: PMC10122892 DOI: 10.1161/jaha.122.028479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background Various hemodynamic changes occur following transcatheter aortic valve implantation (TAVI) that may impact therapeutic decisions. NICaS is a noninvasive bioimpedance monitoring system aimed at hemodynamic assessment. We used the NICaS system in patients with severe aortic stenosis (AS) to evaluate short-term hemodynamic changes after TAVI. Methods and Results We performed hemodynamic analysis using NICaS on 97 patients with severe AS who underwent TAVI using either self-expandable (68%) or balloon-expandable (32%) valves. Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), coronary artery disease (46%), and diabetes (37%). NICaS was performed at several time points-before TAVI, soon after TAVI, at hospital discharge, and during follow-up. Compared with baseline NICaS measurements, we observed a significant increase in systolic blood pressure and total peripheral resistance (systolic blood pressure 132±21 mm Hg at baseline versus 147±23 mm Hg after TAVI, P<0.001; total peripheral resistance 1751±512 versus 2084±762 dynes*s/cm5, respectively, P<0.001) concurrent with a decrease in cardiac output and stroke volume (cardiac output 4.2±1.5 versus 3.9±1.3 L/min, P=0.037; stroke volume 61.4±14.8 versus 56.2±15.9 mL, P=0.001) in the immediate post-TAVI period. At follow-up (median 59 days [interquartile range, 40.5-91]) these measurements returned to values that were not different from the baseline. A significant improvement in echocardiography-based left ventricular ejection fraction was observed from baseline to follow-up (55.6%±11.6% to 59.4%±9.4%, P<0.001). Conclusions Unique short-term adaptive hemodynamic changes were observed using NICaS in patients with AS soon after TAVI. Noninvasive hemodynamic evaluation immediately following TAVI may contribute to the understanding of complex hemodynamic changes and merits favorable consideration.
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Affiliation(s)
- Tzlil Grinberg
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Aviv
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Mordehay Vaturi
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Leor Perl
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maya Wiessman
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hanna Vaknin-Assa
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Pablo Codner
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Shapira
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ran Kornowski
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Katia Orvin
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Correlation of Impedance Cardiography-Derived and Cardiac Magnetic Resonance-Derived Stroke Volumes. Curr Probl Cardiol 2023; 48:101457. [PMID: 36273652 DOI: 10.1016/j.cpcardiol.2022.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Cardiac output (CO) and other hemodynamic parameter measurements play an important role in the management of cardiovascular conditions; however, due to limitations of current day technologies, such measurements are either not routinely performed or incorporated into clinical practice. Moreover, measurement of these hemodynamic parameters in the outpatient setting at different time points to assess interval change is currently not feasible. We attempted to validate total-body impedance cardiography-based Non-Invasive Cardiac System (NICaS) derived stroke volume (SV) with that from cardiac magnetic resonance (CMR), a current day gold standard method of assessment. We compared SV, as it is the primary unit of measurement utilized by both technologies. Forty-one consecutive patients undergoing CMR were also investigated by NICaS following CMR. The consistency of non-invasive technology-derived SV measurement was validated by NICaS measurement in 10 subjects, both before and after CMR. Of the 41 enrolled patients; data from 38 patients was adequate for comparison (motion artifact prevented CMR measures in 3 patients). Fourteen patients (37%) were female; mean age was 55 ± 15 years (28-87 years) and body-mass index was 28.7 ± 5.5 kg/m2 (20.5-41.9 kg/m2). Hypertrophic cardiomyopathy (9/41) was the most common study indication for CMR. NICaS-derived SV strongly correlated with CMR [NICaS 77 ± 20 ml (31-123 ml) and CMR 84 ± 23 ml (47-132 ml); P < 0.001; r = 0.77; ICC = 0.73]. The Bland-Altman limits of agreement between NICaS and CMR were -26.7% and 39.9%. NICaS-derived SV collected before and after MRI did not differ [80 ± 18 ml (51-102 ml) pre and 76 ± 17 ml (50-99 ml) post; P = 0.0007, Kappa = 1]. Agreement between NICaS-derived and CMR-derived SV was within the acceptable range of boundaries set by the US Food and the Drug Administration. Consistency in SV measurement at different time-points may allow use of this technology to identify interval hemodynamic changes noninvasively.
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Chia PY, Teo A, Yeo TW. Association of Neutrophil Mediators With Dengue Disease Severity and Cardiac Impairment in Adults. J Infect Dis 2022; 226:1974-1984. [PMID: 36208158 DOI: 10.1093/infdis/jiac383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiac impairment contributes to hypotension in severe dengue (SD). However, studies examining pathogenic factors affecting dengue-associated cardiac impairment are lacking. We examined the role of neutrophil mediators on cardiac impairment in clinical dengue. METHODS We prospectively enrolled adult patients with dengue and controls. Cardiac parameters were measured using a bioimpedance device. Neutrophils mediators were measured, including myeloperoxidase (MPO) and citrullinated histone H3. RESULTS We recruited 107 dengue patients and 30 controls. Patients with dengue were classified according to World Health Organization 2009 guidelines (44 with dengue fever [DF], 51 with DF with warning signs, and 12 with SD). During critical phase, stroke index (P < .001), cardiac index (P = .03), and Granov-Goor index (P < .001) were significantly lower in patients with dengue than in controls. During critical phase, MPO was significantly higher in patients with dengue than in controls (P < .001) and also significantly higher in patients with SD than in those with DF. In addition, MPO was inversely associated with the stroke, cardiac, and Granov-Goor indexes, during the critical phase, and longitudinally as well. CONCLUSIONS Cardiac function was decreased, and MPO increased, during with critical phase in patients SD compared with those with DF and controls. MPO may mediate dengue-associated cardiac impairment.
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Affiliation(s)
- Po Ying Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Medicine, The Doherty Institute, University of Melbourne, Victoria, Australia
| | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
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Teo A, Chia PY, Ramireddi GK, Khoo SKM, Yeo TW. Clinical and prognostic relevance of sST2 in adults with dengue-associated cardiac impairment and severe dengue. PLoS Negl Trop Dis 2022; 16:e0010864. [PMID: 36228040 PMCID: PMC9595566 DOI: 10.1371/journal.pntd.0010864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/25/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dengue can be complicated by severe outcomes including cardiac impairment, and the lack of reliable prognostic biomarkers poses a challenge in managing febrile dengue patients. Here, we investigated the functionality of soluble suppressor of tumorigenicity (sST2) as a predictive marker of severe dengue and its association in dengue-associated cardiac impairment. METHODS Plasma samples, aged >16 years, collected from 36 dengue fever, 43 dengue with warning signs, 11 severe dengue (collected at febrile, critical and recovery phases) and 30 controls were assayed for plasma levels of sST2, troponin T and N-terminal (NT)-pro hormone brain natriuretic peptide (NT-proBNP) by ELISA. Cardiac parameters: stroke index (SI), cardiac index (CI) and Granov-Goor Index (GGI) were measured with a bioimpedance device during the different phases for dengue subjects and once for the controls. PRINCIPAL FINDINGS In the febrile, critical and early recovery phases, sST2 levels were significantly elevated in dengue participants and sST2 levels increased with increasing disease severity (P < 0.01 for all). sST2 concentrations were negatively correlated with SI (r = -0.48; P < 0.001, r = -0.55; P < 0.001), CI (r = -0.26; P = 0.02, r = -0.6: P < 0.001) and GGI (r = -0.44; P < 0.001, r = -0.57; P < 0.001) in the critical and early recovery phases. In contrast, sST2 levels in the febrile and critical phases, were positive correlated to troponin T (r = 0.44, P < 0.001; r = 0.22, P = 0.03, respectively) and NT-proBNP (r = 0.21, P = 0.03; r = 0.35, P < 0.001). ROC analysis demonstrated sST2 as a good biomarker of severe dengue in the critical phase, AUROC 0.79, P < 0.001. CONCLUSION/SIGNIFICANCE sST2 levels were elevated in patients with dengue especially in cases of severe dengue. Furthermore, increased sST2 levels were associated with cardiac indicators suggesting lower cardiac performance. While further research is needed to demonstrate its clinical utility, sST2 may be a useful prognostic biomarker of severe dengue.
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Affiliation(s)
- Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Medicine, The Doherty Institute, University of Melbourne, Melbourne, Australia
- National Centre for Infectious Diseases, Singapore, Singapore
- * E-mail: (AT); (YTW)
| | - Po Ying Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- * E-mail: (AT); (YTW)
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Guha A, Arora D, Mehta Y. Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery. Ann Card Anaesth 2022; 25:335-342. [PMID: 35799563 PMCID: PMC9387605 DOI: 10.4103/aca.aca_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaS Hemodynamic Navigator system and the gold standard TD method using pulmonary artery catheter in patients undergoing OPCAB. A total of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman. The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres. The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.
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Affiliation(s)
- Amrita Guha
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Dheeraj Arora
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
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Greco B, Chait Y, Nathanson BH, Germain MJ. A Novel Hypertension Management Algorithm Guided by Hemodynamic Data. Kidney Int Rep 2022; 7:330-333. [PMID: 35155873 PMCID: PMC8820980 DOI: 10.1016/j.ekir.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
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Nachman D, Rahamim E, Kolben Y, Mengesha B, Elbaz-Greener G, Amir O, Asleh R. In Search of Clinical Impact: Advanced Monitoring Technologies in Daily Heart Failure Care. J Clin Med 2021; 10:jcm10204692. [PMID: 34682813 PMCID: PMC8537939 DOI: 10.3390/jcm10204692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
Despite significant advances in the management of heart failure (HF), further improvement in the outcome of this chronic and progressive disease is still considered a major unmet need. Recurrent hospitalizations due to decompensated HF frequently occur, resulting in increased morbidity and mortality rates. Past attempts at early detection of clinical deterioration were mainly based on monitoring of signs and symptoms of HF exacerbation, which have mostly given disappointing results. Extensive research of the pathophysiology of HF decompensation has indicated that hemodynamic alterations start days prior to clinical manifestation. Novel technologies aim to monitor these minute hemodynamic changes, allowing time for therapeutic interventions to prevent hemodynamic derangement and HF exacerbation. The latest noticeable advancements include assessment of lung fluid volume, wearable devices with integrated sensors, and microelectromechanical systems-based implantable devices for continuous measurement of cardiac filling pressures. This manuscript will review the rationale for monitoring HF patients and discuss previous and ongoing attempts to develop clinically meaningful monitoring devices to improve daily HF health care, with particular emphasis on the recent advances and clinical trials relevant to this evolving field.
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Affiliation(s)
- Dean Nachman
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
- Correspondence: (D.N.); (R.A.); Tel.: +972-2-6757657 (D.N.); +972-2-6775266 (R.A.)
| | - Eldad Rahamim
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
| | - Yotam Kolben
- Hadassah Medical Center, Department of Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel;
| | - Bethlehem Mengesha
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
| | - Gabby Elbaz-Greener
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
| | - Offer Amir
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - Rabea Asleh
- Hadassah Medical Center, Faculty of Medicine, Heart Institute, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (E.R.); (B.M.); (G.E.-G.); (O.A.)
- Correspondence: (D.N.); (R.A.); Tel.: +972-2-6757657 (D.N.); +972-2-6775266 (R.A.)
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Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis. Crit Care Med 2021; 50:126-137. [PMID: 34325447 DOI: 10.1097/ccm.0000000000005144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review and meta-analyze the validity of electrical bioimpedance-based noninvasive cardiac output monitoring in pediatrics compared with standard methods such as thermodilution and echocardiography. DATA SOURCES Systematic searches were conducted in MEDLINE and EMBASE (2000-2019). STUDY SELECTION Method-comparison studies of transthoracic electrical velocimetry or whole body electrical bioimpedance versus standard cardiac output monitoring methods in children (0-18 yr old) were included. DATA EXTRACTION Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Mean differences of cardiac output, stroke volume, or cardiac index measurements were pooled using a random-effects model (R Core Team, R Foundation for Statistical Computing, Vienna, Austria, 2019). Bland-Altman statistics assessing agreement between devices and author conclusions about inferiority/noninferiority were extracted. DATA SYNTHESIS Twenty-nine of 649 identified studies were included in the qualitative analysis, and 25 studies in the meta-analyses. No significant difference was found between means of cardiac output, stroke volume, and cardiac index measurements, except in exclusively neonatal/infant studies reporting stroke volume (mean difference, 1.00 mL; 95% CI, 0.23-1.77). Median percentage error in child/adolescent studies approached acceptability (percentage error less than or equal to 30%) for cardiac output in L/min (31%; range, 13-158%) and stroke volume in mL (26%; range, 14-27%), but not in neonatal/infant studies (45%; range, 29-53% and 45%; range, 28-70%, respectively). Twenty of 29 studies concluded that transthoracic electrical velocimetry/whole body electrical bioimpedance was noninferior. Transthoracic electrical velocimetry was considered inferior in six of nine studies with heterogeneous congenital heart disease populations. CONCLUSIONS The meta-analyses demonstrated no significant difference between means of compared devices (except in neonatal stroke volume studies). The wide range of percentage error reported may be due to heterogeneity of study designs, devices, and populations included. Transthoracic electrical velocimetry/whole body electrical bioimpedance may be acceptable for use in child/adolescent populations, but validity in neonates and congenital heart disease patients remains uncertain. Larger studies in specific clinical contexts with standardized methodologies are required.
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Laskov I, Alpern S, Ronel I, Segal R, Zindel O, Zoborovsky I, Michaan N, Grisaru D. Cardiac Function and Hemodynamic Changes during Minimally Invasive Hysterectomy with Pneumoperitoneum and Steep Trendelenburg Position for Patients with Endometrial Cancer Who Are Obese. J Minim Invasive Gynecol 2020; 28:1079-1085. [PMID: 33065261 DOI: 10.1016/j.jmig.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVE To assess the effect of carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg position on patients' cardiac function and hemodynamics during minimally invasive staging surgery for endometrial cancer. DESIGN Single-center prospective longitudinal study. SETTING University-affiliated tertiary hospital. PATIENTS Patients with endometrial cancer undergoing minimally invasive surgery. INTERVENTIONS After consent, the patients' hemodynamic parameters were assessed by the Non-Invasive Cardiac System (NI Medical, Petah Tikva, Israel) at 5 time points: before general anesthesia, after induction of general anesthesia, after CO2 insufflation of the peritoneum, after steep Trendelenburg position, and at the end of surgery. MEASUREMENTS AND MAIN RESULTS Twenty-three women were recruited. The median age of the patients was 68 years (interquartile range [IQR] 62-75), with a median body mass index of 34.9 kg/m2 (IQR 31.2-39.5) and an American Society of Anesthesiologists score ≥2. The initial median mean arterial pressure was 108 mmHg (IQR 101-113), and the baseline median cardiac output was 7.2 L/min (IQR 5.6-8.7). The median mean arterial pressure significantly decreased by 18% after insufflation (p = .001), again after Trendelenburg position (p = .003), and did not fully recover at the end of surgery in comparison with the preanesthesia baseline (p = .001). The median stroke volume significantly decreased by 17% after insufflation compared with the baseline (p = .01) and then gradually recovered to the baseline levels by the end of surgery. The median cardiac power significantly decreased by 35% after insufflation (0.009), remained low during Trendelenburg position (p = .009), and recovered by the end of surgery to 18% below the baseline levels (p = .035). CONCLUSION Significant hemodynamic changes occur during minimally invasive staging surgery for endometrial cancer. CO2 insufflation is accompanied by the most dramatic hemodynamic deterioration during surgery, and this does not get affected much with Trendelenburg. Knowledge of the hemodynamic values of women classified as high risk when using a noninvasive technique during surgery is obtainable and may assist both surgeon and anesthesiologist to ensure a safer procedure.
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Affiliation(s)
- Ido Laskov
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Sharon Alpern
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Ilai Ronel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Roy Segal
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Ofra Zindel
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Ilanit Zoborovsky
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Nadav Michaan
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel.
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Rafaeli Rabin R, Rosin I, Matitiau A, Simpson Y, Flidel-Rimon O. Assessing Patent Ductus Arteriosus (PDA) Significance on Cardiac Output by Whole-Body Bio-impedance. Pediatr Cardiol 2020; 41:1386-1390. [PMID: 32524206 DOI: 10.1007/s00246-020-02380-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
We evaluated the effectiveness of a whole-body bioimpedance device (NICaS®, NI Medical, Petach Tikva, Israel) to predict the presence of a hemodynamically significant patent ductus arteriosus (PDA) in premature infants. A total of 36 infants less than 35 week's gestation age and birth weights of less than 1750 g were included in the study. Using the NICaS® device, we obtained whole-body bioimpedance measurements of stroke volume index (SI), cardiac output index (CI) and total peripheral resistance index. A total of 61 measurements were taken together with echocardiograph imaging. The study population was divided into three groups according to the echocardiograph results: group 1-small PDA, group 2-moderate PDA, and group 3-large PDA. Both SI and CI significantly increased from a median value of 22.6 ml/m2 and 3.4 l/min/m2 to 23.8 and 3.7, to 39.8 and 5.4 between groups 1, 2 and 3 respectively. The difference was statistically significant between groups 1 and 3 (P = 0.005 for SI and P = 0.002 for CI) and between groups 2 and 3 (P = 0.037 for SI and P = 0.05 for CI). We found statistically significant differences in SI and CI between infants with large PDAs and infants with no or small and medium PDAs. We suggest that these differences can be used in real time, in addition to echocardiography, in assessing the presence of significant PDAs.
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Affiliation(s)
| | - Ilya Rosin
- Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel
| | - Avraham Matitiau
- Unit of Pediatric Cardiology, Hebrew University, Jerusalem, Israel
| | - Yael Simpson
- Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel
| | - Orna Flidel-Rimon
- Department of Neonatology, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel.
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15
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A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study. Shock 2020; 55:230-235. [PMID: 32769818 DOI: 10.1097/shk.0000000000001621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Alternation in traditional vital signs can only be observed during advanced stages of hypovolemia and shortly before the hemodynamic collapse. However, even minimal blood loss induces a decrease in the cardiac preload which translates to a decrease in stroke volume, but these indices are not readily monitored. We aimed to determine whether minor hemodynamic alternations induced by controlled and standardized hypovolemia can be detected by a whole-body bio-impedance technology. METHODS This was a non-randomized controlled trial that enrolled healthy blood donors. Vital signs, as well as shock index and stroke volume (SV), were recorded using noninvasive cardiac system, a noninvasive whole-body impedance-based hemodynamic analysis system, during phlebotomy. RESULTS Sixty subjects were included in the study group and 20 in the control group. Blood loss of 450 mL resulted in a significant decrease in systolic blood pressure (5 mm Hg; 95% CI 3, 6) and SV (5.07 mL; 95% CI 3.21, 6.92), and increase in shock index (0.03 bpm/mm Hg; 95% CI 0.01, 0.05). Clinically detectable changes (≥10%) in blood pressure and shock index were detectable in 15% and 5%, respectively. SV decreased by more than 10% in 40% of blood donors. No significant changes occurred in the control group. CONCLUSION Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.
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16
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Goldkorn R, Naimushin A, Rozen E, Freimark D. Early post-stress decrease in cardiac performance by impedance cardiography and its relationship to the severity and extent of ischemia by myocardial perfusion imaging. BMC Cardiovasc Disord 2020; 20:354. [PMID: 32736524 PMCID: PMC7394672 DOI: 10.1186/s12872-020-01639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background While single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established noninvasive procedure for the evaluation of patients with coronary artery disease (CAD), it is unable to detect the presence of, or underestimates the extent of CAD in certain patients. We aimed to show that a bio-impedance device can detect early post-stress changes in several hemodynamic parameters, thereby serving as a potential marker for the presence of significant ischemia. Methods Prospectively enrolled patients, referred to our Medical Center for clinically-indicated MPI, underwent testing using a Non-Invasive Cardiac System (NICaS) before and immediately after exercise. The differences between rest and stress hemodynamic parameters were compared with the severity and extent of myocardial ischemia by MPI. The study included 198 patients; mean age was 62 years, 26% were women, 54% had hypertension, and 29% diabetes mellitus. Of them, 188 patients had ≤10%, and 10 had > 10% of myocardial ischemia. Results In the first group, there was a significantly greater increase in post-exercise stroke index, stroke work index, cardiac index and cardiac power index (19.2, 29.1, 90.5 and 107%, respectively) compared with the second group (− 2.7, 3.8, 43.7 and 53.5%, respectively), as well as a significantly greater decrease in total peripheral resistance index (− 38.7% compared with − 16.3%), with corresponding p values of 0.015, 0.017, 0.040, 0.016, and < 0.001, respectively. Conclusions Our data suggest that immediate post-stress changes in several hemodynamic parameters, detected by the NICaS, can be used as an important adjunct to SPECT MPI for the early detection of myocardial ischemia.
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Affiliation(s)
- Ronen Goldkorn
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Alexey Naimushin
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Eli Rozen
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Dov Freimark
- Leviev Heart Center, Sheba Medical Center, 52621, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Marchese LDD, Chermont S, Warol D, Oliveira LBD, Pereira SB, Quintão M, Mesquita ET. Controlled Study of Central Hemodynamic Changes in Inspiratory Exercise with Different Loads in Heart Failure. Arq Bras Cardiol 2020; 114:656-663. [PMID: 32491006 DOI: 10.36660/abc.20180375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Inspiratory muscle weakness contributes to exercise intolerance and decreased quality of life in patients with heart failure. Studies with inspiratory muscle training show improvement in inspiratory muscle strength, functional capacity and quality of life. However, little is known about the central hemodynamic response (CHR) during inspiratory exercise (IE). Objective To evaluate CHR in a single IE session with different loads (placebo, 30% and 60%) in heart failure. Methods Randomized placebo-controlled clinical trial in patients with heart failure with reduced ejection fraction, functional class II and III. Twenty patients aged 65 ± 11 years completed a single session of inspiratory exercise, in 3 cycles of 15 minutes, with a 1-hour washout, involving loads of 30% (C30), 60% (C60) and placebo, using a linear load resistor (PowerBreathe Light). The noninvasive hemodynamic study was performed by cardiothoracic bioimpedance (Niccomo™ CardioScreen®). Statistical analysis was performed with Student's t-test and Pearson's correlation, and P≤0.05 was considered significant. Results An increase in heart rate (HR) was observed with C30 (64 ± 15 vs 69 ± 15 bpm; p = 0.005) and C60 (67 ± 14 vs 73 ± 14 bpm, p = 0.002). A decrease was observed in systolic volume (SV) with C30 (73 ± 26 vs 64 ± 20 ml; p = 0.004). Cardiac output (CO), on its turn, increased only with C60 (4.6 ± 1.5 vs 5.3 ± 1.7 l/min; p = -0.001). Conclusion When using the 60% load, in a single IE session, changes in CHR were observed. HR and CD increased, as did the Borg scales and subjective sensation of dyspnea. The 30% load reduced the SV. (Arq Bras Cardiol. 2020; 114(4):656-663).
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Affiliation(s)
- Luana de Decco Marchese
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Clínica de Insuficiência Cardíaca, Centro Universitário Serra dos Órgãos, Teresópolis, RJ, Brasil
| | - Sergio Chermont
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Hospital do Coração, São Paulo, SP, Brasil
| | | | | | | | - Mônica Quintão
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Instituto Nacional do Câncer, Rio de Janeiro, RJ – Brazil
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Schamroth Pravda N, Lev S, Itzhaki Ben Zadok O, Kornowski R, Iakobishvili Z. Non-Invasive Hemodynamic Whole-Body Bioimpedance Indices for the Early Detection of Cancer Treatment-Related Cardiotoxicity: A Retrospective Observational Study. Cardiology 2020; 145:350-355. [DOI: 10.1159/000505809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/08/2020] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Patients undergoing chemotherapy are extremely vulnerable to cardiotoxicity. Early detection of cardiac dysfunction is of vital importance to optimize the management of these patients. <b><i>Objective:</i></b> The aim of this study was to test the effectiveness of non-invasive hemodynamic whole-body bioimpedance (WBI) technology as a modality to detect heart failure in patients undergoing chemotherapy treatment. <b><i>Methods:</i></b> This retrospective observational trial included 84 patients treated at the cardio-oncology outpatient clinic of the Rabin Medical Center. Clinical assessments were performed including biomarker testing and measurement of hemodynamic and volume status parameters as measured by WBI. <b><i>Results:</i></b> We included 84 patients with a median age of 64.8 years, and 40.5% were males. Clinical heart failure was detected in 43% of the whole group. Patients were divided into two groups according to baseline NT-proBNP levels with a cut-off of 900 pg/mL. Left ventricular ejection fraction did not differ between the groups. Those with NT-proBNP >900 pg/mL had lower levels of stroke index, cardiac index, and Granov-Goor index (GGI; 25.9 vs. 34.0, 2.0 vs. 2.3, 8.3 vs. 11.4, respectively, with <i>p</i> < 0.001 for all comparisons). The optimal cut-off value for the GGI to detect NT-proBNP >900 pg/mL was 8.3. The area under the curve of a GGI cut-off <8.3 to detect NT-proBNP >900 pg/mL was 0.81 (positive predictive value 95% and negative predictive value 72%), with a 51% sensitivity and 98% specificity. <b><i>Conclusion:</i></b> GGI, a parameter measured by WBI, can reliably correlate to biomarker evidence of heart failure in patients after chemotherapy. Its use as a screening tool for cardiotoxicity in patients with ongoing anticancer therapy is promising.
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Levin NW, de Abreu MHFG, Borges LE, Tavares Filho HA, Sarwar R, Gupta S, Hafeez T, Lev S, Williams C. Hemodynamic response to fluid removal during hemodialysis: categorization of causes of intradialytic hypotension. Nephrol Dial Transplant 2019; 33:1643-1649. [PMID: 29669016 DOI: 10.1093/ndt/gfy048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Intradialytic hypotension is a clinically significant problem, however, the hemodynamics that underlie ultrafiltration and consequent hypotensive episodes has not been studied comprehensively. Methods Intradialytic cardiac output, cardiac power and peripheral resistance changes from pretreatment measurements were evaluated using a novel regional impedance cardiographic device (NICaS, NI Medical, Peta Tikva, Israel) in 263 hemodialysis sessions in 54 patients in dialysis units in the USA and Brazil with the goal of determining the various hemodynamic trends as blood pressure decreases. Results Hypotensive episodes occurred in 99 (13.5%) of 736 intra- and postdialytic evaluations. The hemodynamic profiles of the episodes were categorized: (i) The cardiac power index significantly decreased in 35% of episodes by 36%, from 0.66 [95% confidence interval (CI) 0.60-0.72] to 0.43 (95% CI 0.37-0.48) [w/m2] with a small reduction in the total peripheral resistance index. (ii) The total peripheral resistance index significantly decreased in 37.4% of episodes by 33%, from 3342 (95% CI 2824-3859) to 2251 (95% CI 1900-2602) [dyn × s/cm5 × m2] with a small reduction in the cardiac power index. (iii) Both the cardiac power index and total peripheral resistance index significantly decreased in 27.3% of episodes, the cardiac power index by 25% from 0.63 (95% CI 0.57-0.70) to 0.48 (95% CI 0.42-0.53) [w/m2] and the total peripheral resistance index by 23% from 2964 (95% CI 2428-3501) to 2266 (95% CI 1891-2642). Conclusions The hemodynamic profiles clearly define specific hemodynamic mechanisms of cardiac power reduction and/or vasodilatation as underlying intradialytic hypotensive episodes. A reduction in cardiac power (reduction of both blood pressure and cardiac output) could be the result of preload reduction due to a high ultrafiltration rate with not enough refilling or low target weight. A reduction in peripheral resistance (reduction in blood pressure and increase in cardiac output) could be the result of relative vasodilatation as arteries do not contract to compensate for volume reduction due to autonomous dysfunction. As both phenomena are independent, they may appear at the same time. Based on these results, a reduction of ultrafiltration rate and an increase in target weight to improve preload or immediate therapeutic actions to increase peripheral resistance are rational measures that could be taken to maintain blood pressure and prevent hypotensive ischemic complications in dialysis patients.
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Affiliation(s)
| | | | - Lucas E Borges
- Biocor Hospital de Doenças Cardiovasculares, Belo Horizonte, Brazil
| | | | - Rabia Sarwar
- Queens Artificial Kidney Center, New York, NY, USA and
| | | | - Tahir Hafeez
- Queens Artificial Kidney Center, New York, NY, USA and
| | - Shaul Lev
- Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Doenyas-Barak K, de Abreu MHFG, Borges LE, Tavares Filho HA, Yunlin F, Yurong Z, Levin NW, Kaufman AM, Efrati S, Pereg D, Litovchik I, Fuchs S, Minha S. Non-invasive hemodynamic profiling of patients undergoing hemodialysis - a multicenter observational cohort study. BMC Nephrol 2019; 20:347. [PMID: 31481031 PMCID: PMC6724365 DOI: 10.1186/s12882-019-1542-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Intradialytic blood pressure (BP) measurement is currently the main parameter used for monitoring hemodynamics during hemodialysis (HD). Since BP is dependent on cardiac output and total peripheral resistance, knowledge of these parameters throughout the HD treatment would potentially be valuable. Methods The use of a novel non-invasive monitoring system for profiling hemodynamic response patterns during HD was explored: a whole-body bio-impedance system was used to assess cardiac index (CI), total peripheral resistance index (TPRI), cardiac power index (CPI) among other parameters in chronic HD patients from 4 medical centers. Measurements were made pre, during and post dialysis. Patients were grouped into 5 hemodynamic profiles based on their main hemodynamic response during dialysis i.e. high TPRI; high CPI; low CPI; low TPRI and those with normal hemodynamics. Comparisons were made between the groups for baseline characteristics and 1-year mortality. Results In 144 patients with mean age of 67.3 ± 12.1 years pre-dialysis hemodynamic measurements were within normal limits in 35.4% but only 6.9% overall remained hemodynamically stable during dialysis. Intradialytic BP decreased in 65 (45.1%) in whom, low CPI (47 (72.3%)) and low TPRI (18 (27.7%) were recorded. At 1-year follow-up, mortality rates were highest in patients with low CPI (23.4%) and low TPRI (22.2%). Conclusions Non-invasive assessment of patients’ response to HD provides relevant hemodynamic information that exceeds that provided by currently used BP measurements. Use of these online analyses could potentially improve the safety and performance standards of dialysis by guiding appropriate interventions, particularly in responding to hypertension and hypotension. Electronic supplementary material The online version of this article (10.1186/s12882-019-1542-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keren Doenyas-Barak
- Nephrology Department Shamir Medical Center (Assaf-Harofeh campus), Zeriffin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | | | - Lucas E Borges
- Biocor Hospital de Doenças Cardiovasculares, Belo Horizonte, Brazil
| | | | - Feng Yunlin
- Renal Division, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Zou Yurong
- Renal Division, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | | | | | - Shay Efrati
- Nephrology Department Shamir Medical Center (Assaf-Harofeh campus), Zeriffin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - David Pereg
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Cardiology Department Meir Medical Center, Kfar-Saba, Israel
| | - Ilya Litovchik
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Cardiology Department Shamir Medical Center (Assaf-Harofeh campus), Zeriffin, Israel
| | - Shmuel Fuchs
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.,Cardiology Department Shamir Medical Center (Assaf-Harofeh campus), Zeriffin, Israel
| | - Sa'ar Minha
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel. .,Cardiology Department Shamir Medical Center (Assaf-Harofeh campus), Zeriffin, Israel.
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Cowart D, Venuti RP, Lynch K, Guptill JT, Noveck RJ, Foo SY. A Phase 1 Randomized Study of Single Intravenous Infusions of the Novel Nitroxyl Donor BMS-986231 in Healthy Volunteers. J Clin Pharmacol 2019; 59:717-730. [PMID: 30703258 PMCID: PMC6519195 DOI: 10.1002/jcph.1364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022]
Abstract
Nitroxyl (HNO) is a reactive nitrogen molecule that has potential therapeutic benefits for patients with acute heart failure. The results of the first‐in‐human study for BMS‐986231, a novel HNO donor, are reported. The aim of this sequential cohort study was to evaluate the safety, tolerability, and pharmacokinetic profile of BMS‐986231 after 24‐ and 48‐hour intravenous infusions in healthy volunteers. Eighty subjects were randomized and dosed. Seven cohorts (stratum A) received BMS‐986231 0.1, 0.33, 1, 3, 5, 10, and 15 μg/kg/min or placebo, infused over 24 hours. An additional cohort (stratum B) received 10 μg/kg/min or placebo, infused over 48 hours. Adverse events (AEs) were reported for 30 days after completion of infusion. Blood/urine samples were collected at regular intervals; other parameters (blood pressure, heart rate/rhythm, cardiac index) were also assessed. Headaches were the most commonly reported drug‐related AE (48%) in those who received BMS‐986231, although their severity was reduced by hydration. No other significant drug‐related AEs were noted. BMS‐986231 was associated with dose‐dependent and well‐tolerated reductions in systolic and diastolic blood pressure versus baseline; cardiac index, as measured noninvasively, was increased. BMS‐986231 had no clinically significant effect on heart rate/rhythm or laboratory parameters. Its mean elimination half‐life was 0.7‐2.5 hours. BMS‐986231 was safe and well‐tolerated for up to 24 hours (15 μg/kg/min) or 48 hours (10 μg/kg/min), with a favorable hemodynamic profile observed. Ongoing studies continue to evaluate the potential benefit of BMS‐986231 in patients with acute heart failure.
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Affiliation(s)
| | | | - Kim Lynch
- Duke Early Phase Clinical Research Unit, Durham, NC, USA
| | | | | | - Shi Yin Foo
- Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
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The value of non-invasive measurement of cardiac output and total peripheral resistance to categorize significant changes of intradialytic blood pressure: a prospective study. BMC Nephrol 2018; 19:310. [PMID: 30400887 PMCID: PMC6219191 DOI: 10.1186/s12882-018-1087-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022] Open
Abstract
Background Blood pressure (BP) is currently the main hemodynamic parameter used to assess the influence of fluid removal during hemodialysis session. Since BP is dependent on cardiac output (CO) and total peripheral resistance (TPRI), investigating these parameters may help to better understand the influence of fluid removal on patient’s hemodynamics. We used a novel non-invasive whole-body bio-impedance cardiography device, recently validated in hemodialysis patients, to examine mechanisms of intradialytic hemodynamics in a Chinese dialysis population. Methods Chronic hemodialysis patients in Sichuan Provincial People’s Hospital were enrolled. Demographic data and dialysis prescriptions were collected. Hemodynamic measurements were made pre-treatment, every 20 min during treatment and immediately after treatment in each random dialysis session. These included blood pressure, cardiac index (CI), total peripheral resistance (TPRI) and cardiac power index (CPI). Patients were divided into 5 hemodynamic groups as per their major hemodynamic response to fluid removal: low CPI, low TPRI, high TPRI, High CPI and those with normal hemodynamics. Results Twenty-seven patients were enrolled, with 12 (44.4%) males. The average age was 65 ± 12 y. The average body mass index (BMI) was 23.7 ± 3.9 kg/m2. 12 (44.4%) patients were diabetic. Three hundred twenty-four hemodynamic measurements were made. Weight, BMI, total fluid removal, pretreatment systolic BP, CI, TPRI and CI differed significantly among the 5 hemodynamic groups.11.1% of patients had low CPI, 25.9% had low TPRI, 18.5% had high CPI, 3.7% had high TPRI and 40.7% had normal hemodynamics. Hemodynamic differences among the 5 subgroups were significant. Conclusion This technology provides multi-dimensional insight into intradialytic hemodynamic parameters, which may be more informative than blood pressure only. Using hemodynamic parameters to describe patients’ status is more specific and accurate, and could help to work out specific and effective therapeutic actions according to underlying abnormalities.
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Lavie A, Ram M, Lev S, Blecher Y, Amikam U, Shulman Y, Avnon T, Weiner E, Many A. Maternal cardiovascular hemodynamics in normotensive versus preeclamptic pregnancies: a prospective longitudinal study using a noninvasive cardiac system (NICaS™). BMC Pregnancy Childbirth 2018; 18:229. [PMID: 29898711 PMCID: PMC6001131 DOI: 10.1186/s12884-018-1861-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preeclampsia is among the most common medical complications of pregnancy. The clinical utility of invasive hemodynamic monitoring in preeclampsia (e.g., Swan-Ganz catheter) is controversial. Thoracic impedance cardiography (TIC) and Doppler echocardiography are noninvasive techniques but they both have important limitations. NICaS™ (NI Medical, PetachTikva, Israel) is a noninvasive cardiac system for determining cardiac output (CO) that utilizes regional impedance cardiography (RIC) by noninvasively measuring the impedance signal in the periphery. It outperformed any other impedance cardiographic technology and was twice as accurate as TIC. METHODS We used the NICaS™ system to compare the hemodynamic parameters of women with severe preeclampsia (PET group, n = 17) to a cohort of healthy normotensive pregnant women with a singleton pregnancy at term (control group, n = 62) (1/2015-6/2015). Heart rate (HR), stroke volume (SV), CO, total peripheral resistance (TPR) and mean arterial pressure (MAP) were measured 15-30 min before CS initiation, immediately after administering spinal anesthesia, immediately after delivery of the fetus and placenta, at the abdominal fascia closure and within 24-36 and 48-72 h postpartum. RESULTS The COs before and during the CS were significantly higher in the control group compared to the PET group (P < .05), but reached equivalent values within 24-36 h postpartum. CO peaked at delivery of the newborn and the placenta and started to decline afterwards in both groups. The MAP and TPR values were significantly higher in the PET group at all points of assessment except at 48-72 h postpartum when it was still significantly higher for MAP while the TPR only exhibited a higher trend but not statistically significant. The NICaS™ device noninvasively demonstrated low CO and high TPR profiles in the PET group compared to controls. CONCLUSIONS The immediate postpartum period is accompanied by the most dramatic hemodynamic changes and fluid shifts, during which the parturient should be closely monitored. The NICaS™ device may help the clinician to customize the most optimal management for individual parturients. Our findings require validation by further studies on larger samples.
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Affiliation(s)
- Anat Lavie
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Maya Ram
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Lev
- General ICU, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Blecher
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amikam
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shulman
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Avnon
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Lis Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Orbach-Zinger S, Bizman I, Firman S, Lev S, Gat R, Ashwal E, Vaturi M, Razinski E, Davis A, Shmueli A, Eidelman LA. Perioperative noninvasive cardiac output monitoring in parturients undergoing cesarean delivery with spinal anesthesia and prophylactic phenylephrine drip: a prospective observational cohort study. J Matern Fetal Neonatal Med 2018; 32:3153-3159. [PMID: 29683007 DOI: 10.1080/14767058.2018.1458835] [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: 10/17/2022]
Abstract
Introduction: Spinal anesthesia for cesarean delivery is associated with high incidence of hypotension and is most often prevented by a prophylactic phenylephrine infusion (PPI). In this study, we aimed to identify maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICaS noninvasive cardiac output monitor in healthy singleton parturients undergoing cesarean delivery (CD) with spinal anesthesia and PPI. Methods: Healthy term women undergoing spinal anesthesia for singleton CD were enrolled. The following data were collected - cardiac output (CO), mean arterial pressure (MAP), stroke volume (SV), and total peripheral resistance (TPR). Measurements were measured at five time points: (1) before arrival in OR, (2) after spinal anesthesia with pi, (3) after delivery of baby and beginning of oxytocin infusion, (4) in post anesthesia care room (5) 24 hours postoperatively, and (6) 48 hours postoperatively. All parturients received standardized spinal solution consisting of 12 mg hyperbaric, 20 µg fentanyl, and 100-µg preservative-free morphine. PPI was titrated to preserve blood pressure to 20% of baseline and stopped at the end of surgery. Oxytocin was administered as a continuous infusion (20-units/1000 cc Ringer lactate) at a rate of 100 cc/h. Results: One hundred thirty-seven women completed the study. Average age was 34.9 ± 5.7 and average BMI was 30.1 ± 5.1. One hour after delivery in the post anesthesia care unit (PACU), there were significant decreases in stroke volume, heart rate, blood pressure, and CO with a concomitant increase in TPR. Within 48 hours the TPR decreased, and CO and stroke volume increased. Conclusions: Significant hemodynamic changes were documented at all time points both intraoperatively and postoperatively with the most significant changes occurring 1 hour postoperatively. Further studies need to be performed to discover hemodynamic changes of spinal anesthesia and PPI in different parturient populations.
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Affiliation(s)
- Sharon Orbach-Zinger
- a Department of Anesthesia, Rabin Medical Center , Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Ilya Bizman
- a Department of Anesthesia, Rabin Medical Center , Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Shlomo Firman
- a Department of Anesthesia, Rabin Medical Center , Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Shaul Lev
- b Intensive Care Unit , Hasharon Hospital , Petah Tikva , Israel
| | - Roi Gat
- c Helen Schneider Hospital for Women, Obstetrics and Gynecology , Rabin Medical Center, Tel Aviv University , Tel Aviv , Israel
| | - Eran Ashwal
- d Sackler Faculty of Medicine , Lis Maternity Hospital, the Tel-Aviv Sourasky Medical Center, Tel-Aviv University , Ramat-Aviv, Tel Aviv , Israel
| | - Mordehay Vaturi
- e Department of Cardiology, Rabin Medical Center , Beilinson Hospital and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eitan Razinski
- a Department of Anesthesia, Rabin Medical Center , Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Atara Davis
- a Department of Anesthesia, Rabin Medical Center , Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Anat Shmueli
- c Helen Schneider Hospital for Women, Obstetrics and Gynecology , Rabin Medical Center, Tel Aviv University , Tel Aviv , Israel
| | - Leonid A Eidelman
- a Department of Anesthesia, Rabin Medical Center , Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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25
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Perioperative Cardiac Output Monitoring Utilizing Non-pulse Contour Methods. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Lavie A, Ram M, Lev S, Blecher Y, Amikam U, Shulman Y, Avnon T, Weiner E, Many A. Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies. Arch Gynecol Obstet 2017; 297:353-363. [PMID: 29189893 DOI: 10.1007/s00404-017-4601-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Differences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS™ in singleton and twins before and during delivery, as well at the early puerperium in healthy women undergoing CS at term. METHODS This prospective longitudinal study included women with twin (n = 27) or singleton pregnancies (n = 62) whose hemodynamic parameters were assessed by NICaS before an elective CS, after spinal anesthesia, immediately after delivery, after fascia closure, and within 24-36 and 48-72 h postpartum. RESULTS By 24-36 h postpartum, the mean arterial pressure and the total peripheral resistance equaled preoperative values in both groups. The CO increased throughout the CS and peaked immediately after delivery in the singleton group (P < 0.0001), after which it abruptly began to decline until reaching a nadir 24-36 h after delivery (P < 0.0001), while it remained steady throughout the CS and then dropped until 24-36 h after delivery in the twin group (P < 0.05). None of the studied parameters differed significantly between the groups for the 24-36 and 48-72 h postpartum measurements. CONCLUSIONS Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS™ in assessing cardiovascular-related pregnancy complications are warranted.
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Affiliation(s)
- Anat Lavie
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Maya Ram
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Lev
- General ICU, Rabin Medical Center, Hasharon Hospital, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Blecher
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amikam
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shulman
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Avnon
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Ram M, Lavie A, Lev S, Blecher Y, Amikam U, Shulman Y, Avnon T, Weiner E, Many A. Casting doubt on the value of assessing the cardiac index in pregnancy. J Matern Fetal Neonatal Med 2017; 31:3080-3084. [DOI: 10.1080/14767058.2017.1364720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maya Ram
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Lavie
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Lev
- General ICU, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Yair Blecher
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Uri Amikam
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Shulman
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer Avnon
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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28
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Germain MJ, Joubert J, O'Grady D, Nathanson BH, Chait Y, Levin NW. Comparison of stroke volume measurements during hemodialysis using bioimpedance cardiography and echocardiography. Hemodial Int 2017; 22:201-208. [PMID: 28796425 DOI: 10.1111/hdi.12589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fluid management remains a major challenge of hemodialysis (HD) care, with serious implications for morbidity and mortality. Intradialytic fluid management is typically guided by blood pressure, an indirect resultant of hemodynamics status. Direct measurements of hemodynamic parameters may improve cardiovascular outcomes by providing rational bases for intervention. We compare stroke volume (SV) measurements using a noninvasive, regional biompedance cardiography device (NiCaS) with Doppler echocardiography (Echo) in HD setting. METHODS Stroke volumes were simultaneously measured using the devices in 17 patients receiving maintenance HD. Measurements were made during 2 weekly HD treatments, and twice within each HD treatment during the first and last hour of each treatment, for a total of 64 SV measurements. Agreement between devices was assessed using linear regression, a Pearson's correlation coefficient, and a Bland-Altman plot all adjusted for repeated measures within patients. RESULTS Echo and NiCaS SV mean and 95% CIs were 58.0 (50.1, 65.8) and 56.7 (49.4, 64.0) mL, respectively. NiCaS SV correlated strongly with Echo SV during the first and last hours of treatments (r = 0.93, P < 0.001 and r = 0.92, P < 0.001, respectively). Linear regression of NiCaS on Echo showed a slope of 0.97, 95% CI (0.91, 1.02) which did not differ from 1, P = 0.20. A Bland-Altman plot and 4-Quadrant plot confirmed that the 2 methods produced comparable measurements. CONCLUSION NiCaS SV measurements are similar to and strongly correlated with Echo SV measurements. This suggests that noninvasive NiCaS technology may be a practical method for measuring SV during HD.
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Affiliation(s)
- Michael J Germain
- Baystate Medical Center, Springfield, Massachusetts and University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jyovani Joubert
- Kidney Care and Transplant Associates of New England, Springfield, Massachusetts, USA
| | | | | | - Yossi Chait
- University of Massachusetts, Amherst, Massachusetts, USA
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29
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Tita C, Gilbert EM, Van Bakel AB, Grzybowski J, Haas GJ, Jarrah M, Dunlap SH, Gottlieb SS, Klapholz M, Patel PC, Pfister R, Seidler T, Shah KB, Zieliński T, Venuti RP, Cowart D, Foo SY, Vishnevsky A, Mitrovic V. A Phase 2a dose-escalation study of the safety, tolerability, pharmacokinetics and haemodynamic effects of BMS-986231 in hospitalized patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2017; 19:1321-1332. [PMID: 28677877 PMCID: PMC6607490 DOI: 10.1002/ejhf.897] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This study was designed to evaluate the safety, tolerability and haemodynamic effects of BMS‐986231, a novel second‐generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF). Methods and results Forty‐six patients hospitalized with decompensated HFrEF were enrolled into four sequential dose‐escalation cohorts in this double‐blind, randomized, placebo‐controlled Phase 2a study. Patients with baseline pulmonary capillary wedge pressure (PCWP) of ≥20 mmHg and a cardiac index of ≤2.5 L/min/m2 received one 6‐h i.v. infusion of BMS‐986231 (at 3, 5, 7 or 12 µg/kg/min) or placebo. BMS‐986231 produced rapid and sustained reductions in PCWP, as well as consistent reductions in time‐averaged pulmonary arterial systolic pressure, pulmonary arterial diastolic pressure and right atrial pressure. BMS‐986231 increased non‐invasively measured time‐averaged stroke volume index, cardiac index and cardiac power index values, and decreased total peripheral vascular resistance. There was no evidence of increased heart rate, drug‐related arrhythmia or symptomatic hypotension with BMS‐986231. Analyses of adverse events throughout the 30‐day follow‐up did not identify any toxicities specific to BMS‐986231, with the potential exception of infrequent mild‐to‐moderate headaches during infusion. There were no treatment‐related serious adverse events. Conclusions BMS‐986231 demonstrated a favourable safety and haemodynamic profile in patients hospitalized with advanced heart failure. Based on preclinical data and these study's findings, it is possible that the haemodynamic benefits may be mediated by inotropic and/or lusitropic as well as vasodilatory effects. The therapeutic potential of BMS‐986231 should be further assessed in patients with heart failure.
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Affiliation(s)
- Cristina Tita
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Edward M Gilbert
- Division of Cardiology, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Adrian B Van Bakel
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Garrie J Haas
- Division of Cardiology and Vascular Medicine, Faculty of Medicine, Ohio State University, Columbus, OH, USA
| | - Mohammad Jarrah
- Department of Cardiology, King Abdullah University Hospital, Irbid, Jordan
| | - Stephanie H Dunlap
- Division of Cardiology, Faculty of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marc Klapholz
- Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Parag C Patel
- Department of Transplant, Mayo Clinic, Jacksonville, FL, USA
| | - Roman Pfister
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - Tim Seidler
- Division of Cardiology and Pulmonology, Medical University of Göttingen, Göttingen, Germany
| | - Keyur B Shah
- Department of Cardiology, Faculty of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Robert P Venuti
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Douglas Cowart
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Shi Yin Foo
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Alexander Vishnevsky
- Intensive Care Unit, Cardiology Department, Pokrovskaya City Hospital, St Petersburg, Russia
| | - Veselin Mitrovic
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
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30
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Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women. J Perinatol 2017; 37:793-799. [PMID: 28406485 DOI: 10.1038/jp.2017.53] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/09/2017] [Accepted: 03/16/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to describe maternal central hemodynamic parameters before and during delivery as well at the early puerperium in healthy women undergoing elective cesarean section (CS) at term. STUDY DESIGN The noninvasive Cardiac System (NICaS, NI Medical, Petah-Tikva, Israel) is a regional impedance device that measures cardiac output (CO) and its derivatives with a good correlation with the gold standard Swan-Ganz catheter. We performed a prospective longitudinal study of healthy women with a singleton pregnancy at term. Maternal hemodynamic parameters were assessed by the NICaS at six time points: a few minutes before undergoing an elective CS, immediately after receiving spinal anesthesia, immediately after delivery of the fetus and placenta, after abdominal fascia closure, and within 24 to 36 and 48 to 72 h postpartum. RESULT Sixty-one consenting women were recruited during the study period (January 2015 to June 2015). Baseline (pre-CS) mean arterial pressure (MAP) was 87.7±7.9 mm Hg, baseline CO was 7.5±1.7 l per min and baseline total peripheral resistance (TPR) was 994±301 dyne × s per cm5. After spinal anesthesia CO significantly increased by 13%, no significant changes were observed in MAP or TPR. Immediately after delivery, a nadir for all parameters was reached: MAP and TPR were significantly reduced by 8% and 26%, respectively (comparing to pre-CS), and CO further increased by 9% (24% comparing to pre-CS). After fascia closure, partial recoveries of all parameters were observed. Twenty-four to thirty-six hours postpartum MAP returned to pre-CS values, while CO and TPR reached -9% and +11% comparing to baseline, respectively. None of the parameters differed significantly between 24 to 36 and 48 to 72 h postpartum. CONCLUSION Significant hemodynamic changes (reduction of TPR and increase of CO) take place at the time of delivery of fetus and placenta. Knowledge of normal hemodynamic values using a reliable noninvasive technique during various stages of pregnancy and the postpartum period is feasible, and might assist clinicians in assessing the level of patient deviation from expected cardiac performance, especially in high-risk women.
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Boos CJ, Holdsworth DA, Hall DP, Mellor A, O'Hara J, Woods DR. Comparison of two methods of assessing total body water at sea level and increasing high altitude. Clin Physiol Funct Imaging 2014; 34:478-84. [DOI: 10.1111/cpf.12121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- C. J. Boos
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Cardiology; Poole Hospital NHS Foundation Trust; Dorset UK
- Centre of Postgraduate Medical Research & Education; Bournemouth University; Bournemouth UK
- Department of Cardiology; Royal Berkshire Hospital; Reading UK
| | - D. A. Holdsworth
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Cardiology; Poole Hospital NHS Foundation Trust; Dorset UK
| | - D. P. Hall
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Anaesthesia; Western General Hospital; Edinburgh UK
| | - A. Mellor
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- James Cook University Hospital; Middlesborough UK
- Leeds Metropolitan University; 104 Carnegie Research Institute (CRI); Leeds UK
| | - J. O'Hara
- Leeds Metropolitan University; 104 Carnegie Research Institute (CRI); Leeds UK
| | - D. R. Woods
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Medicine; Royal Victoria Infirmary and Northumbria NHS Foundation Trust; Newcastle upon Tyne UK
- University of Newcastle; Newcastle upon Tyne UK
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32
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Maternal Hemodynamics by Thoracic Impedance Cardiography for Normal Pregnancy and the Postpartum Period. Obstet Gynecol 2014; 123:318-324. [DOI: 10.1097/aog.0000000000000104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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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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Balparda JK, Gallo JA, McEwen JG, Ochoa JE, Aristizábal D. Evaluación hemodinámica no invasiva con cardiografía de impedancia: aplicaciones en falla cardíaca y en hipertensión arterial. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rozenman Y, Rotzak R, Patterson RP. Detection of left ventricular systolic dysfunction using a newly developed, laptop based, impedance cardiographic index. Int J Cardiol 2011; 149:248-250. [DOI: 10.1016/j.ijcard.2011.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 02/10/2011] [Indexed: 11/27/2022]
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Wang JJ, Hu WC, Kao T, Liu CP, Lin SK. Development of forearm impedance plethysmography for the minimally invasive monitoring of cardiac pumping function. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jbise.2011.42018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tahvanainen A, Koskela J, Tikkakoski A, Lahtela J, Leskinen M, Kähönen M, Nieminen T, Kööbi T, Mustonen J, Pörsti I. Analysis of cardiovascular responses to passive head‐up tilt using continuous pulse wave analysis and impedance cardiography. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:128-37. [DOI: 10.1080/00365510802439098] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tanino Y, Shite J, Paredes OL, Shinke T, Ogasawara D, Sawada T, Kawamori H, Miyoshi N, Kato H, Yoshino N, Hirata KI. Whole Body Bioimpedance Monitoring for Outpatient Chronic Heart Failure Follow up. Circ J 2009; 73:1074-9. [DOI: 10.1253/circj.cj-08-0847] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yusuke Tanino
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Junya Shite
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Oscar L Paredes
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Daisuke Ogasawara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takahiro Sawada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Naoki Miyoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroki Kato
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Naoki Yoshino
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Wang JJ, Wang PW, Liu CP, Lin SK, Hu WC, Kao T. Evaluation of changes in cardiac output from the electrical impedance waveform in the forearm. Physiol Meas 2007; 28:989-99. [PMID: 17827648 DOI: 10.1088/0967-3334/28/9/002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We tested the validity of regional impedance cardiography (RIC) for measuring changes in both cardiac output and stroke volume by comparing the values with a 2D ultrasound technique in response to the breath-hold manipulation. Among 13 subjects, changes in the maximum amplitude of the regional impedance waveform from the forearm conformed to those in stroke volume (r = 0.86, p < 0.001) and cardiac output (r = 0.76, p < 0.003) measured with the ultrasound technique in baseline and immediately after a 30 s breath-hold maneuver. We also found that the per cent change in cardiac output (r = 0.73, p < 0.005) and the per cent change in stroke volume (r = 0.84, p < 0.0003) by the echocardiography were both positively correlated with the per cent change in the peak impedance amplitude. In addition, both the change and the per cent change in the mean area under the impedance curve were consistent with those in the stroke volume, respectively. Accordingly, the regional electrical impedance waveform from lower limbs may be helpful in providing a non-invasive and continuous assessment of left ventricular output, especially during cardiac procedures.
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Affiliation(s)
- Jia-Jung Wang
- Department of Biomedical Engineering, I-Shou University, Taiwan, Republic of China.
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