1
|
Middel C, Stetzuhn M, Sander N, Kalkbrenner B, Tigges T, Pielmus AG, Spies C, Pietzner K, Klum M, von Haefen C, Hunsicker O, Sehouli J, Konietschke F, Feldheiser A. Perioperative advanced haemodynamic monitoring of patients undergoing multivisceral debulking surgery: an observational pilot study. Intensive Care Med Exp 2023; 11:61. [PMID: 37682496 PMCID: PMC10491568 DOI: 10.1186/s40635-023-00543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients undergoing high-risk surgery show haemodynamic instability and an increased risk of morbidity. However, most of the available data concentrate on the intraoperative period. This study aims to characterise patients with advanced haemodynamic monitoring throughout the whole perioperative period using electrical cardiometry. METHODS In a prospective, observational, monocentric pilot study, electrical cardiometry measurements were obtained using an Osypka ICON™ monitor before surgery, during surgery, and repeatedly throughout the hospital stay for 30 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. Severe postoperative complications according to the Clavien-Dindo classification were used as a grouping criterion. RESULTS The relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median - 19 [25-quartile - 26%; 75-quartile - 10%]%, p < 0.0001), stroke volume index (SVI, - 9.5 [- 15.3; 3.2]%, p = 0.0038), cardiac index (CI, - 24.5 [- 32; - 13]%, p < 0.0001) and index of contractility (- 17.5 [- 35.3; - 0.8]%, p < 0.0001). Throughout the perioperative course, patients had intraoperatively a reduced HR and CI (both p < 0.0001) and postoperatively an increased HR (p < 0.0001) and CI (p = 0.016), whereas SVI was unchanged. Thoracic fluid volume increased continuously versus preoperative values and did not normalise up to the day of discharge. Patients having postoperative complications showed a lower index of contractility (p = 0.0435) and a higher systolic time ratio (p = 0.0008) over the perioperative course in comparison to patients without complications, whereas the CI (p = 0.3337) was comparable between groups. One patient had to be excluded from data analysis for not receiving the planned surgery. CONCLUSIONS Substantial decreases in HR, SVI, CI, and index of contractility occurred from the day before surgery to the first intraoperative timepoint. HR and CI were altered throughout the perioperative course. Patients with postoperative complications differed from patients without complications in the markers of cardiac function, a lower index of contractility and a lower SVI. The analyses of trends over the whole perioperative time course by using non-invasive technologies like EC seem to be useful to identify patients with altered haemodynamic parameters and therefore at an increased risk for postoperative complications after major surgery.
Collapse
Affiliation(s)
- Charlotte Middel
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Stetzuhn
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadine Sander
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Kalkbrenner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Timo Tigges
- Department of Electronics and Medical Signal Processing, Technical University, Berlin, Germany
| | | | - Claudia Spies
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynaecology With Center for Oncological Surgery, Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Klum
- Department of Electronics and Medical Signal Processing, Technical University, Berlin, Germany
| | - Clarissa von Haefen
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Hunsicker
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynaecology With Center for Oncological Surgery, Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Aarne Feldheiser
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Evangelische Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, 45136, Essen, Germany.
| |
Collapse
|
2
|
Semiz B, Carek AM, Johnson JC, Ahmad S, Heller JA, Vicente FG, Caron S, Hogue CW, Etemadi M, Inan OT. Non-Invasive Wearable Patch Utilizing Seismocardiography for Peri-Operative Use in Surgical Patients. IEEE J Biomed Health Inform 2021; 25:1572-1582. [PMID: 33090962 PMCID: PMC8189504 DOI: 10.1109/jbhi.2020.3032938] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Optimizing peri-operative fluid management has been shown to improve patient outcomes and the use of stroke volume (SV) measurement has become an accepted tool to guide fluid therapy. The Transesophageal Doppler (TED) is a validated, minimally invasive device that allows clinical assessment of SV. Unfortunately, the use of the TED is restricted to the intra-operative setting in anesthetized patients and requires constant supervision and periodic adjustment for accurate signal quality. However, post-operative fluid management is also vital for improved outcomes. Currently, there is no device regularly used in clinics that can track patient's SV continuously and non-invasively both during and after surgery. METHODS In this paper, we propose the use of a wearable patch mounted on the mid-sternum, which captures the seismocardiogram (SCG) and electrocardiogram (ECG) signals continuously to predict SV in patients undergoing major surgery. In a study of 12 patients, hemodynamic data was recorded simultaneously using the TED and wearable patch. Signal processing and regression techniques were used to derive SV from the signals (SCG and ECG) captured by the wearable patch and compare it to values obtained by the TED. RESULTS The results showed that the combination of SCG and ECG contains substantial information regarding SV, resulting in a correlation and median absolute error between the predicted and reference SV values of 0.81 and 7.56 mL, respectively. SIGNIFICANCE This work shows promise for the proposed wearable-based methodology to be used as an alternative to TED for continuous patient monitoring and guiding peri-operative fluid management.
Collapse
|
3
|
Arshad SH, Murphy EK, Callahan JM, DeVries JT, Odame KM, Halter RJ. Cardiac eigen imaging: a novel method to isolate cardiac activity in thoracic electrical impedance tomography. Physiol Meas 2020; 41:095008. [PMID: 33021240 DOI: 10.1088/1361-6579/abb141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE As the global burden of cardiovascular disease increases, proactive cardiovascular healthcare by means of accurate, precise, continuous, and non-invasive monitoring is becoming crucial. However, no current device is able to provide cardiac hemodynamic monitoring with the aforementioned criterion. Electrical impedance tomography (EIT) is an inexpensive, non-invasive imaging modality that can provide real-time images of internal conductivity distributions that describe physiological activity. This work explores and compares a standard approach of regular cardiac gated averaging (RCGA) and a newly developed method, cardiac eigen-imaging (CEI), based on the singular value decomposition (SVD) to isolate cardiac activity in thoracic EIT. APPROACH EIT and heart-rate (HR) data were collected from 20 heart-failure patients preceding echocardiography. Features from RCGA and CEI images were correlated with stroke volume (SV) from echocardiography and image reconstruction parameters were optimized using leave-one-out (LOO) cross-validation. MAIN RESULTS CEI per-pixel-based features achieved a Pearson correlation coefficient of 0.80 with SV relative to 0.72 with RCGA. CEI had 33 high-correlating pixels while RCGA had 8. High-correlating pixels tend to concentrate in the right-ventricle (RV) when referenced to a general chest model. SIGNIFICANCE While both RCGA and CEI images had high-correlating pixels, CEI had higher correlations, a larger number of high-correlating pixels, and unlike RCGA is not dependent on the quality of the HR data collected. The observed performance of the CEI approach represents a promising step forward for EIT-based cardiac monitoring in either clinical or ambulatory settings.
Collapse
Affiliation(s)
- Saaid H Arshad
- Thayer School of Engineering at Dartmouth College, Hanover, NH 03755, United States of America
| | | | | | | | | | | |
Collapse
|
4
|
Heydari F, P. Ebrahim M, Redoute J, Joe K, Walker K, Avolio A, R. Yuce M. Clinical study of a chest‐based cuffless blood pressure monitoring system. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/mds3.10091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fatemeh Heydari
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Malikeh P. Ebrahim
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Jean‐Michel Redoute
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Keith Joe
- Emergency Department Cabrini Health Melbourne Vic. Australia
| | - Katie Walker
- Emergency Department Cabrini Health Melbourne Vic. Australia
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Vic. Australia
| | - Alberto Avolio
- The Australian School of Advanced Medicine Macquarie University Sydney NSW Australia
| | - Mehmet R. Yuce
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| |
Collapse
|
5
|
Blood Pressure Estimation Using On-body Continuous Wave Radar and Photoplethysmogram in Various Posture and Exercise Conditions. Sci Rep 2019; 9:16346. [PMID: 31705001 PMCID: PMC6841972 DOI: 10.1038/s41598-019-52710-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/21/2019] [Indexed: 11/12/2022] Open
Abstract
The pulse arrival time (PAT), pre-ejection period (PEP) and pulse transit time (PTT) are calculated using on-body continuous wave radar (CWR), Photoplethysmogram (PPG) and Electrocardiogram (ECG) sensors for wearable continuous systolic blood pressure (SBP) measurements. The CWR and PPG sensors are placed on the sternum and left earlobe respectively. This paper presents a signal processing method based on wavelet transform and adaptive filtering to remove noise from CWR signals. Experimental data are collected from 43 subjects in various static postures and 26 subjects doing 6 different exercise tasks. Two mathematical models are used to calculate SBPs from PTTs/PATs. For 38 subjects participating in posture tasks, the best cumulative error percentage (CEP) is 92.28% and for 21 subjects participating in exercise tasks, the best CEP is 82.61%. The results show the proposed method is promising in estimating SBP using PTT. Additionally, removing PEP from PAT leads to improving results by around 9%. The CWR sensors present a low-power, continuous and potentially wearable system with minimal body contact to monitor aortic valve mechanical activities directly. Results of this study, of wearable radar sensors, demonstrate the potential superiority of CWR-based PEP extraction for various medical monitoring applications, including BP measurement.
Collapse
|
6
|
Zhang X, Zhang L, Wang K, Yu C, Zhu T, Tang J. A rapid approach to assess cardiac contractility by ballistocardiogram and electrocardiogram. ACTA ACUST UNITED AC 2018; 63:113-122. [PMID: 27824610 DOI: 10.1515/bmt-2015-0204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/06/2016] [Indexed: 11/15/2022]
Abstract
In this paper, we propose a rapid assessment on cardiac contractility by using the time interval between the I wave of ballistocardiogram (BCG) and the R wave of electrocardiogram (ECG) which is referred to as the RI interval. The whole work can be divided into two parts. First, the correlation between the RI interval and the ejection fraction (EF), which is a clinical index to assess systolic performance, was computed. For 39 subjects, the correlation coefficient is -0.54 (p<0.001). Moreover, RI intervals of heart failure (HF) patients and healthy subjects were measured, and a significant difference was found among different New York Heart Association (NYHA) classes and the healthy group. Second, the beat-to-beat correlation analysis between the RI interval and the pre-ejection period (PEP), which is a parameter of systolic time interval to evaluate the cardiac contractility, was calculated. For 4578 heart beats across eight healthy subjects, the correlation coefficient is 0.85 (p<0.001). As a conclusion, these results indicate that the RI interval can be used as a noninvasive assessment of cardiac contractility.
Collapse
Affiliation(s)
- Xianwen Zhang
- Key Laboratory of Particle and Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, 100084, China
| | - Liyan Zhang
- Key Laboratory of Particle and Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, 100084, China
| | - Kun Wang
- Key Laboratory of Particle and Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, 100084, China
| | - Chao Yu
- Peking University People's Hospital, Beijing, 100084, China
| | - Tiangang Zhu
- Peking University People's Hospital, Beijing, 100084, China
| | - Jintian Tang
- Key Laboratory of Particle and Radiation Imaging, Tsinghua University, Ministry of Education, Beijing, 100084, China
| |
Collapse
|
7
|
Chabchoub S, Mansouri S, Ben Salah R. Detection of valvular heart diseases using impedance cardiography ICG. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
The Quality of Automatic Artifact Identification in Ambulatory Impedance Cardiography Monitoring. IFMBE PROCEEDINGS 2018. [DOI: 10.1007/978-981-10-5122-7_42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
9
|
Nazário Leão R, Silva PMD, Pocinho RM, Alves M, Virella D, Palma Reis R. Good agreement between echocardiography and impedance cardiography in the assessment of left ventricular performance in hypertensive patients. Clin Exp Hypertens 2017; 40:461-467. [PMID: 29172784 DOI: 10.1080/10641963.2017.1392558] [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: 10/18/2022]
Abstract
BACKGROUND Impedance cardiography (ICG) is a noninvasive hemodynamic monitoring tool which can define hypertensive patients' hemodynamic profiles and help to tailor antihypertensive therapy. This study assesses the concordance between ICG-derived indexes used to evaluate left ventricular performance and transthoracic echocardiography (TTE) in hypertensive patients. METHODS In this IMPEDDANS post-hoc analysis, the ICG-derived indexes are compared with TTE by Bland-Altman method. Statistical significance of the relationship between the values obtained was assessed by generalized linear mixed-effects models. RESULTS In supine position, Bland-Altman analysis showed good concordance for cardiac output (CO) (mean difference of 0.006 mL/min [-0.120; 0.133]), cardiac index (CI) (mean difference of 0.016 mL/min/m2 [-0.471; 0.504]), pre-ejection period (PEP) (mean difference of -0.216 ms [-4.510; 4.077]), left ventricular ejection time (LVET) (mean difference of -0.140 ms [-6.573; 6.293]), and systolic time ratio (STR) (mean difference of -0.00004 [-0.008; 0.008]). In orthostatic position, good concordance was found for CO (mean difference 0.028 mL/min [-2.036; 1.980]), CI (mean difference -0.012 mL/min/m2 [-1.063; 1.039]), and STR (mean difference -0.101 [0.296; 0.094]). No significant difference between methods was identified by the linear mixed-effects models. CONCLUSION The ICG-derived indexes CO, CI, PEP, LVET, and STR in supine position have good agreement with TTE. Therefore, ICG can be used to accurately evaluate left ventricular performance.
Collapse
Affiliation(s)
- Rodrigo Nazário Leão
- a Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal.,b NOVA Medical School, Universidade NOVA de Lisboa , Lisboa , Portugal
| | - Pedro Marques Da Silva
- b NOVA Medical School, Universidade NOVA de Lisboa , Lisboa , Portugal.,c Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal
| | - Rita Marques Pocinho
- a Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal
| | - Marta Alves
- d Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar de Lisboa Central-EPE , Lisboa , Portugal
| | - Daniel Virella
- f Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar Lisboa Central-EPE , Lisboa , Portugal
| | - Roberto Palma Reis
- b NOVA Medical School, Universidade NOVA de Lisboa , Lisboa , Portugal.,e Unidade de Cardiologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte-EPE , Lisboa , Portugal
| |
Collapse
|
10
|
Nederend I, Ten Harkel ADJ, Blom NA, Berntson GG, de Geus EJC. Impedance cardiography in healthy children and children with congenital heart disease: Improving stroke volume assessment. Int J Psychophysiol 2017; 120:136-147. [PMID: 28778397 DOI: 10.1016/j.ijpsycho.2017.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Stroke volume (SV) and cardiac output are important measures in the clinical evaluation of cardiac patients and are also frequently used in research applications. This study was aimed to improve SV scoring derived from spot-electrode based impedance cardiography (ICG) in a pediatric population of healthy volunteers and patients with a corrected congenital heart defect. METHODS 128 healthy volunteers and 66 patients participated. First, scoring methods for ambiguous ICG signals were optimized to improve agreement of B- and X-points with aortic valve opening/closure in simultaneously recorded transthoracic echocardiography (TTE). Building on the improved scoring of B- and X-points, the Kubicek equation for SV estimation was optimized by testing the agreement with the simultaneously recorded SV by TTE. Both steps were initially done in a subset of the sample of healthy children and then validated in the remaining subset of healthy children and in a sample of patients. RESULTS SV assessment by ICG in healthy children strongly improved (intra class correlation increased from 0.26 to 0.72) after replacing baseline thorax impedance (Z0) in the Kubicek equation by an equation (7.337-6.208∗dZ/dtmax), where dZ/dtmax is the amplitude of the ICG signal at the C-point. Reliable SV assessment remained more difficult in patients compared to healthy controls. CONCLUSIONS After proper adjustment of the Kubicek equation, SV assessed by the use of spot-electrode based ICG is comparable to that obtained from TTE. This approach is highly feasible in a pediatric population and can be used in an ambulatory setting.
Collapse
Affiliation(s)
- Ineke Nederend
- Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Nico A Blom
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Gary G Berntson
- Ohio State University, Department of Psychology, 1835 Neil Avenue, Columbus OH 43210, United States.
| | - Eco J C de Geus
- Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Buxi D, Hermeling E, Mercuri M, Beutel F, van der Westen RG, Torfs T, Redoute JM, Yuce MR. Systolic Time Interval Estimation Using Continuous Wave Radar With On-Body Antennas. IEEE J Biomed Health Inform 2017; 22:129-139. [PMID: 28749359 DOI: 10.1109/jbhi.2017.2731790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The estimation of systolic time intervals (STIs) is done using continuous wave (CW) radar at 2.45 GHz with an on-body antenna. MOTIVATION In the state of the art, typically bioimpedance, heart sounds and/or ultrasound are used to measure STIs. All three methods suffer from insufficient accuracy of STI estimation due to various reasons. CW radar is investigated for its ability to overcome the deficiencies in the state of the art. METHODS Ten healthy male subjects aged 25-45 were asked to lie down at a 30 incline. Recordings of 60 s were taken without breathing and with paced breathing. Heart sounds, electrocardiogram, respiration, and impedance cardiogram were measured simultaneously as reference. The radar antennas were placed at two positions on the chest. The antennas were placed directly on the body as well as with cotton textile in between. The beat to beat STIs have been determined from the reference signals as well as CW radar signals. RESULTS The results indicate that CW radar can be used to estimate STIs in ambulatory monitoring. SIGNIFICANCE The results pave way to a potentially more compact method of estimating STIs, which can be integrated into a wearable device.
Collapse
|
12
|
Stepanov R, Podtaev S, Frick P, Dumler A. Beat-to-beat cardiovascular hemodynamic parameters based on wavelet spectrogram of impedance data. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Ashouri H, Inan OT. Automatic Detection of Seismocardiogram Sensor Misplacement for Robust Pre-Ejection Period Estimation in Unsupervised Settings. IEEE SENSORS JOURNAL 2017; 17:3805-3813. [PMID: 29085256 PMCID: PMC5659316 DOI: 10.1109/jsen.2017.2701349] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Seismocardiography (SCG), the measurement of the local chest vibrations due to the movements of blood and the heart, is a non-invasive technique for assessing myocardial contractility via the pre-ejection period (PEP). Recently, SCG-based extraction of PEP has been shown to be an effective means of classifying decompensated from compensated heart failure patients, and thus can be potentially used for monitoring such patients at home. Accurate extraction of PEP from SCG signals hinges on lab-based population data (i.e., regression curves) linking particular time-domain features of the SCG signal to corresponding features from reference standard bulky instruments such as impedance cardiography (ICG). Such regression curves, in the case of SCG, have always been estimated based on the "ideal" positioning of the SCG sensor on the chest. However, in settings such as the home where users may position the SCG measurement hardware on the chest without supervision, it is likely that the sensor will not always be placed exactly on this "ideal" location on the sternum, but rather on other positions on the chest as well. In this study, we show for the first time that the regression curve for estimating PEP from SCG signals differs significantly as the position of the sensor changes. We further devise a method to automatically detect when the sensor is placed in any position other than the desired one in order to avoid inaccurate systolic time interval estimation. Our classification algorithm for this purpose resulted in 0.83 precision and 0.82 recall when classifying whether the sensor is placed in the desired position or not. The classifier was tested with heartbeats taken both at rest, and also during exercise recovery to ensure that waveform changes due to positioning could be accurately discriminated from those due to physiological effects.
Collapse
Affiliation(s)
- Hazar Ashouri
- School of Electrical and Computer Engineering at the Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Omer T Inan
- School of Electrical and Computer Engineering at the Georgia Institute of Technology, Atlanta, GA 30332 USA
| |
Collapse
|
14
|
Buxi D, Redout JM, Yuce MR. Blood Pressure Estimation Using Pulse Transit Time From Bioimpedance and Continuous Wave Radar. IEEE Trans Biomed Eng 2017; 64:917-927. [DOI: 10.1109/tbme.2016.2582472] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
15
|
Brindle RC, Ginty AT, Phillips AC, Fisher JP, McIntyre D, Carroll D. Heart rate complexity: A novel approach to assessing cardiac stress reactivity. Psychophysiology 2015; 53:465-72. [PMID: 26585809 DOI: 10.1111/psyp.12576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/08/2015] [Indexed: 02/04/2023]
Abstract
Correlation dimension (D2), a measure of heart rate (HR) complexity, has been shown to decrease in response to acute mental stress and relate to adverse cardiovascular health. However, the relationship between stress-induced changes in D2 and HR has yet to be established. The present studies aimed to assess this relationship systematically while controlling for changes in respiration and autonomic activity. In Study 1 (N = 25) D2 decreased during stress and predicted HR reactivity even after adjusting for changes in respiration rate, and cardiac vagal tone. This result was replicated in Study 2 (N = 162) and extended by including a measure of cardiac sympathetic activity; correlation dimension remained an independent predictor of HR reactivity in a hierarchical linear model containing measures of cardiac parasympathetic and sympathetic activity and their interaction. These results suggest that correlation dimension may provide additional information regarding cardiac stress reactivity above that provided by traditional measures of cardiac autonomic function.
Collapse
Affiliation(s)
- Ryan C Brindle
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Annie T Ginty
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna C Phillips
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - James P Fisher
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - David McIntyre
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Douglas Carroll
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
16
|
Effects of trunk posture in Fowler's position on hemodynamics. Auton Neurosci 2015; 189:56-9. [PMID: 25600883 DOI: 10.1016/j.autneu.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/10/2014] [Accepted: 01/06/2015] [Indexed: 11/23/2022]
Abstract
We speculated that stroke volume would be higher and heart rate would be lower when the head and upper trunk were mainly upright in the Fowler's position. We therefore analyzed the effects of three trunk postures in Fowler's position on heart rate, blood pressure and circulatory volume. Heart rate (HR), blood pressure (BP), stroke volume (SV), cardiac output (Q), systemic vascular resistance (SVR), ejection time (ET) and pre-ejection period (PEP) were measured in 10 healthy male volunteers (mean age ± SEM, 20.7 ± 0.5 y; range, 19-23 y) while in three trunk postures in Fowler's position. Stroke volume and Q were measured using impedance cardiography. The three trunk postures were 30° of lower and upper trunk inclination (WT30°), 30° and 60° of lower and upper trunk inclination (UT 60°), respectively and 60° of upper and lower trunk inclination (WT60°). Both SV and ET were significantly higher and HR and PEP were lower at UT60° than at WT60° (p < 0.01) whereas these values did not significantly differ between WT30° and UT60° (p > 0.05). None of Q, SVR and BP significantly differed among the three conditions (p > 0.05). These findings suggested that SV and preload are higher when the upper trunk is upright (UT60°) than when the entire trunk is upright (WT60°) while in Fowler's position. In addition, Q might be maintained without increasing HR through vagal withdrawal when only the upper trunk is upright in healthy young males in Fowler's position.
Collapse
|
17
|
Koźluk E, Cybulski G, Piątkowska A, Zastawna I, Niewiadomski W, Strasz A, Gąsiorowska A, Kempa M, Kozłowski D, Opolski G. Early hemodynamic response to the tilt test in patients with syncope. Arch Med Sci 2014; 10:1078-85. [PMID: 25624842 PMCID: PMC4296066 DOI: 10.5114/aoms.2014.47820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/25/2013] [Accepted: 10/02/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Our aim was to evaluate the differences in the early hemodynamic response to the tilt test (HUTT) in patients with and without syncope using impedance cardiography (ICG). MATERIAL AND METHODS One hundred twenty-six patients (72 female/48 male; 37 ±17 years) were divided into a group with syncope (HUTT(+), n = 45 patients) and a group without syncope (HUTT(-), n = 81 patients). ECG and ICG signals were continuously recorded during the whole examination, allowing the calculation of heart rate (HR), stroke volume (SV), and cardiac output (CO) for every beat. The hemodynamic parameters (averaged over 1 min) were analyzed at the following points of the HUTT: the last minute of resting, the period immediately after the tilt (0 min), 1 min and 5 min after the maneuver. The absolute changes of HR, SV and CO were calculated for 0, 1, and 5 min after the maneuver in relation to the values at rest (ΔHR, ΔSV, ΔCO). Also, the percentage changes were calculated (HRi, SVi, COi). RESULTS There were no differences between the groups in absolute and percentage changes of hemodynamic parameters immediately after and 1 min after tilting. Significant differences between the HUTT(+) and HUTT(-) groups were observed in the 5(th) min of tilting: for ΔSV (-27.2 ±21.2 ml vs. -9.7 ±27.2 ml; p = 0.03), ΔCO (-1.78 ±1.62 l/min vs. -0.34 ±2.48 l/min; p = 0.032), COi (-30 ±28% vs. -0.2 ±58%; p = 0.034). CONCLUSIONS In the 5(th) min the decrease of hemodynamic parameters (ΔSV, ΔCO, COi) was significantly more pronounced in HUTT(+) patients in comparison to the HUTT(-) group.
Collapse
Affiliation(s)
- Edward Koźluk
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Gerard Cybulski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Institute of Metrology and Biomedical Engineering, Department of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - Agnieszka Piątkowska
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Inga Zastawna
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department and Clinic of Cardiac Rehabilitation and Noninvasive Electrocardiology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Wiktor Niewiadomski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Chair and Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Strasz
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gąsiorowska
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Clinical Subjects, Institute of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland
| | - Grzegorz Opolski
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
18
|
Ermishkin VV, Kolesnikov VA, Lukoshkova EV. Age-dependent and ‘pathologic’ changes in ICG waveforms resulting from superposition of pre-ejection and ejection waves. Physiol Meas 2014; 35:943-63. [DOI: 10.1088/0967-3334/35/6/943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Noninvasive cardiac monitoring in pregnancy: impedance cardiography versus echocardiography. J Perinatol 2013; 33:675-80. [PMID: 23680787 PMCID: PMC3751992 DOI: 10.1038/jp.2013.35] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/16/2013] [Accepted: 02/12/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to report thoracic impedance cardiography (ICG) measurements and compare them with echocardiography (echo) measurements throughout pregnancy and in varied maternal positions. METHOD A prospective cohort study involving 28 healthy parturients was performed using ICG and echo at three time points and in two maternal positions. Pearson's correlations, Bland-Altman plots and paired t-tests were used for statistical analysis. RESULT Significant agreements between many but not all ICG and echo contractility, flow and resistance measurements were demonstrated. Differences in stroke volume (SV) due to maternal position were also detected by ICG in the antepartum (AP) period. Significant trends were observed by ICG for cardiac output and thoracic fluid content (TFC; P<0.025) with advancing pregnancy stages. CONCLUSION ICG and echo demonstrate significant correlations in some but not all measurements of cardiac function. ICG has the ability to detect small changes in SV associated with maternal position change. ICG measurements reflected maximal cardiac contractility in the a AP period yet reflected a decrease in contractility and an increase in TFC in the postpartum period.
Collapse
|
20
|
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
|
21
|
Wong MYM, Pickwell-MacPherson E, Zhang YT, Cheng JCY. The effects of pre-ejection period on post-exercise systolic blood pressure estimation using the pulse arrival time technique. Eur J Appl Physiol 2010; 111:135-44. [PMID: 20824282 DOI: 10.1007/s00421-010-1626-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2010] [Indexed: 11/27/2022]
Abstract
Pulse arrival time (PAT) is comprised of the vascular transit time (TT) through the arterial system and the pre-ejection period (PEP) in the heart. It has been used to predict arterial blood pressure (BP) without using a cuff. The aim of this study was to investigate the effects of including the PEP on the accuracy of cuffless systolic BP (SBP) estimation using the PAT technique in post-exercise recovery. Experiments were conducted on 22 normotensive participants. PAT, TT and PEP were determined from simultaneous measurements of the electrocardiogram, photoplethysmogram and impedance cardiogram. Moderate exercise induced significant (p < 0.05) increases in SBP and heart rate and significant (p < 0.05) decreases in PEP and PAT. Diastolic blood pressure and TT only varied insignificantly (p > 0.05). SBP was moderately correlated with PEP (r = -0.61) and PAT (r = -0.81). PAT and PEP were moderately correlated (r = 0.67). When SBP was estimated using least-squares methods, the differences between the measured and predicted SBP using PEP, PAT and TT were 0.0 ± 6.6, 0.0 ± 4.9 and 0.0 ± 9.3 mmHg, respectively. The findings suggested that PAT gives the best SBP prediction and PEP has some potential to predict blood pressure. The inclusion of PEP in the PAT measurement is necessary to facilitate accurate cuffless blood pressure prediction after exercise.
Collapse
Affiliation(s)
- Mico Yee Man Wong
- The Joint Research Centre for Biomedical Engineering, Electronic Engineering Department, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | |
Collapse
|
22
|
Bilinska M, Kosydar-Piechna M, Gasiorowska A, Mikulski T, Piotrowski W, Nazar K, Piotrowicz R. Influence of Dynamic Training on Hemodynamic, Neurohormonal Responses to Static Exercise and on Inflammatory Markers in Patients After Coronary Artery Bypass Grafting. Circ J 2010; 74:2598-604. [DOI: 10.1253/circj.cj-10-0104] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maria Bilinska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology
| | | | - Anna Gasiorowska
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences
| | - Tomasz Mikulski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences
| | - Walerian Piotrowski
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology
| | - Krystyna Nazar
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology
| |
Collapse
|
23
|
Carroll D, Phillips AC, Balanos GM. Metabolically exaggerated cardiac reactions to acute psychological stress revisited. Psychophysiology 2009; 46:270-5. [DOI: 10.1111/j.1469-8986.2008.00762.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Kardos A, Földesi C, Nagy A, Sáringer A, Kiss A, Kiss G, Marschalkó P, Szabó M. Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol in children. Acta Anaesthesiol Scand 2006; 50:869-74. [PMID: 16879471 DOI: 10.1111/j.1399-6576.2006.01073.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Induction of anaesthesia may cause decreased cardiac output and blood pressure. Head-down tilt is often the first clinical step to treat hypotension. The objective of this randomized single centre study was to determine, with the use of impedance cardiography (ICG), whether Trendelenburg positioning modifies the haemodynamic response to propofol/fentanyl induction of anaesthesia in ASA I children. METHODS Thirty ASA I children aged between 7 and 16 years scheduled for elective minor orthopaedic surgery were included. After intravenous induction with propofol and fentanyl in the head-down group (HDG, n = 15), 5 min of 20 degrees head-down tilt was applied. In the supine group (SG, n = 15), no change in the supine position was made. Heart rate (HR), mean arterial blood pressure (MABP), end-tidal carbon dioxide (ETCO(2)), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI) and Heather index (HI) were recorded before (B), at 3 (A(3)), 5 (A(5)) and 8 (A(8)) minutes after induction in each group. RESULTS After induction, a significant decrease in CI, MABP, HR and HI was recorded in both groups. In the study group, significantly lower values of HR (66 vs. 78 beat/min) and higher values of SVI (42.9 vs. 40.6 ml/min/m(2)) were measured at A(3) compared with the control group. After induction, no difference in CI and SVRI was found between the two groups. CONCLUSION The present study shows that cardiac performance is not improved by Trendelenburg positioning after propofol/fentanyl induction of anaesthesia in children.
Collapse
Affiliation(s)
- A Kardos
- Paediatric Intensive Care Unit, Heim Pál Children's Hospital, Ullöi Str. 89, 1086 Budapest, Hungary.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Kupper N, Willemsen G, Boomsma DI, de Geus EJC. Heritability of indices for cardiac contractility in ambulatory recordings. J Cardiovasc Electrophysiol 2006; 17:877-83. [PMID: 16800859 DOI: 10.1111/j.1540-8167.2006.00535.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Overactivity of the sympathetic nervous system (SNS) plays a pivotal role in the development of cardiovascular disease. This involvement suggests that the genetic susceptibility to adverse cardiovascular events may derive in part from individual differences in SNS activity. METHODS AND RESULTS To establish a genetic contribution to SNS activity, we measured sympathetic effects on cardiac contractility in 755 healthy adult twins and their singleton siblings. The preejection period (PEP) and the ratio of PEP to the left ventricular ejection time (PEP/LVET ratio) were derived from ambulatory recordings of the ECG and thorax impedance. During this type of prolonged recordings in a real life setting, the extent of cardiac sympathetic activity will vary with the demands of daily activities. Therefore, the genetic architecture of both indices was examined separately across three daytime periods (morning, afternoon, evening), and during nighttime sleep. Results showed significant genetic contribution to PEP (48-62%) over all daily periods. Heritability estimates for PEP/LVET ratio ranged between 35% and 58%. Cardiac sympathetic activity during the waking and sleep periods was largely influenced by genetic factors that were common to the entire 24-hour period. During sleep, additional genetic influences emerged that accounted for 8% of the variance in PEP. CONCLUSION Impedance-derived measures of sympathetic effects on cardiac contractility show substantial heritability across all periods of the day and during sleep.
Collapse
Affiliation(s)
- Nina Kupper
- Department of Biological Psychology, Vrije Universiteit, Van der Boechorststraat, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|