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Van Daele M, Cooper SL, Pannucci P, Wragg ES, March J, de Jong I, Woolard J. Monitoring haemodynamic changes in rodent models to better inform safety pharmacology: Novel insights from in vivo studies and waveform analysis. JRSM Cardiovasc Dis 2022; 11:20480040221092893. [PMID: 35646334 PMCID: PMC9133998 DOI: 10.1177/20480040221092893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/21/2022] [Accepted: 03/22/2022] [Indexed: 01/13/2023] Open
Abstract
Animal models are essential for assessing cardiovascular responses to novel therapeutics. Cardiovascular safety liabilities represent a leading cause of drug attrition and better preclinical measurements are essential to predict drug-related toxicities. Presently, radiotelemetric approaches recording blood pressure are routinely used in preclinical in vivo haemodynamic assessments, providing valuable information on therapy-associated cardiovascular effects. Nonetheless, this technique is chiefly limited to the monitoring of blood pressure and heart rate alone. Alongside these measurements, Doppler flowmetry can provide additional information on the vasculature by simultaneously measuring changes in blood flow in multiple different regional vascular beds. However, due to the time-consuming and expensive nature of this approach, it is not widely used in the industry. Currently, analysis of waveform data obtained from telemetry and Doppler flowmetry typically examines averages or peak values of waveforms. Subtle changes in the morphology and variability of physiological waveforms have previously been shown to be early markers of toxicity and pathology. Therefore, a detailed analysis of pressure and flowmetry waveforms could enhance the understanding of toxicological mechanisms and the ability to translate these preclinical observations to clinical outcomes. In this review, we give an overview of the different approaches to monitor the effects of drugs on cardiovascular parameters (particularly regional blood flow, heart rate and blood pressure) and suggest that further development of waveform analysis could enhance our understanding of safety pharmacology, providing valuable information without increasing the number of in vivo studies needed.
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Affiliation(s)
- Marieke Van Daele
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- Centre of Membrane Proteins and Receptors, University of Birmingham and University of Nottingham, Midlands, UK
| | - Samantha L Cooper
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- Centre of Membrane Proteins and Receptors, University of Birmingham and University of Nottingham, Midlands, UK
| | - Patrizia Pannucci
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- Centre of Membrane Proteins and Receptors, University of Birmingham and University of Nottingham, Midlands, UK
| | - Edward S Wragg
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- Centre of Membrane Proteins and Receptors, University of Birmingham and University of Nottingham, Midlands, UK
| | - Julie March
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Iwan de Jong
- Maastricht Instruments BV, Maastricht University, Maastricht, The Netherlands
| | - Jeanette Woolard
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
- Centre of Membrane Proteins and Receptors, University of Birmingham and University of Nottingham, Midlands, UK
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Eleid MF, Nishimura RA. Aortic stenosis and the pulse contour: A true marker of severity? Catheter Cardiovasc Interv 2019; 95:1235-1239. [PMID: 31868287 DOI: 10.1002/ccd.28674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/07/2019] [Accepted: 12/15/2019] [Indexed: 11/06/2022]
Abstract
The aortic pulse contour displays characteristic changes associated with the progression of aortic stenosis (AS). A diminished and delayed aortic pulse contour is indicative of significant AS, but the aortic contour may also be affected by factors including aging, hypertension and increased peripheral arterial elastance. This review describes the components of the aortic pulse contour in AS and how it can be affected by different conditions and interventions.
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Noninvasive iPhone Measurement of Left Ventricular Ejection Fraction Using Intrinsic Frequency Methodology*. Crit Care Med 2017; 45:1115-1120. [DOI: 10.1097/ccm.0000000000002459] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arai T, Lee K, Marini RP, Cohen RJ. Estimation of changes in instantaneous aortic blood flow by the analysis of arterial blood pressure. J Appl Physiol (1985) 2012; 112:1832-8. [PMID: 22442022 DOI: 10.1152/japplphysiol.01565.2011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to introduce and validate a new algorithm to estimate instantaneous aortic blood flow (ABF) by mathematical analysis of arterial blood pressure (ABP) waveforms. The algorithm is based on an autoregressive with exogenous input (ARX) model. We applied this algorithm to diastolic ABP waveforms to estimate the autoregressive model coefficients by requiring the estimated diastolic flow to be zero. The algorithm incorporating the coefficients was then applied to the entire ABP signal to estimate ABF. The algorithm was applied to six Yorkshire swine data sets over a wide range of physiological conditions for validation. Quantitative measures of waveform shape (standard deviation, skewness, and kurtosis), as well as stroke volume and cardiac output from the estimated ABF, were computed. Values of these measures were compared with those obtained from ABF waveforms recorded using a Transonic aortic flow probe placed around the aortic root. The estimation errors were compared with those obtained using a windkessel model. The ARX model algorithm achieved significantly lower errors in the waveform measures, stroke volume, and cardiac output than those obtained using the windkessel model (P < 0.05).
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Affiliation(s)
- Tatsuya Arai
- Aerospace Biomedical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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Bernstein DP. Pressure Pulse Contour-derived Stroke Volume and Cardiac Output in the Morbidly Obese Patient. Obes Surg 2008; 18:1015-21. [DOI: 10.1007/s11695-007-9378-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/23/2007] [Indexed: 01/14/2023]
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Karamanoglu M, Bennett TD. A right ventricular pressure waveform based pulse contour cardiac output algorithm in canines. ACTA ACUST UNITED AC 2007; 6:83-92. [PMID: 16960760 DOI: 10.1007/s10558-006-9014-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tracking changes in stroke volume or cardiac output (CO) can be useful in the diagnosis and treatment of various cardiac illnesses. Existing arterial pressure waveform based pulse contour CO algorithms perform poorly during altered systemic hemodynamics. In this study, a right ventricular pressure waveform based pulse contour CO algorithm was developed to estimate the amplitude and duration of a hypothetical triangular flow waveform in the pulmonary artery. This algorithm was tested against gold standard blood flow measurements in ten canines during acute perturbations to preload (inferior vena caval occlusion (IVCO), rapid saline infusion), afterload (descending aortic occlusion (DAO), serotonin, angiotensin II, sodium nitroprusside infusion), and cardiac contractility (dobutamine and propranolol infusion). The algorithm correctly predicted the changes in CO (r2 = 0.82) that varied from - 45 to 31% of the baseline levels. To explain this finding both the pulmonary arterial (PA) and the ascending aortic (AA) input impedances were modeled as three element windkessels. In the AA the peripheral resistance (from - 61 to 191%), characteristic impedance (from - 59 to 20%) and total arterial compliance (from - 49 to 34%) varied significantly with these perturbations. In contrast, these parameters in the PA changed little. In particular, except serotonin infusion, the characteristic impedance of the PA deviated only 6% (SD/mean) from baseline values. This suggests right ventricular pressure waveform based estimate of CO is possible during acute changes in left ventricular hemodynamics.
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Affiliation(s)
- Mustafa Karamanoglu
- Heart Failure Management, Medtronic Inc, 7000 Central Ave NE, CW320, Fridley, MN 55432, USA.
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Felbinger TW, Goepfert MS, Goresch T, Goetz AE, Reuter DA. Arterielle Pulskonturanalyse zur Messung des Herzindex unter Veränderungen der Vorlast und der aortalen Impedanz. Anaesthesist 2005; 54:755-62. [PMID: 16010518 DOI: 10.1007/s00101-005-0847-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac index obtained by arterial pulse contour analysis (CI(PC)) demonstrated good agreement with arterial or pulmonary arterial thermodilution derived cardiac index (CI(TD), CI(PA)) in cardiac surgical or critically ill patients. However as the accuracy of pulse contour analysis during changes of the aortic impedance is unclear, we compared CI(PC), CI(TD) and CI(PA) during changes of preload and the aortic impedance as occurring during sternotomy. PATIENTS AND METHODS CI(PC) und CI(TD), were compared in 28 patients, (and CI(PA) in 6 patients) undergoing elective coronary artery bypass grafting, before and after sternotomy. The relative changes DeltaCI(PC) und DeltaCI(PC) were calculated. RESULTS Sternotomy resulted in a significant increase in CI in 25 out of 28 patients. Regression analysis was performed between CI(PC) and CI(TD) before and after sternotomy (r(2) = 0.87, p<0.0001, r(2) = 0.88, p<0.0001) as well as between CI(PC) and CI(PA), before and after sternotomy (r(2) = 0.85, p<0.0001, r(2) = 0.93, p<0.01) and between DeltaCI(PC) and DeltaCI(TD) (r(2) = 0.72, p<0.0001). Bland Altman-Analysis for determining bias (m) and precision (2SD) between CI(PC) and CI(TD) before and after sternotomy and between DeltaCI(PC) and DeltaCI(TD) resulted in m = -0.03 L/min/m(2), 2SD = -0.34 to 0.28 L/min/m(2), m = -0.06 L/min/m(2), 2SD = -0.45 to 0.33 L/min/m(2) and m = -0.02 L/min/m(2), SD = -0.47 to 0.44 L/min/m(2). CONCLUSION Pulse contour analysis derived CI(PC) accurately reflects thermodilution derived CI(TD) or CI(PA) during changes of preload and the aortic impedance as occurring during sternotomy.
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Affiliation(s)
- T W Felbinger
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf.
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Tanaka S, Gao S, Nogawa M, Yamakoshi KI. Noninvasive measurement of instantaneous, radial artery blood pressure. ACTA ACUST UNITED AC 2005; 24:32-7. [PMID: 16119210 DOI: 10.1109/memb.2005.1463393] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinobu Tanaka
- Department of Human and Mechanical Systems Engineering, Faculty of Engineering, Kanazawa University, Kodatsuno, Japan.
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Arnold DH, Spiro DM, Desmond RA, Hagood JS. Estimation of airway obstruction using oximeter plethysmograph waveform data. Respir Res 2005; 6:65. [PMID: 15985171 PMCID: PMC1168908 DOI: 10.1186/1465-9921-6-65] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 06/28/2005] [Indexed: 11/15/2022] Open
Abstract
Background Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure. Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.
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Affiliation(s)
- Donald H Arnold
- Departments of Emergency Medicine and Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David M Spiro
- Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renee' A Desmond
- Department of Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - James S Hagood
- Department of Pediatrics, Division of Pulmonary Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Felbinger TW, Reuter DA, Eltzschig HK, Bayerlein J, Goetz AE. Cardiac index measurements during rapid preload changes: a comparison of pulmonary artery thermodilution with arterial pulse contour analysis. J Clin Anesth 2005; 17:241-8. [PMID: 15950846 DOI: 10.1016/j.jclinane.2004.06.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 06/24/2004] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To compare cardiac index (CI) values obtained by pulmonary artery thermodilution (CIPA), arterial thermodilution (CITD), and arterial pulse contour analysis (CIPC) during rapid fluid administration, as accurate and rapid detection of CI changes is critical during acute preload changes for guiding volume and vasopressor therapy in critically ill patients, and the accuracy of CIPC during acute changes in loading condition is currently unknown. DESIGN Prospective clinical study. SETTING Cardiac surgical intensive care unit of a university hospital. PATIENTS Seventeen American Society of Anesthesiologists (ASA) physical status II and III patients, aged 32 to 76 years, with normal left ventricular function during the early postoperative period after elective coronary artery bypass graft surgery. MEASUREMENTS After baseline determinations of CIPA, CIPC, and CITD were made, fluid loading was performed using 10 mL times body mass index of hydroxyethyl starch 6%. CIPA, CIPC, and CITD were determined, and changes in CI (DeltaCI) were calculated. Fluid load was repeated until no increase in stroke volume index (DeltaSVI <10%) was achieved. MAIN RESULTS Regression analysis between CIPA/CIPC, CIPA/CITD, and CIPC/CITD revealed r2 = 0.92, r2 = 0.92, and r2 = 0.98. Regression analysis between DeltaCIPA/DeltaCIPC, DeltaCIPA/DeltaCITD, and DeltaCIPC/DeltaCITD revealed r2 = 0.57, r2 = 0.67, and r2 = 0.74, respectively. Bland-Altman analysis was used to determine accuracy and precision of the 3 methods compared. The mean differences (m) and SD between DeltaCIPA/DeltaCIPC, DeltaCIPA/DeltaCITD, and DeltaCIPC/DeltaCITD resulted in m = -1.01%, SD = 6.51%; m = -0.83%, SD = 5.80%; and m = -0.33%, SD = 4.65%, respectively. CONCLUSION Compared with pulmonary artery thermodilution, arterial pulse contour analysis reflects relative changes in CI during rapid changes of preload with clinically acceptable accuracy.
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Affiliation(s)
- Thomas W Felbinger
- Department of Anesthesiology, Grosshadern Medical Center, University of Munich, 81377 Munich, Germany.
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Felbinger TW, Reuter DA, Eltzschig HK, Moerstedt K, Goedje O, Goetz AE. Comparison of pulmonary arterial thermodilution and arterial pulse contour analysis: evaluation of a new algorithm. J Clin Anesth 2002; 14:296-301. [PMID: 12088815 DOI: 10.1016/s0952-8180(02)00363-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To compare cardiac index (CI) measurement by arterial pulse contour analysis using two different algorithms (CI(PC), CI(PCnew)) with pulmonary arterial thermodilution values (CI(PA)) so as to evaluate the difference between the conventional algorithm, CI(PC), and a new algorithm, CI(PCnew), that accounts for patients' individual aortic compliance. DESIGN Prospective, clinical study. SETTING Intensive care unit of a university hospital. PATIENTS 20 ASA physical status II and III patients following elective cardiac surgery. MEASUREMENTS AND MAIN RESULTS 360 parallel triplicate determinations of CI (CI(PA), CI(PC), CI(PCnew)) were performed within a 90-minute period during the immediate postoperative period. Prior to the start of the study period, CI(PC) as well as CI(PCnew) were calibrated by triplicate femoral arterial thermodilution measurements. Regression analysis of CI(PA) and CI(PC), as well as CI(PA) and CI(PCnew), revealed r = 0.89, p < 0.001, and r = 0.93, p < 0.001, respectively. Bland-Altman analysis was used for determining the accuracy and precision of CI(PC) and CI(PCnew) compared with CI(PA). The mean differences (m) and standard deviation (SD) between CI(PA) and CI(PC,) as well as CI(PA) and CI(PCnew), resulted in m = -0.312 L/min/m(2), SD = 0.456 L/min/m(2), and m = - 0.140 L/min/m(2), SD = 0.328 L/min/m(2), respectively. CONCLUSION Arterial pulse contour analysis measurement of CI using either algorithm correlates well with CI values derived by pulmonary arterial thermodilution. However, the algorithm introduced in this study proved to be a more accurate predictor of values as derived by pulmonary artery catheter.
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Affiliation(s)
- Thomas W Felbinger
- Department of Anesthesiology, Grosshadern Medical Center, University of Munich, Munich, Germany
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