INTRODUCTION: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the 'cuff pulsatility index'. PURPOSE: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. METHODS: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m-2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient's dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). RESULTS: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. CONCLUSIONS: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.
- Klíčová slova
- Left ventricular assist device, non-invasive, pulsatility index,
- MeSH
- arterie patofyziologie MeSH
- asistovaná cirkulace přístrojové vybavení metody MeSH
- diagnostické techniky kardiovaskulární MeSH
- krevní tlak fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- pulz metody MeSH
- pulzatilní průtok fyziologie MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- srdeční selhání * patofyziologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Proper identification of the cardiac cycle is essential for gated SPECT myocardial perfusion imaging. We have developed an alternate method of ECG for gating, that is, using the peripheral pulse wave (PW) as the triggering signal for gated SPECT acquisition. The aim of this study is to compare the use of this method of gating with the standard ECG trigger. METHODS: We tested the PW triggering by comparing it with the ECG trigger. We evaluated 33 patients (25 males, 8 females), average age of 61 years (39-80) referred for stress myocardial perfusion imaging. Data from all patients were acquired twice and were processed by CEqual and QGS software. We compared the left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes (EDV, ESV). Paired t test and Pearson correlation coefficient were used for comparison. RESULTS: The mean LVEF, EDV, and ESV calculated with the ECG trigger were 0.52, 120, and 64, respectively, those with the pulse-wave trigger were 0.48, 126, and 71, respectively. Mean paired difference for LVEF was -0.034 (P<0.001), for EDV 5.9 (P=0.012), and for ESV 7.9 (P<0.001). Pearson correlation coefficient for LVEF was 0.955, for EDV 0.987, and for ESV 0.991 (P<0.001 for all correlations). CONCLUSION: Triggering of gated-data acquisition by the PW is feasible. Quantitative parameters of cardiac function correlate highly with those obtained from the ECG trigger and the absolute differences are not clinically significant across a wide range of values.
- MeSH
- elektrokardiografie MeSH
- funkce levé komory srdeční MeSH
- jednofotonová emisní výpočetní tomografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačové zpracování signálu * MeSH
- pulz metody MeSH
- srdeční akcí synchronizované zobrazovací metody metody MeSH
- tepový objem MeSH
- zobrazování myokardiální perfuze metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Pulsations of the dorsal vessel were investigated with new optocardiographic techniques based on the transmission and reflection of pulse-light through optic fibers. This noninvasive technique enabled simultaneous, in vivo multisensor recordings of the heartbeat without touching the pupal integument. There was a very regular heartbeat reversal with 3 distinctive phases: (a) a backward-oriented (retrograde) cardiac pulsation; (b) a forward-oriented (anterograde) pulsation with faster frequency; and (c) shorter or longer periods of temporary cardiac standstill that usually occurred after the termination of the anterograde phase. Occasionally, there were localized series of systolic cardiac contractions during the retrograde phase. Simultaneous recordings from the base and the tail of the abdomen revealed a reciprocal, "mirror image-like", quantitative relationship. The most intensive anterograde hemolymph flow occurred at the base while the most intensive retrograde flow occurred at the tail of the abdomen. The bi-directional switchovers of heartbeat (reversal) were occasionally associated with modifications during each of the unidirectional cardiac phases. Anterograde peristalsis showed a 2-fold higher frequency of pulsation in the thoracic aorta in comparison with the posterior parts of the heart. Thus, in addition to the "odd" peristaltic waves originating at the tail, there were intercallated "even" peristaltic waves originating in the middle of the abdomen. Both of them propagated hemolymph through the thoracic aorta into the head; the first waves took the hemolymph in from the distal end, while the second sucked it from the middle of the abdomen. The use of multiple optocardiographic sensors also enabled detection of cardiac pulsations on the opposite, ventral side of the body, within the ventral perineural sinus. The ventral side of the head showed only the presence of an anterograde pulse, whereas the ventral side of the tail exhibited a strong reciprocal retrograde phase and a very weak anterograde phase. These results explain why the existence of a periodic heartbeat reversal should be essential for circulatory functions at both extremities of the cylindrical insect body. In diapausing pupae, regular cycles of heartbeat reversal were substituted by prolonged periods of anterograde pulsation during the entire duration of bursts of CO2 release (average duration of the burst was 18-20 min, periodicity 5 to 18 h). The physiological nature of such feed-back correlation between heartbeat and metabolic CO2 production is not yet clear, because the anterograde heartbeat could be also induced by a number of nonspecific factors unrelated to CO2 (mechanical irritation, injury, injections, elevated temperature). During the postdiapause, developing pharate-adult stage, the correlation between CO2 and anterograde heartbeat completely disappeared. It has been concluded that regulation of insect heartbeat represents a highly coordinated, myogenic stereotype with inherent rhythmicity, which can be modified by a number of external and internal factors.
- MeSH
- biologická proměna fyziologie MeSH
- hemolymfa fyziologie MeSH
- kontrakce myokardu fyziologie MeSH
- krevní oběh fyziologie MeSH
- kukla fyziologie MeSH
- Manduca fyziologie MeSH
- oxid uhličitý krev MeSH
- pulz přístrojové vybavení metody MeSH
- srdeční frekvence fyziologie MeSH
- technologie optických vláken přístrojové vybavení MeSH
- termografie přístrojové vybavení metody MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- Názvy látek
- oxid uhličitý MeSH
- MeSH
- arterie fyziologie MeSH
- bérec krevní zásobení MeSH
- lidé MeSH
- pružnost MeSH
- pulz * metody MeSH
- rychlost toku krve MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
