Abstract
Left ventricular volume–time curves (VTCs) provide hemodynamic data, and may help clinical decision making. The generation of VTCs using echocardiography, however, is time-consuming and prone to inter-operator variability. In this study, we used a new non-invasive, operator-independent technique, the hemodynamic cardiac profiler (HCP), to generate VTCs. The HCP, which uses a low-intensity, patient-safe, high-frequency applied AC current, and 12 standard ECG electrodes attached on the thorax in a pre-defined pattern, was applied to five young healthy volunteers, five older healthy volunteers, and five patients with severe mitral regurgitation. From the VTCs generated by the HCP, the presence or absence of an isovolumetric contraction phase (ICP) was assessed, as well as the left ventricular ejection time (LVET), time of the pre-ejection period (tPEP), and ratio of the volumes of the early (E) and late (A) diastolic filling (EV/AV ratio), and compared to 2D transthoracic echocardiography (2D TTE) at rest. The reproducibility by two different operators showed good results (RMS = 5.2%). For intra-patient measurement RMS was 2.8%. Both LVET and the EV/AV ratio showed a strong significant correlation between HCP and 2D TTE derived parameters (p < 0.05). For tPEP, the correlation was still weak (p = 0.32). In all five patients with mitral regurgitation, the ICP was absent in the VTC from the HCP, whereas it was present in the 10 healthy volunteers, which is in accordance with pathophysiology. We conclude that the HCP seems to be a method for reproducible VTC generation, and may become a useful early screening tool for cardiac dysfunction in the future.
Highlights
Numerous techniques have been developed for the screening and monitoring of patients with cardiac diseases
We present the assessment of volume–time curves (VTCs) by the hemologic cardiac profiler (HPC) in healthy volunteers and patients with severe mitral regurgitation (MR), and a pilot study on the accuracy of these curves, by comparing parameters derived from the VTCs from the hemodynamic cardiac profiler (HCP) to the corresponding parameters derived from 2D echocardiography
Based on experiments in five young healthy volunteers, five older healthy volunteers and five patients with MR, we demonstrate that the HCP can produce VTCs with a high time resolution (200 points s−1), so that short-lived phenomena are clearly detectable
Summary
Numerous techniques have been developed for the screening and monitoring of patients with cardiac diseases. Most extensively used in clinical practice is the electrocardiogram (ECG), which provides a non-invasive and continuous measurement of the electric activity of the heart. It lacks information about the actual blood volume displacement. Deviations in the VTC may be useful in the screening and monitoring of patients with a cardiac disease. A general example from clinical practice is the impaired diastolic filling as the first sign of ischemia (Montalescot et al 2013); VTC-derived parameters for diastolic function have shown to be well correlated with the severity of ischemia (Nakae et al 2008). Early detection and regular monitoring using the VTC, may prevent progression of disease
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