Transthoracic Electrical Impedance Research Articles

A fresh look at sports PSM-systems

Abstract The aim of the proposed study is to reveal the correlations between the dynamics of Respiratory Rate (RR) and Heart Rate (HR) during intermittent physical work at maximum power on a cycle ergometer. The stage of investigating the General functional athlete readiness (GFAR) was conducted using the sports standard “R-Engine” and the cycle ergometer in 16 volunteers (10 men, 6 women) whose average age was 21±1.17 years. To determine the athletic potential of the volunteers in this study, we used our own Coefficient of Anaerobic Capacity (CANAC Q, beats). Continuous registration of the heart rate and respiratory rate of volunteers in the maximum power sports test was performed by the “RheoCardioMonitor” system with a module of the athlete functional readiness based on the method of Transthoracic electrical impedance rheography (TEIRG). The degree of correlation of functional indicators (M, HRM, GFAR) with CANAC Q in all experimental series of the study group as a whole (n=80) was at a very high level, which confirmed the effectiveness of using the Coefficient of Anaerobic Capacity (CANAC Q) in assessing the general functional athlete readiness of the volunteers. CANAC Q is measured in “beats” of the heart and is recorded very accurately using the method of transthoracic electrical impedance rheography (TEIRG). For this reason, as a promising sports PSM-system, CANAC Q can replace the methods for determining the functional athlete readiness by blood lactate concentration and maximum oxygen consumption.

Comprehensive Biotechnical System for Screening Risk-based Diagnosis of COVID-19 and Post-COVID Syndrome.

At present, there are no hardware or biochemical systems that allow to assess the severity of post-COVID syndrome in vivo. The hardware of the proposed biotechnical system is based on routine transthoracic electrical impedance rheography, which makes it possible to register the frequency characteristics of the patient's bioimpedance response to controlled stress stimulation, thereby simultaneously fixing the characteristics of his productive heart, the state of the hemomicrocirculatory bed, the efficiency of the gas transport function of his blood, and also reliably assess personal reactivity and adaptive potential. Subsequent mathematical approximation of the obtained biometric data by an original neural network makes it possible to rank the results obtained and automatically generate a program of medical rehabilitation for a particular patient, depending on the severity of his post-COVID syndrome. The study results proved two reliable physiological signs confirming the presence of latent post-COVID complications: a decrease in the base impedance value for light exercise and an increase in the length of the systolic arc of the rheocardiogram.

Electrode Positioning to Investigate the Changes of the Thoracic Bioimpedance Caused by Aortic Dissection - A Simulation Study.

Impedance cardiography (ICG) is a non-invasive method to evaluate several cardiodynamic parameters by measuring the cardiac-synchronous changes in the dynamic transthoracic electrical impedance. ICG allows us to identify and quantify conductivity changes inside the thorax by measuring the impedance on the thorax during a cardiac cycle. Pathologic changes in the aorta, like aortic dissection, will alter the aortic shape as well as the blood flow and consequently, the impedance cardiogram. This fact distorts the evaluated cardiodynamic parameters, but it could lead to the possibility to identify aortic pathology. A 3D numerical simulation model is used to compute the impedance changes on the thorax surface in case of the type B aortic dissection. A sensitivity analysis is applied using this simulation model to investigate the suitability of different electrode configurations considering several patient-specific cases. Results show that the remarkable pathological changes in the aorta caused by aortic dissection alters the impedance cardiogram significantly.

Measurement of Thoracic Impedance and Approximations: A Diagnosis Technique for Clinical Utilisation

The purpose of this paper is to facilitate the readers and the researchers about the implementations and applications of thoracic impedance measurements and approximations for diagnosis of several related diseases. In this study, two entirely non-invasive approaches and simple assumptions are taken into consideration to measure the transthoracic electrical impedance and lung volume. In the first method, the fluid volume is calculated by considering a pre-defined curve and anthropometric dimensions of the human thorax, whereas in the second method, the thorax is considered as a cylinder and the cylindrical mathematical standard formulae are utilised for approximation of the lung volume. The thoracic impedance is measured directly by placing the tetrapolar electrodes on the right side of the human thorax. The right side of the thorax is considered in order to avoid the incorporation of the geometrical aspects and the behaviour of the heart. The anthropometric dimensions are taken for six normal male subjects of sound health. With the help of these parameters, the thoracic fluid volume is predicted using two methods. In the first method, the thoracic volume is predicted by considering the thorax as a cylinder and by using basic relations of the periphery and volume of the cylinder. Human thorax dimensions are approximated as height and breadth of the cylinder and certain approximations have been adopted. The anthropometric dimensions are taken for the chest at normal resting conditions and at breath-hold positions. In both the approaches, the difference between the measured and the predicted impedances and volumes are clearly observable.

Prediction of quantitative intrathoracic fluid volume to diagnose pulmonary oedema using LabVIEW

Pulmonary oedema is a life-threatening disease that requires special attention in the area of research and clinical diagnosis. Computer-based techniques are rarely used to quantify the intrathoracic fluid volume (IFV) for diagnostic purposes. This paper discusses a software program developed to detect and diagnose pulmonary oedema using LabVIEW. The software runs on anthropometric dimensions and physiological parameters, mainly transthoracic electrical impedance (TEI). This technique is accurate and faster than existing manual techniques. The LabVIEW software was used to compute the parameters required to quantify IFV. An equation relating per cent control and IFV was obtained. The results of predicted TEI and measured TEI were compared with previously reported data to validate the developed program. It was found that the predicted values of TEI obtained from the computer-based technique were much closer to the measured values of TEI. Six new subjects were enrolled to measure and predict transthoracic impedance and hence to quantify IFV. A similar difference was also observed in the measured and predicted values of TEI for the new subjects.

A method for suppressing cardiogenic oscillations in impedance pneumography

The transthoracic electrical impedance signal originates from the cardiac and respiratory functions. In impedance pneumography (IP) the lung function is assessed and the cardiac impedance signal, cardiogenic oscillations (CGOs), is considered an additive noise in the measured signal. In order to accurately determine pulmonary flow parameters from the signal, the CGO needs to be attenuated without distorting the respiratory part of the signal. We assessed the suitability of a filtering technique, originally described by Schuessler et al (1998 Ann. Biomed. Eng. 26 260–7) for an esophageal pressure signal, for CGO attenuation in the IP signal. The technique is based on ensemble averaging the CGO events using the electrocardiogram (ECG) R-wave as the trigger signal. Lung volume is known to affect the CGO waveforms. Therefore we modified the filtering method to produce a lung volume-dependent parametric model of the CGO waveform. A simultaneous recording of ECG, IP and pneumotachograph (PNT) was conducted on 41 healthy, sitting adults. The performance of the proposed method was compared to a low-pass filter and a Savitzky–Golay filter in terms of CGO attenuation and respiratory signal distortion. The method was found to be excellent, exhibiting CGO attenuation of 35.0±12.5 dB (mean±SD) and minimal distortion of the respiratory part of the impedance signal.

An Optimal Spot-Electrodes Array for Voltage Pick-Up Determined from the Measurement of Transthoracic Electrical Impedance Change Following Cardiac Ejection

An Optimal Spot-Electrodes Array for Voltage Pick-Up Determined from the Measurement of Transthoracic Electrical Impedance Change Following Cardiac Ejection

Transthoracic electrical impedance during external defibrillation: comparison of measured and modelled waveforms

The transthoracic electrical impedance is an important defibrillation parameter, affecting the defibrillating current amplitude and energy, and therefore the defibrillation efficiency. A close relationship between transthoracic impedance and defibrillation success rate was observed. Pre-shock measurements (using low amplitude high frequency current) of the impedance were considered a solution for selection of adequate shock voltages or for current-based defibrillation dosage. A recent approach, called `impedance-compensating defibrillation' was implemented, where the pulse duration was controlled with respect to the impedance measured during the initial phase of the shock. These considerations raised our interest in reassessment of the transthoracic impedance characteristics and the corresponding measurement methods. The purpose of this work is to study the variations of the transthoracic impedance by a continuous measurement technique during the defibrillation shock and comparing the data with results obtained by modelling. Voltage and current impulse waveforms were acquired during cardioversion of patients with atrial fibrillation or flutter. The same type of defibrillation pulse was taken from dogs after induction of fibrillation. The electrodes were located in the anterior position, for both the patients and animals.

Effect of Application of Force to Self-Adhesive Defibrillator Pads on Transthoracic Electrical Impedance and Countershock Success

Study objective: To examine the effect of the application of force to self-adhesive defibrillator pads on transthoracic electrical impedance and countershock success. Methods: A prospective, randomized, controlled pilot study was carried out in an experimental animal laboratory, involving 32 mixed-breed swine weighing 36.5 to 55.7 kg each. Ventricular fibrillation (VF) was induced, and the animals were randomly allocated to 1 of 4 groups, with 8 animals per group. Animals in groups I and II remained in VF for 30 seconds; those in groups III and IV remained in VF for 5 minutes. At the end of the VF period, up to 3 countershocks were given. In groups I and III, countershocks were delivered through the self-adhesive defibrillator pads alone; in groups II and IV, they were delivered through the defibrillator pads with 25 lb of applied force. Any animal without return of spontaneous circulation after 3 countershocks was given epinephrine after 1 minute of CPR, followed by 1 additional minute of CPR and 1 additional countershock if required. Results: The main measurements included baseline and countershock transthoracic impedance, cumulative countershock success rate, and 30-minute survival rate. Application of 25 lb of force to the defibrillator pads significantly decreased transthoracic impedance, compared with baseline values (group II, 15.1% decrease; group IV, 16.1% decrease). The first-shock success rate was higher when force was applied during the countershock (87.5% versus 50% for groups II and I, respectively; 62.5% and 37.5% for groups IV and III, respectively). In the animals who experienced 5 minutes of VF, there were greater rates of success after the second, third, and fourth countershocks when force was applied (group IV) than when no force was applied (group III). Groups I and II (VF for 30 seconds) demonstrated 100% survival at 30 minutes. Group IV had a higher 30-minute survival rate (3/8 animals) than did group III (1/8). However, the rates of countershock success and 30-minute survival were not statistically different among the groups. Conclusion: Application of force to self-adhesive defibrillator pads decreases transthoracic impedance during countershock. This effect may contribute to improving the countershock success rate. [Persse DE, Dzwonczyk R, Brown CG: Effect of application of force to self-adhesive defibrillator pads on transthoracic electrical impedance and countershock success. Ann Emerg Med August 1999;34:129-133.]

Assessment of gastric mucosal perfusion during simulated hypovolemia in healthy volunteers.

We described here an original device for laser Doppler (LD) flowmetry measurements of gastric mucosal perfusion, which was used here in healthy volunteers. A modified nasogastric tube containing the LD probe was inserted. Aspiration via a catheter, fixed in parallel to the probe, held the probe against the gastric wall. This new device was used to assess gastric mucosal perfusion in seven volunteers during simulated hypovolemia induced by lower body negative pressure (LBNP) application. The LBNP consisted of three successive levels of depression (-10, -20, and -30 mm Hg). Although mean arterial pressure remained unchanged during negative pressure application, there was a significant decrease in cardiac output (transthoracic electrical impedance) at each stage of LBNP. In contrast, gastric mucosal perfusion decreased significantly only at higher level of sympathetic stimulation corresponding to unloading of both cardiopulmonary and arterial baroreflexes (-30 mm Hg). It may be hypothetized that local vascular mechanisms exist to maintain gastric mucosal perfusion during moderate sympathetic stimulation induced by selective unloading of cardiopulmonary receptors. In the healthy volunteers studied, we found that LD flowmetry is a valuable tool to evaluate gastric mucosal perfusion when the probe is maintained in a constant position by the technique described here.

The effect of haematocrit on transthoracic electrical impedance and on the calculation of cardiac output by an impedance cardiograph

The Transthoracic electrical impedance (TEI) was measured using the Bomed NCCOM3 non-invasive cardiac output monitor in 27 patients with polycythemia rubra vera (PCRV) and in a control group of 27 patients with normal haematocrits. The mean haematocrit was 49.4% (SD 2.61) in the patients with PCRV and 42.1% (SD 2.95) in the control group, a difference that was significant (p less than 0.001). The mean TEI was also significantly higher in patients with PCRV than in the control group (p less than 0.05), the respective values being 31.25 (5.48) Ohms and 27.5 (3.31) Ohms. The mean values for cardiac output (CO) and cardiac index (CI) were similar in both groups.

Effect of infant position on breath amplitude measured by transthoracic impedance and strain gauges

Continuous monitoring of respiration by transthoracic electrical impedance gives a signal that has certain not well understood irregularities. Among them is a change in the amplitude of the signal when there is no apparent change in the infant's tidal respiration. One factor that could hypothetically account for alterations of the impedance signal is a change in current path through the thorax secondary to a change in body position. To test this hypothesis we have studied the relationships between breath amplitude measured by transthoracic impedance, one strain gauge on the chest and one on the abdomen, and tidal volume by integrated flow in four body positions. Median breath amplitude was found to vary significantly with body position according to the measuring device. The median impedance breath amplitude increased by 27% in the supine position compared with the prone position, with no associated change in tidal volume. Differences in the strain gauge signal amplitude for these positions were not statistically significant. Correlation between breath amplitude measured by impedance changes and tidal volume was minimal (r = 0.114). These results indicate that infant position affects impedance breath amplitude independently of changes in tidal volume.

大動脈内バルーンパンピング法(IABP)施行中のバルーン作動状態の解析

大動脈内バルーンパンピング法(IABP)施行中のバルーン作動状態の解析

Impaired pulmonary and cardiac function after maximal exercise.

The cardiopulmonary response to maximal rowing exercise of short duration was studied in six healthy well-trained oarsmen. The lung diffusing capacity for carbon monoxide was significantly decreased below the pre-exercise value for 2.5 days post-exercise (P less than 0.05). Residual volume (RV) showed a significantly increased value at 30 min of recovery (P less than 0.01) with no change in total lung capacity. There was no significant change in transthoracic electrical impedance following exercise but a decrease may have been masked by the increased RV. The changes in the pulmonary parameters may reflect the occurrence of a transient interstitial lung oedema. Exercise-induced bronchoconstriction may be a part of the cardiopulmonary response as peak expiratory flow rate (PEFR) was significantly reduced at 30 min of recovery. The reason for the increase in pulmonary extravascular water volume may be a marked distension of the lung capillaries due to increased blood volume in the lungs and as a consequence increased vascular permeability. The changes may also be caused by impaired myocardial contractility indicated by a split impedance dZ/dt waveform, not previously described in healthy persons, which occurred in all six subjects immediately following exercise.

Transthoracic electrical impedance at 1 and 100 kHz--a means for separating thoracic fluid compartments?

The electrical impedance of biological tissues varies with their water and electrolyte contents. Alternating current above 5-10 kHz passes both intra- and extracellular fluid, and lower frequency current preferentially extracellular fluid. In an attempt to evaluate thoracic fluid in different compartments, transthoracic electrical impedance (TEI) was measured at 1 and 100 kHz in 15 consecutive patients, without overt left heart failure and under haemodynamic surveillance, during the first two days of myocardial infarction. To achieve different states of hydration the patients were given i.v. furosemide, either 40 mg t.i.d. (high dose group--HDG) or 20 mg once daily (low dose group--LDG). Effects of altered body position and the respective furosemide injections, were evaluated on both days. Mean 24-h-diuresis was 3.9 l in the HDG and 2.5 l in the LDG. After 24 h mean pulmonary arterial diastolic pressure had decreased by 30% in the HDG but remained almost unchanged in the LDG. By then mean basal TEI was increased only in the HDG, by 17% at 1 kHz and 13% at 100 kHz. On Day 1, within one hour after furosemide, TEI increased temporarily by 3-5%, at both frequencies and in both groups. On Day 2, this short-term increase was similar in the LDG at both frequencies and in the HDG at 100 kHz, but not at 1 kHz, consistent with a major extracellular fluid loss in the HDG. TEI at 1 and 100 kHz may thus reflect extracellular and total thoracic fluid, respectively.

Influence of Furosemide and Body Posture on Transthoracic Electrical Impedance in AMI

Transthoracic electrical impedance (TEI) is related to thoracic fluid content. In order to analyze this relation, we studied the acute effects of changes in body posture and of intravenous administration of furosemide on TEI in patients with different diuretic regimens. The TEI was measured using a tetrapolar electrode system, and a 100 microA constant current at 100 kHz. The measurements were performed repeatedly during the first two days in 15 consecutive patients with acute myocardial infarction (AMI) and without overt left heart failure, as evaluated from clinical data and bedside catheterization. It was concluded that TEI appears to be a sensitive, noninvasive means of evaluating changes in thoracic fluid content in AMI.

Prophylactic Furosemide Treatment in Acute Myocardial Infarction

Prophylactic diuretic therapy in acute myocardial infarction (AMI) was evaluated in 83 consecutive patients without severe left ventricular failure (LVF) on admission. A high dose group (HDG) received 120-160 mg and a low dose group (LDG) 20-40 mg furosemide daily for six weeks. Mortality and reinfarction rates did not differ between the groups. One HDG patient and five LDG patients developed severe LVF. Four HDG patients developed severe dehydration. Serum enzyme activities and electrolytes were similar in both groups. The increased diuresis in the HDG was accompanied by a 4% hemoconcentration, smaller radiological heart volumes, higher heart rates, a higher demand for nitroglycerin and higher ratings of thirst. Exercise tests yielded similar results in both groups. Later blood volumes and transthoracic electrical impedance were similar in both groups. It is concluded that liberal prophylactic furosemide treatment in AMI offers no major clinical advantage.

Transthoracic electrical impedance as an index of extracellular fluid volume in man.

Findings in 76 subjects without cardiac failure were analyzed to detect relationships between observed changes in transthoracic electrical impedance (TEI) and total body extracellular fluid volume (ECFV) during various manoeuvres and between absolute TEI and ECFV values. TEI was normalized to electrode distance (Z0/delta el) and ECFV to lean body mass (ECFV/LBM). A distinct relation was found between percent changes of TEI and ECFV (r = -0.76, p less than 0.0001) and between absolute Z0/delta el and ECFV/LBM values (r = -0.66, p less than 0.0001 for men; r = -0.61, p less than 0.0001 for women). It is concluded that in the same subject a change in TEI is possibly a sensitive index for a change in ECFV and that a single measurement of TEI, normalized to electrode distance, gives information about the state of hydration (ECFV) of patients without cardiac failure.

Indirect assessment of thoracic fluid balance following maximal exercise in man

Abstract A series of three studies was conducted to help determine the physiological mechanism responsible for the previously reported increase in residual volume following maximal exercise. Study I showed that in 18 male volunteers, residual volume and total lung capacity were significantly (P<0.05) increased over the pre‐exercise values through 30 and 15 min of recovery, respectively. Transthoracic electrical impedance was significantly decreased below the pre‐exercise value through 15 min of recovery. This suggests that there was an increase in intrathoracic fluid following exercise. By experimentally manipulating central blood volume via G‐suit inflation and venous occlusion, study II (n = 10) showed that post‐exercise residual volume was relatively insensitive to increases in intravascular fluid within the thorax. Study III (n = 5) showed that the post‐exercise diffusion capacity (DLco/VA was unchanged following exercise, despite an increase in the post‐exercise heart rate. It was concluded that a su...

Effect of age on systolic time intervals at rest and during exercise on a bicycle ergometer

Measurements of systolic time intervals were obtained by simultaneous recordings of ECG and first derivative transthoracic electrical impedance curves, at rest in the supine and upright body positions and during exercise while sitting on a bicycle ergometer. The same schedule was applied to 70 normal males divided into 3 groups: 20 boys 11–14 years, 25 yound adults 20–30 years, and 25 middle-aged men 45–55 years.