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Signal‐morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension
Author(s) -
Ferreira Eloara M.,
Arakaki Jaquelina S. Ota,
B. Barbosa Priscila,
Siqueira Ana Cristina B.,
Bravo Daniela M.,
Kapins Carlos Eduardo B.,
Silva Célia Maria C.,
Nery Luiz Eduardo,
Alberto Neder J.
Publication year - 2012
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/j.1475-097x.2012.01135.x
Subject(s) - medicine , impedance cardiography , cardiology , hemodynamics , pulmonary hypertension , stroke volume , population , cardiac output , cardiac index , heart failure , ejection fraction , environmental health
Summary Background Haemodynamic responses to exercise are related to physical impairment and worse prognosis in patients with pulmonary arterial hypertension ( PAH ). It is clinically relevant, therefore, to investigate the practical usefulness of non‐invasive methods of monitoring exercise haemodynamics in this patient population. Methods Using a novel impedance cardiography ( ICG ) approach that does not require basal impedance estimations and relies on a morphological analysis of the impedance signal (Signal‐Morphology‐ ICG ™ ), stroke volume ( SV ) and cardiac index ( CI ) were evaluated in 50 patients and 21 age‐matched controls during a ramp‐incremental cardiopulmonary exercise testing. Results Technically unacceptable readings were found in 12 of 50 (24%) patients. In the remaining subjects, early decrease ( N = 9) or a ‘plateau’ in SV ( N = 8) and Δ (peak‐unloaded exercise) SV <10 ml were markers of more advanced PAH ( P <0.05). ΔCI ≤ 1.5‐fold and early estimated lactate threshold were the only independent predictors of a severely reduced peak oxygen uptake (V · O 2 ) in patients ( R 2 = 0.71, P <0.001). The finding of ΔCI ≤ 1.5‐fold plus peakV · O 2 < 50% predicted was associated with a number of clinical and functional markers of disease severity ( P <0.001). In addition, abnormal SV responses and ΔCI ≤ 1.5‐fold were significantly related to 1‐year frequency of PAH‐related adverse events (death and balloon atrial septostomy, N = 8; P <0.05). Conclusions ‘Qualitative’ and ‘semi‐quantitative’ signal‐morphology impedance cardiography ™ (PhysioFlow ™ ) during incremental exercise provided clinically useful information to estimate disease severity and short‐term prognosis in patients with PAH in whom acceptable impedance signals could be obtained.