Signal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension

Signal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension

Author Ferreira, Eloara M. Autor UNIFESP Google Scholar
Ota-Arakaki, Jaquelina S. Autor UNIFESP Google Scholar
Barbosa, Priscila B. Autor UNIFESP Google Scholar
Siqueira, Ana Cristina B. Autor UNIFESP Google Scholar
Bravo, Daniela M. Autor UNIFESP Google Scholar
Kapins, Carlos Eduardo B. Autor UNIFESP Google Scholar
Silva, Celia Maria C. Autor UNIFESP Google Scholar
Nery, Luiz Eduardo Autor UNIFESP Google Scholar
Alberto Neder, J. Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract 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 (TM)), 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 Delta (peak-unloaded exercise) SV <10 ml were markers of more advanced PAH (P<0.05). Delta CI = 1.5-fold and early estimated lactate threshold were the only independent predictors of a severely reduced peak oxygen uptake ((V) over dotO(2)) in patients (R-2 = 0.71, P<0.001). the finding of Delta CI = 1.5-fold plus peak (V) over dot 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 Delta CI = 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 (TM) (PhysioFlow (TM)) 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.
Keywords cardiac output
exertion
haemodynamics
impedance cardiography
pulmonary hypertension
Language English
Date 2012-09-01
Published in Clinical Physiology and Functional Imaging. Hoboken: Wiley-Blackwell, v. 32, n. 5, p. 343-352, 2012.
ISSN 1475-0961 (Sherpa/Romeo, impact factor)
Publisher Wiley-Blackwell
Extent 343-352
Origin http://dx.doi.org/10.1111/j.1475-097X.2012.01135.x
Access rights Closed access
Type Article
Web of Science ID WOS:000307002400003
URI http://repositorio.unifesp.br/handle/11600/35257

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