Minimally Invasive and Noninvasive Hemodynamic Monitoring of the Cardiovascular System: Available Options and Future Perspectives

Romano, Salvatore Mario; Olivotto, Iacopo; Chiostri, Marco; Giglioli, Cristina; Margheri, Massimo; Gensini, Gian Franco

doi:10.2174/157340306775515308

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…The hemodynamic variables obtained by this monitoring system were: systolic, diastolic, dicrotic and mean arterial pressures (mm Hg); CO (l/min); SV (ml); CPO (W); dP/ dt max (mm Hg/s); CCE (units) [12][13][14] , and SVR (dyn ؒ s/cm 5 ). All these variables were expressed as the change (% or, for CCE, absolute units) from the baseline value.…”

Section: Measurement Of Hemodynamic Parameters By Prammentioning

confidence: 99%

“…A significant increase in CCE was observed in our patients. This parameter represents the ratio between hemodynamic work performed by the heart and the energy expenditure [13,14] ; therefore, its increase reflects the reduction in energy spent by the cardiovascular system to maintain some degree of hemodynamic balance [12,13] . This result can be interpreted as an improvement in ventricular-arterial coupling performance determined by fluid removal by means of several hemodynamic variations discussed above.…”

Section: Clinical and Hemodynamic Relationshipsmentioning

confidence: 99%

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Cardiac Efficiency Improvement after Slow Continuous Ultrafiltration Is Assessed by Beat-to-Beat Minimally Invasive Monitoring in Congestive Heart Failure Patients: A Preliminary Report

Giglioli¹,

Landi²,

Gensini

et al. 2009

Blood Purif

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Background: We have evaluate the effect of slow continuous ultrafiltration (SCUF) on cardiac output (CO) and other hemodynamic parameters related to the overall performance of the cardiovascular system in patients with congestive heart failure (CHF). Minimally invasive hemodynamic monitoring was performed via the radial artery using a pressure recording analytical method (PRAM) during SCUF treatment. Patients and Methods: Using PRAM, hemodynamic changes were assessed in 15 CHF patients (New York Heart Association (NYHA) class III–IV) treated with fluid overload removal by ultrafiltration. We analyzed the clinical and hemodynamic data recorded from 6 h before to 36 h after SCUF treatment. Results: Fluid removal was associated with clinical improvements, reductions in weight (7.4%, p < 0.01), edema and dyspnea, increased response to diuretics, and reductions in NYHA class (3.5 ± 0.52 to 2.4 ± 0.63, p < 0.01) and plasma pro-B-type natriuretic peptide (BNP) levels (21,810 ± 13,016 to 8,581 ± 5,549 pg/ml, p < 0.05). Clinical improvement was associated with significant variations in stroke volume (+17%, p < 0.05), CO (+19%, p < 0.05), cardiac power output (+19%, p < 0.05), dP/dt_max (+49%, p < 0.01), cardiac cycle efficiency (CCE; +0.44 units, p < 0.01), systemic vascular resistances (SVR; –12%, p < 0.05) and dicrotic pressure (–10%, p < 0.05) with respect to their baseline values. No significant variations in heart rate, and systolic and mean blood pressure were observed. Pro-BNP levels were found to correlate positively with both SVR (r = 0.96, p = 0.002) and NYHA class (r = 0.96, p = 0.037) and negatively with dP/dt_max (r = –0.83, p = 0.039), CCE (r = –0.93, p = 0.011) and CO (r = –0.94, p = 0.014). Conclusions: In CHF patients, ultrafiltration improves not only CO, as previously reported, but also contractile cardiac efficiency and performance. The PRAM system, a minimally invasive method, was able to record hemodynamic changes during SCUF treatment.

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Section: Measurement Of Hemodynamic Parameters By Prammentioning

confidence: 99%

Section: Clinical and Hemodynamic Relationshipsmentioning

confidence: 99%

Cardiac Efficiency Improvement after Slow Continuous Ultrafiltration Is Assessed by Beat-to-Beat Minimally Invasive Monitoring in Congestive Heart Failure Patients: A Preliminary Report

Giglioli¹,

Landi²,

Gensini

et al. 2009

Blood Purif

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“…In terms of flow, aortic dP/dt max is the pressure analog of peak aortic blood acceleration (dQ/dt max ) and depends on both left ventricular contractility and arterial impedance [20][21][22].…”

Section: Hemodynamic Recordings and Pram: Theoretical Background And mentioning

confidence: 99%

Continuous Hemodynamic Monitoring During Laparoscopic Gastric Bypass in Superobese Patients by Pressure Recording Analytical Method

et al. 2008

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“…In our responder patients, we observed an increase in CCE, another novel parameter indicating the overall performance of cardiovascular system, which represents the ratio between hemodynamic work performed by the heart and energy expenditure 25,26 …”

Section: Discussionmentioning

confidence: 82%

Levosimendan Produces an Additional Clinical and Hemodynamic Benefit in Patients With Decompensated Heart Failure Successfully Submitted to a Fluid Removal Treatment

Giglioli

Cecchi

Landi

et al. 2011

Congestive Heart Failure

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A pivotal role in treating decompensated heart failure (HF) is played by inotropes and calcium sensitizers such as levosimendan. In this study, the authors evaluated whether levosimendan could determine further clinical and hemodynamic benefits in 31 HF patients (New York Heart Association [NYHA] class III or IV), after successful treatment with diuretics (n=15) or ultrafiltration (n=16). Systolic, diastolic, dicrotic, and mean arterial pressures; systemic vascular resistance (SVR); some classic hemodynamic variables (cardiac output [CO], stroke volume [SV], dP/dt(max) ); and indices of cardiovascular system performance (cardiac cycle efficiency [CCE], cardiac power output) have been assessed by the pressure recording analytical method (PRAM), a minimally invasive monitoring system, before levosimendan infusion, at the end of treatment (EoT), and 36 hours after EoT (post-36). A significant increase in CCE, CO, SV, and dP/dt(max) and a significant decrease in diastolic and dicrotic arterial pressures and in SVR have been observed at EoT and at post-36. After the addition of levosimendan, a further reduction in signs and symptoms of HF and NYHA class was observed. Five patients showed an opposite trend of several hemodynamic parameters without any significant clinical improvement (nonresponders). In conclusion, most HF patients treated with diuretics or ultrafiltration receive additional clinical and hemodynamic benefits from levosimendan. The characterization of nonresponders could help in optimizing its use.

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Minimally Invasive and Noninvasive Hemodynamic Monitoring of the Cardiovascular System: Available Options and Future Perspectives

Abstract: Monitoring of Cardiac Output (CO

Cited by 13 publications

References 20 publications

Cardiac Efficiency Improvement after Slow Continuous Ultrafiltration Is Assessed by Beat-to-Beat Minimally Invasive Monitoring in Congestive Heart Failure Patients: A Preliminary Report

Cardiac Efficiency Improvement after Slow Continuous Ultrafiltration Is Assessed by Beat-to-Beat Minimally Invasive Monitoring in Congestive Heart Failure Patients: A Preliminary Report

Continuous Hemodynamic Monitoring During Laparoscopic Gastric Bypass in Superobese Patients by Pressure Recording Analytical Method

Levosimendan Produces an Additional Clinical and Hemodynamic Benefit in Patients With Decompensated Heart Failure Successfully Submitted to a Fluid Removal Treatment

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