Noninvasive methods for detecting elevated left-sided cardiac filling pressure

Sanders, Gregory P.; Mendes, Lisa A.; Colucci, Wilson S.; Givertz, Michael M.

doi:10.1016/s1071-9164(00)90018-6

Cited by 24 publications

(6 citation statements)

References 47 publications

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“…8 The abnormal heart rate responses suggest impaired ANS processes in the HF patients, an interpretation supported by numerous other studies. 17,18 fMRI signals from several HF patient brain regions within HF subjects to the Valsalva maneuver differed significantly from controls. The affected regions included the hypothalamus and amygdala, which are classically associated with regulating parasympathetic and sympathetic action.…”

Section: Discussionmentioning

confidence: 85%

Aberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure

Woo

Macey

Keens

et al. 2007

Congestive Heart Failure

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Heart failure (HF) is associated with aberrant autonomic nervous system (ANS) activity, with altered responses to blood pressure and breathing challenges that appear to reflect abnormal central nervous system function. The authors used functional magnetic resonance imaging (fMRI) to determine whether the Valsalva maneuver, an ANS challenge, would show abnormal responses in ANS regulatory areas of the brain in HF. Brain fMRI signal changes in 5 HF patients (left ventricular ejection fraction, 0.15±0.08; age, 50±10 years) and 14 controls (age, 47±11 years) were assessed during 3 successive Valsalva maneuvers. The hypothalamus, hippocampus, putamen, amygdala, mid‐cingulate, right insula, and cerebellar cortex showed exaggerated and phase‐shifted fMRI responses in HF; other areas showed inverted signals from those found in controls. Central ANS control areas have altered phase, extent, and direction of responses to Valsalva maneuvers in a small sample of HF patients. These findings suggest that therapeutics that address neuroprotective aspects may be useful interventions for the condition.

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Section: Discussionmentioning

confidence: 85%

Aberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure

Woo

Macey

Keens

et al. 2007

Congestive Heart Failure

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“…Assessing cardiac filling pressure clinically is challenging, especially with current non-invasive strategies (e.g. physical exam, blood markers), since many tests are neither sensitive nor specific [ 12 ]. The Valsalva maneuver, defined as a sustained straining against a closed upper airway, has shown utility in assessing volume status and cardiac hemodynamic properties [ 13 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

et al. 2015

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BackgroundA noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis.MethodsWe tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically.ResultsTwenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01).ConclusionAn index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis.

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“…Even when it is visualized, there can be significant discrepancies between JVP estimation of right atrial pressure (RAP) and invasive measurements [8,9]. While more sophisticated bedside techniques, such as evaluating the change in blood pressure to Valsalva, have attempted to improve bedside physical examination detection of elevated filling left ventricle (LV) filling pressure, this technique also has its limitations [10]. As such, there is a need for a more reliable bedside technique for determination of patient volume status.…”

Section: Bedside Assessment Of Volume Status and Ejection Fractionmentioning

confidence: 99%

“…Rather than estimating RAP, echocardiography also can be used to predict LV filling pressures, and therefore, may prove useful for bedside assessment of patients with HF [10]. The most promising technique involves interrogating mitral inflows in conjunction with myocardial tissue velocities [18,19].…”

Section: Bedside Assessment Of Volume Status and Left Ventricular Ejementioning

confidence: 99%

Handcarried Echocardiography to Assess Hemodynamics in Acute Decompensated Heart Failure

Goonewardena

Spencer

2010

Curr Heart Fail Rep

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Heart failure is a major source of cardiovascular morbidity, including acute decompensations requiring hospitalization. Because most therapeutic interventions in acute heart failure target optimization of cardiac output and volume status, accurate assessment of these parameters at the point of care is critical to guide management. However, physician bedside assessments of left ventricular (LV) function and volume status have limited accuracy. Traditional echocardiographic platforms, while useful for assessing ventricular and valvular function and volume status, have limitations for bedside use or frequent serial evaluation. Handcarried cardiac ultrasound devices, with their substantially lower costs, portability, and ease of use, circumvent many of the limitations of traditional echocardiographic platforms. The diagnostic capabilities of handcarried devices provide the opportunity for ultrasound assessment of LV function and serial bedside evaluation of volume status in patients with acutely decompensated heart failure.

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Noninvasive methods for detecting elevated left-sided cardiac filling pressure

Cited by 24 publications

References 47 publications

Aberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure

Aberrant Central Nervous System Responses to the Valsalva Maneuver in Heart Failure

A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

Handcarried Echocardiography to Assess Hemodynamics in Acute Decompensated Heart Failure

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