Article (Scientific journals)
Pre-ejection period, the reason why the electrocardiogram Q-wave is an unreliable indicator of pulse wave initialization
Balmer, J.; Pretty, C.; Davidson, S. et al.
2018In Physiological Measurement, 39 (9)
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Keywords :
Animals; Aorta; Cardiovascular Diseases; Electrocardiography; Hemodynamics; Pulse Wave Analysis; Reproducibility of Results; Sus scrofa
Abstract :
[en] Objective: Pulse wave velocity measurements are an indicator of arterial stiffness and possible cardiovascular dysfunction. It is usually calculated by measuring the pulse transit time (PTT) over a known distance through the arteries. In animal studies, reliable PTT measures can be obtained using two pressure catheters. However, such direct, invasive methods are undesirable in clinical settings. A less invasive alternative measure of PTT is pulse arrival time (PAT), the time between the Q-wave of an electrocardiogram (ECG) and the arrival of the foot of the beats pressure waveform at one pressure catheter. Since the Q-wave signifies the start of ventricular contraction, PAT includes the pre-ejection period (PEP), a time where no blood is ejected. Thus, inter- or intra- subject variation in PEP could result in poor correlation between pulse arrival time (PAT) and the desired pulse transit time (PTT). Approach: This study looks at the relationship between PAT and PTT, over a range of common critical care therapies and determines the effect of PEP on PAT as a possible surrogate of PTT in a critical care environment. The analysis uses data from five porcine experiments, where ECG, aortic arch and abdominal aortic pressure were measured simultaneously, over a range of induced hemodynamic conditions. Results: The resulting correlations of PAT verse PTT varied within pigs and across interventions (r 2 = 0.32-0.69), and across pigs (r 2 = 0.05-0.60). Variability was due to three main causes. First, the interventions themselves effect PEP and PTT differently, second, pig specific response to the interventions, and third, inter- and intra- pig variability in PEP, independent of PTT. Significance: The overall analysis shows PAT is an unreliable measure of PTT and a poor surrogate under clinical interventions common in a critical care setting, due to intra- and inter- subject variability in PEP. © 2018 Institute of Physics and Engineering in Medicine.
Disciplines :
Cardiovascular & respiratory systems
Anesthesia & intensive care
Author, co-author :
Balmer, J.;  Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
Pretty, C.;  Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
Davidson, S.;  Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
Desaive, Thomas  ;  Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Kamoi, S.;  Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
Pironet, A.;  GIGA-In Silico Medicine, University of Liè, Liè, Belgium
Morimont, Philippe ;  Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Département des sciences biomédicales et précliniques
Janssen, N.;  GIGA-Cardiovascular Sciences, University of Liè, Liè, Belgium
Lambermont, Bernard  ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Shaw, G. M.;  Intensive Care Unit, Christchurch Hospital, Christchurch, New Zealand
Chase, J. G.;  Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
Title :
Pre-ejection period, the reason why the electrocardiogram Q-wave is an unreliable indicator of pulse wave initialization
Publication date :
2018
Journal title :
Physiological Measurement
ISSN :
0967-3334
Publisher :
Institute of Physics Publishing
Volume :
39
Issue :
9
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
Center for Outcomes Research and Evaluation, Yale School of MedicineMinistry for Business Innovation and EmploymentRoyal Society of New Zealand
Available on ORBi :
since 11 June 2020

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