Soon Bin Kwon, Bennett Weinerman, Daniel Nametz, Murad Megjhani, Isaac Lee, Anthony Habib, Oliver Barry, Soojin Park
{"title":"Non-invasive pulse arrival time is associated with cardiac index in pediatric heart transplant patients with normal ejection fraction.","authors":"Soon Bin Kwon, Bennett Weinerman, Daniel Nametz, Murad Megjhani, Isaac Lee, Anthony Habib, Oliver Barry, Soojin Park","doi":"10.1088/1361-6579/ad61b9","DOIUrl":null,"url":null,"abstract":"<p><p><i>Objective.</i>Cardiac Index (CI) is a key physiologic parameter to ensure end organ perfusion in the pediatric intensive care unit (PICU). Determination of CI requires invasive cardiac measurements and is not routinely done at the PICU bedside. To date, there is no gold standard non-invasive means to determine CI. This study aims to use a novel non-invasive methodology, based on routine continuous physiologic data, called Pulse Arrival Time (PAT) as a surrogate for CI in patients with normal Ejection Fraction (EF).<i>Approach.</i>Electrocardiogram (ECG) and photoplethysmogram (PPG) signals were collected from beside monitors at a sampling frequency of 250 samples per second. Continuous PAT, derived from the ECG and PPG waveforms was averaged per patient. Pearson's correlation coefficient was calculated between PAT and CI, PAT and heart rate (HR), and PAT and EF.<i>Main Results.</i>Twenty patients underwent right heart cardiac catheterization. The mean age of patients was 11.7 ± 5.4 years old, ranging from 11 months old to 19 years old, the median age was 13.4 years old. HR in this cohort was 93.8 ± 17.0 beats per minute. The average EF was 54.4 ± 9.6%. The average CI was 3.51 ± 0.72 l min<sup>-1</sup>m<sup>-2</sup>, with ranging from 2.6 to 4.77 l min<sup>-1</sup>m<sup>-2</sup>. The average PAT was 0.31 ± 0.12 s. Pearson correlation analysis showed a positive correlation between PAT and CI (0.57,<i>p</i>< 0.01). Pearson correlation between HR and CI, and correlation between EF and CI was 0.22 (<i>p</i>= 0.35) and 0.03 (<i>p</i>= 0.23) respectively. The correlation between PAT, when indexed by HR (i.e. PAT × HR), and CI minimally improved to 0.58 (<i>p</i>< 0.01).<i>Significance.</i>This pilot study demonstrates that PAT may serve as a valuable surrogate marker for CI at the bedside, as a non-invasive and continuous modality in the PICU. The use of PAT in clinical practice remains to be thoroughly investigated.</p>","PeriodicalId":20047,"journal":{"name":"Physiological measurement","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262133/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Physiological measurement","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.1088/1361-6579/ad61b9","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"BIOPHYSICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective.Cardiac Index (CI) is a key physiologic parameter to ensure end organ perfusion in the pediatric intensive care unit (PICU). Determination of CI requires invasive cardiac measurements and is not routinely done at the PICU bedside. To date, there is no gold standard non-invasive means to determine CI. This study aims to use a novel non-invasive methodology, based on routine continuous physiologic data, called Pulse Arrival Time (PAT) as a surrogate for CI in patients with normal Ejection Fraction (EF).Approach.Electrocardiogram (ECG) and photoplethysmogram (PPG) signals were collected from beside monitors at a sampling frequency of 250 samples per second. Continuous PAT, derived from the ECG and PPG waveforms was averaged per patient. Pearson's correlation coefficient was calculated between PAT and CI, PAT and heart rate (HR), and PAT and EF.Main Results.Twenty patients underwent right heart cardiac catheterization. The mean age of patients was 11.7 ± 5.4 years old, ranging from 11 months old to 19 years old, the median age was 13.4 years old. HR in this cohort was 93.8 ± 17.0 beats per minute. The average EF was 54.4 ± 9.6%. The average CI was 3.51 ± 0.72 l min-1m-2, with ranging from 2.6 to 4.77 l min-1m-2. The average PAT was 0.31 ± 0.12 s. Pearson correlation analysis showed a positive correlation between PAT and CI (0.57,p< 0.01). Pearson correlation between HR and CI, and correlation between EF and CI was 0.22 (p= 0.35) and 0.03 (p= 0.23) respectively. The correlation between PAT, when indexed by HR (i.e. PAT × HR), and CI minimally improved to 0.58 (p< 0.01).Significance.This pilot study demonstrates that PAT may serve as a valuable surrogate marker for CI at the bedside, as a non-invasive and continuous modality in the PICU. The use of PAT in clinical practice remains to be thoroughly investigated.
目的:心脏指数(CI)是确保儿科重症监护病房(PICU)末端器官灌注的关键生理参数。确定 CI 需要进行有创心脏测量,但在重症监护病房床旁并不是常规操作。迄今为止,还没有确定 CI 的金标准无创方法。本研究旨在使用一种基于常规连续生理数据的新型无创方法--脉搏到达时间(PAT)--来替代射血分数正常患者的 CI:以每秒 250 个样本的采样频率从旁边的监视器收集心电图(ECG)和光电搏动图(PPG)信号。根据心电图和 PPG 波形得出的连续 PAT 为每位患者的平均值。计算 PAT 与 CI、PAT 与心率(HR)、PAT 与射血分数(EF)之间的皮尔逊相关系数:20 名患者接受了右心导管检查。患者平均年龄为(11.7±5.4)岁,从 11 个月大到 19 岁不等,中位年龄为 13.4 岁。心率为(93.8±17.0)次/分。平均 EF 为 54.4±9.6%。平均 CI 为 3.51±0.72 L/min/m2,范围为 2.6 至 4.77 L/min/m2。平均 PAT 为 0.31±0.12 秒。Pearson 相关性分析表明,PAT 与 CI 呈正相关(0.57,P < 0.01)。HR 与 CI 之间的皮尔逊相关性以及 EF 与 CI 之间的相关性分别为 0.22(p = 0.35)和 0.03(p = 0.23)。以心率(即 PAT × 心率)为指标的 PAT 与 CI 之间的相关性最小提高到 0.58(p < 0.01):这项试点研究表明,PAT 可作为床旁 CI 的重要替代指标,是 PICU 中的一种无创和连续模式。PAT 在临床实践中的应用还有待深入研究。
期刊介绍:
Physiological Measurement publishes papers about the quantitative assessment and visualization of physiological function in clinical research and practice, with an emphasis on the development of new methods of measurement and their validation.
Papers are published on topics including:
applied physiology in illness and health
electrical bioimpedance, optical and acoustic measurement techniques
advanced methods of time series and other data analysis
biomedical and clinical engineering
in-patient and ambulatory monitoring
point-of-care technologies
novel clinical measurements of cardiovascular, neurological, and musculoskeletal systems.
measurements in molecular, cellular and organ physiology and electrophysiology
physiological modeling and simulation
novel biomedical sensors, instruments, devices and systems
measurement standards and guidelines.