panagis galiatsatos , md johns hopkins bayview medical center february 2 nd 2013
DESCRIPTION
A Noninvasive, Hand-Held Device for Assessing Left Ventricular End-Diastolic Pressure Based on Finger Photoplethysmography and the Valsalva Maneuver. Panagis Galiatsatos , MD Johns Hopkins Bayview Medical Center February 2 nd 2013. No Disclosures. Outline. Background information - PowerPoint PPT PresentationTRANSCRIPT
A Noninvasive, Hand-Held Device for Assessing Left Ventricular End-Diastolic
Pressure Based on Finger Photoplethysmography and the
Valsalva Maneuver
Panagis Galiatsatos, MDJohns Hopkins Bayview Medical Center
February 2nd 2013
No Disclosures
Outline
• Background information• Objective of the study• Methods• Results• Conclusions• Future Direction
Background Information
• Knowledge of left ventricular filling pressure useful in certain clinical settings.
• Non-invasive tools:– Physical Exam– Chest X-ray– Daily weights– Bloodwork (pro-BNP)
Background Information
Valsalva Maneuver- Created by Antonio Maria Valsalva- Effects on the cardiovascular system
Background Information
Valsalva ManeuverPhase 1: Initial blood pressure increasePhase 2: Maintaining the strain – decrease in pressurePhase 3: Release of the strain – short decrease of arterial pressurePhase 4: Distinct overshoot of pressure“Sinusoidal Response”
Background Information
Valsalva ManeuverBedside technique with sphygmomanometry
Issue1. No standardization of technique2. Does not yield continuous measure
Background Information
“Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure”Silber HA et al. Am J Physiol Heart Circ Physiol 2012
Photoplethysmograph (PPG)Pulse Amplitude Ratio (PAR)
Objective
Validate a new hand-held, battery-powered device that inputs finger PPG and expiratory pressure signals during the Valsalva maneuver, guides subject performance and calculates PAR automatically.
Mouthpiece / pressure transducer
Photoplethysmography (PPG) probe
User-friendly display
A
A B
B
C
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Methods
Patients who were scheduled to undergo a cardiac catheterization including the measurement of LVEDP.
Expiratory pressure during Valsalva was measured by having the subject place a tube in their mouth that was connected to a pressure transducer input into the device.
Methods
The subject was coached to keep the expiratory effort at about 20 mmHg during a 10-second Valsalva maneuver.
The output measure of the device is the ratio of the amplitude of the PPG waveform near the end of Valsalva to the amplitude at baseline
Methods
Results
CharacteristicsAll Patients
(N=14)+ SD
Age 53 + 8.5
Female 7 (50%)
BMI (kg/m2) 33.1 + 7.6
Co-MorbiditiesHypertension (n)Hemodialysis (n)
Diabetes mellitus (n)Coronary Artery Disease (n)
7 (50%)2 (14%)4 (29%)8 (57%)
MedicationsCalcium channel blockers (n)
Beta blockers (n)Thiazide diuretics (n)
ACE-I / ARB (n)Loop diuretics (n)
1 (7%)9 (64%)1 (7%)
9 (64%)1 (7%)
PAR > 0.72 was 78% sensitive and 100% specific in identifying LVEDP > 15 mmHg.
Conclusions
• This study represents initial testing of a hand-held, battery-powered device using finger PPG during the Valsalva maneuver for assessing left ventricular filling pressure noninvasively.
• The output measure of the device, Pulse Amplitude Ratio (PAR), correlated well with LVEDP obtained invasively by cardiac catheterization.
Conclusions
• PAR > 0.72 was 78% sensitive and 100% specific in identifying LVEDP > 15 mmHg, a clinically meaningful cutoff value in heart failure.
• Further testing is warranted to explore the clinical utility of this device in heart failure management and other settings.
Future Directions
• Use of the device to assess adequate fluid removal from in-patient diuresis in heart failure patients.
• PAR in the use of fluid removal in hemodialysis.
Acknowledgements
• Harry Silber, MD, PhD– Principal Investigator
• Jennifer Monti, MD, MPH• Interventional Cardiologists
– David Bush, MD– Jeffrey C. Trost, MD– Peter Johnston, MD
• Colleen Christmas, MD
Questions