The calculation of cardiac stroke volume from variations in transthoracic electrical impedance.
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OBJECTIVE: Hypotension and decreased serum atrial natriuretic peptide (ANP) in response to hemodialysis have both been attributed to a decrease in central blood volume. The aim of this study was to test whether circulatory performance and serum ANP were related to changes in central blood volume, in conjunction with hemodialysis with loss of plasma volume. MATERIAL AND METHODS: Ten uremic patients without cardiopulmonary symptoms were investigated before, immediately after and 2 h after a regular dialysis session. Bolus indocyanine green dilution was used for the measurements of central blood volume, cardiac output and stroke volume. Serum ANP was analyzed using a radioimmunoassay technique. RESULTS: Hemodialysis resulted in a 3.8 +/- 1.3 kg decrease in weight and an increase in hemoglobin concentration, while central blood volume, stroke volume, cardiac output, blood pressure and serum ANP fell in parallel. Two h after dialysis, central blood volume recovered to its pre-dialytic level, whereas weight, plasma volume, stroke volume, blood pressure and serum ANP stayed at low levels. There were strong correlations between serum ANP and hemoglobin concentration, stroke volume, cardiac output and blood pressure, but not between serum ANP and central blood volume. Correlations between central blood volume and plasma volume, stroke volume, cardiac output, and blood pressure were also weak. CONCLUSIONS: The close correlation between circulatory performance and serum ANP implies a reduction in preload in response to dialysis. The lack of correlations between central blood volume and circulatory performance and serum ANP suggests that the compliance in the central vasculature is increased in response to dialysis.
Cardiac chamber volumes (both atria and ventricles) in 19 healthy volunteers were measured noninvasively by cine magnetic resonance imaging (MRI). First, cardiac localization was determined from the coronal image by 0.5-T superconducting magnetic imager. Then, transaxial ECG gated multislice spin echo images were obtained from the bottom to the top of the heart. In the last step, cine MRI was performed at each level of all these transaxial spin echo MR images involving the heart. Each cardiac chamber volume at the same phase was calculated by adding chamber areas in each anatomic section multiplied by slice thickness. Left ventricular (LV) end-diastolic volume (EDV) 132.0 +/- 26.9 mL) and LV end-systolic volume (ESV) (47.8 +/- 13.9 mL) were smaller than right ventricular (RV) EDV (141.1 +/- 24.8 mL) and RVESV (57.0 +/- 12.6 mL), respectively (p < 0.01). LV stroke volume (84.3 +/- 17.9 mL) was equivalent to RV stroke volume (84.2 +/- 17.6 mL) (r = 0.91, p < 0.01). Left atrial (LA) and right atrial (RA) maximal volumes were 75.8 +/- 15.4 mL and 84.4 +/- 18.7 mL, respectively. LA minimal volume (37.5 +/- 10.7 mL) was smaller than RA minimal volume (47.8 +/- 12.2 mL). These values measured by cine MRI are satisfactory and cine MRI will be a useful method of determining cardiac chamber volumes, especially atrial volumes.
The value of pulmonary artery catheterization is a matter for discussion. Previous studies suggest that direct measurements of intravascular volume distribution and cardiac volume indices may be of greater relevance than central venous and pulmonary capillary wedge pressure. We therefore used a thermo-dye dilution technique for the quantification of central blood volume, right ventricular end-diastolic volume and left heart volume in patients undergoing coronary artery bypass surgery. Measurements were performed after the induction of anaesthesia as well as 1, 6 and 24 h after surgery. Central venous pressure was significantly increased at 1 and 6 h, whereas right ventricular end-diastolic volume was increased only at 6 h post-operatively. Pulmonary capillary wedge pressure showed a tendency to increase whereas left heart and central blood volume decreased significantly after surgery. The results of the present study suggest that changes in cardiac filling pressure do not indicate changes in indices of cardiac volume in patients after coronary bypass surgery.
The effect of combined administration of ethyl alcohol with caffeine and hydroxyzine on cardiac volume and vascular resistance was studied. Combined administration of these compounds diminished cardiac stroke volume and minute output and increased general vascular resistance. Simultaneous administration of ethanol with caffeine and hydroxyzine exerts an unfavorable effect on haemodynamics of circulatory system.
The stroke volume and cardiac output changes in twenty-four patients undergoing laparoscopy were measured using the non-invasive technique of impedance cardiography. There was a moderate fall of stroke volume and cardiac output during intraperitoneal insufflation of carbon dioxide which was directly related to the volume of gas used. The need for caution during laparoscopy particularly in ill patients is emphasised.
In order to investigate the connection between the cardiac volume and the cardiac shadow plane, 385 anterior-posterior radiographs of the thorax have been selected comparing their cardiac shadow plane with the corresponding cardiac volumes determined by the autopsy of the cadavers. The comparison showed a connection of both magnitudes by means of the formula Hvol = 0.49 x Fa x square root of Fa (Hvol = cardiac volume in cm3, Fa = cardiac shadow plane of the anterior-posterior radiograph in cm2, corrections were made from the radiation divergence). A verification of the formula showed a very high correlation (r = 0.984) in 25 cadavers to be dissected. The comparing volume of the cardiac shadow plane has been investigated by means of the water displacement method, in which the cardiac vessels were ligated and the heart taken out of the cadaver. The cardiac volume, evaluated from the cardiac shadow plane showed a significant correlation at the cardiac death by internal natural cause. The comparison of the mathematical evaluated cardiac blood volumes of the symptoms causing death showed that the cardiac blood volumes in the group of poisonings and the group of drowning, suffocations and hanging with 231 ml and 211 ml in the men collective were at the same level as the cardiac death (246 ml). About the same applied to the women collective.(ABSTRACT TRUNCATED AT 250 WORDS)
Orthostatic intolerance may result from either an abnormally large postural decrease in central blood volume, cardiac filling pressures, and stroke volume, or inadequate neurohumoral responses to orthostasis. Endurance athletes have been reported as having a high incidence of orthostatic intolerance, which has been attributed primarily to abnormalities in baroreflex regulation of heart rate and peripheral resistance. In this review, we present evidence that athletes also have structural changes in the cardiovascular system that although beneficial during exercise, lead to an excessively large decrease in stroke volume during orthostasis and contribute to orthostatic intolerance. A unifying hypothesis based on cardiac mechanics that may explain the divergence of findings in conditions such as bed rest or spaceflight, and short- and long-term endurance training is presented.
Minimal cardiac transit times (MTTs) are differences between times of appearance of the indicator at consecutive segments of the cardiopulmonary circulation. The MTTs are shown to be directly proportional to the quotient of volume to flow. The relationship of the cardiac MTTs to ventricular ejection fraction was derived. Utilizing this technique the ejection fractions of the left and right ventricles in 72 normal individuals were calculated. Theoretical aspects of measuring cardiac MTTs were related to experience of clinical application and confirmed its usefulness.
Hypoxia produced by intravenous infusion of gaseous carbon dioxide was associated in conscious rabbits with decreases in cardiac output and stroke volume. At the same time the arterial blood pressure, oxygen uptake and blood pH decreased, whereas carbon dioxide pressure and lactate level in the arterial blood increased. Pulmonary ventilation increased too, due to the rise in the respiratory frequency and tidal volume. The fall in cardiac output and stroke volume explains a great fall of oxygen uptake in response to decrease of oxygen pressure in the blood.
The cardiac and peripheral vascular adjustments to angiotensin II (0.1-0.2 microgram kg-1 min-1 i.v.) during high beta-adrenergic activity by a continuous isoproterenol infusion (0.2-0.3 microgram kg-1 min-1 i.v.) were examined in anaesthetized, atropinized dogs. Hepatic, splenic and left ventricular (LV) volume changes were estimated by an ultrasonic technique, and the blood flow distribution was measured by injecting radioactive microspheres and by electromagnetic flowmetry on the caval veins, the hepatic artery and the portal vein. During isoproterenol infusion, angiotensin II increased the systolic LV pressure by 45 +/- 3 mmHg and the stroke volume by 17 +/- 6%. Concomitantly, the hepatic and splenic blood volumes declined by 29 +/- 4 and 14 +/- 6 ml, respectively, and the LV end-diastolic segment length increased by 3 +/- 1%. The flow through the inferior caval vein increased by 39 +/- 9%, whereas the superior vena caval flow remained unchanged. The hepatic arterial flow more than doubled. Thus, at high inotropy by isoproterenol infusion, angiotensin II relocates blood from the liver and the spleen towards the heart. By activating the Frank-Starling mechanism, cardiac output is increased and conducted through the lower body, especially through the hepatic artery, because of the poor autoregulation of flow through this vessel.
Stroke and minute cardiac volumes were simultaneously determined at rest in seven healthy male subjects aged 28-48 and 13 patients with various forms of partial insufficiency of the central hemodynamics with the use of thoracic electrical bioimpedance and Doppler echocardiography. The bio-impedance method employed IBM-compatible NCCOM3-R7. The Doppler echocardiograms were registered using TOSHIBA-50. Correlative analysis of the records was performed on 4 parameters, i.e. minute volume (MV), stroke volume (SV), cardiac index (CI), and stroke index (SI). In the group with partial insufficiency the correlation coefficient amounted to 0.89, 0.92, 0.81 and 0.92 for MV, SV, CI and SI, respectively. In healthy subjects the correlation coefficient made up 0.91, 0.90, 0.89 and 0.91 for MV, SV, CI and SI, respectively. In the combined group the correlation coefficient averaged 0.88, 0.92, 0.83 and 0.92 for MV, SV, CI and SI, respectively. These results allow to rate high the accuracy of thoracic electrical bio-impedance and recommend it for the program of medical selection and annual health check of occupational groups systematically exposed to extreme impacts.
PURPOSE: To demonstrate the usefulness of cine-MRI for the evaluation of apical left ventricular aneurysms (ALVA) and for prediction of the surgical outcome. MATERIALS AND METHODS: We investigated 28 patients with ALVA, 13 of them additionally after aneurysmectomy at 1.5 T; 15 healthy volunteers served as normal controls. For cine-MRI k-space segmented Fl-2D-GE sequences were used. Analysis comprised the calculation of cardiac volume indices, cardiac function, and percentual myocardial thickening (PMT). For prediction of surgical results we divided left ventricle into an aneurysmatic and a non-aneurysmatic part. The non-aneurysmatic part was assumed as the left ventricle after surgical remodelling. RESULTS: Enddiastolic and endsystolic volume indices (EDVIs and LV-ESVIs) were higher in patients with ALVA (123.7 +/- 30.2 ml/m(2), 94.3 +/- 32.5 ml/m(2), respectively) than in volunteers (79.1 +/- 13.9 ml/m(2), 25.5 +/- 5.1 ml/m(2), respectively) (p < 0.001). Stroke volume index (SVIs), cardiac index (CIs) and ejection fraction (EFs) were significantly lower in patients (30.4 +/- 9.1 vs. 54.2 +/- 0.2 ml/beat/m(2); 2.2 +/- 0.8 vs. 3.9 +/- 0.9 l/min/m(2), 26.0 +/- 9.7 vs. 67.9 +/- 4.5 %, respectively) (p < 0.001). There was a significant decrease of LV-EDVIs and LV-ESVIs (102.8 +/- 30.3 ml/m(2), 66.3 +/- 28.0 ml/m(2), respectively) (p = 0,002, p < 0.001, respectively), no change of SVIs (36.4 +/- 6.0 ml/beat/m(2)) (p > 0.05) and a significant increase of CIs and EFs (3.0 +/- 0.6 l/min/m(2), 37.91 +/- 10.15 %, respectively) (p < 0.001) after surgery. We found a good correlation between the preoperatively calculated (32.6 +/- 10.1 %) and the measured EF after surgery (37.9 +/- 9.8 %) (r = 0.70; p = 0.035). PMT was significantly lower in patients than in volunteers (median 11.9 +/- 10.7 vs. 70.2 +/- 13.9 %; p < 0.001), especially in the aneurysmatic parts of left ventricle (median - 6.8 %; p < 0.001). CONCLUSION: Cine-MRI offers accurate evaluation of ALVA and enables preoperative estimation of left-ventricular volumes after surgery.
The cardiac volume data of 49 normal children were compared with those of 23 with secundum atrial septal defect and 24 with patent ductus arteriosus. Significantly smaller ventricular end-diastolic volumes were observed in the normal infants than in older children (right ventricle 53.9 versus 75.5 cm3/m2; left ventricle 46.7 versus 63.6 cm3/m2). "Distensibility" of the right ventricle (DRV), left ventricle (DLV) and left atrium increased normally with age. DRV and DLV were similar shortly after birth; thereafter, DRV increased more rapidly than DLV (mean DRV 12.7; mean DLV 7.8 cm3/m2 per mm Hg, P less than 0.001). In both atrial septal defect and patent ductus arteriosus, the ipsilateral (involved) ventricles had increased volume, increased output, normal ejection fraction and increased distensibility. The contralateral (left) ventricle in atrial septal defect was smaller than normal (39.6 versus 49.7 cm3, P less than 0.001), and had a smaller ejection fraction (0.63 versus 0.71, P less than 0.01) and output (3.70 versus 4.57 liters/min per m2, P less than 0.005). In contrast, the contralateral (right) ventricle in patent ductus arteriosus remained normal. Left atrial maximal volume was larger than normal in atrial septal defect (46.6 versus 35.9 cm3/m2, P less than 0.001). The left atrial and left ventricular volumes in patent ductus arteriosus were, respectively, 152 and 142 percent of normal, indicating comparable response to the volume load. The left head changes in atrial septal defect may be related both to a functionally restrictive defect and to the difference in distensibility of the ventricles.
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