Fully Automatable, Reproducible, Noninvasive Simple Plethysmographic Optimization: Proof of Concept and Potential for Implantability.
Background: Hemodynamic optimization of cardiac resynchronization therapy (CRT) can be achieved reproducibly and-with bulky, nonimplantable equipment-noninvasively. We explored whether a simple photoplethysmogram signal might be used instead. Method: Twenty patients (age 65 ± 12) with CRT underwent...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 35; no. 8; pp. 948 - 961 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts tracings Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104487742&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104487742 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Aug2012 vid: 35 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104487742 78323509 10.1111/j.1540-8159.2012.03435.x NLM22747698 104487742 ppf: 948 ppct: 13 formats: fmt: @attributes: type: P tig: atl: Fully Automatable, Reproducible, Noninvasive Simple Plethysmographic Optimization: Proof of Concept and Potential for Implantability. aug: au: Kyriacou, Andreas Pabari, Punam A. Whinnett, Zachary I. Arri, Satpal Willson, Keith Baruah, Resham Stegemann, Berthold Mayet, Jamil Kanagaratnam, Prapa Hughes, Alun D. Francis, Darrel P. affil: International Centre for Circulatory Health, St. Mary's Hospital and Imperial College, London, United Kingdom sug: subj: Cardiac Pacing, Artificial Plethysmography Evaluation Heart Failure Classification Human Male Female Middle Age Aged Descriptive Statistics Data Analysis Software Reproducibility of Results Test-Retest Reliability Pulse Oximeters Blood Pressure Determination Pilot Studies Noninvasive Procedures Electrocardiography Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Hemodynamic optimization of cardiac resynchronization therapy (CRT) can be achieved reproducibly and-with bulky, nonimplantable equipment-noninvasively. We explored whether a simple photoplethysmogram signal might be used instead. Method: Twenty patients (age 65 ± 12) with CRT underwent automatic atrioventricular (AV) delay optimization, using a multiple-transitions protocol, at two atrially paced heart rates: just above sinus rate ('slow ApVp,' 77 ± 11 beats per minute [bpm]) and 100 bpm ('fast ApVp'). We then retested to assess short-term reproducibility. Results: All 80 optimizations identified an optimum (correctly oriented parabola). At 100 bpm, the simple photoplethysmogram had wider scatter between repeat optimizations than did Finometer: standard deviation of difference (SDD) 22 ms versus 14 ms, respectively, P = 0.028. The simple photoplethysmogram improved in reproducibility when slope (instead of peak) of its signal was used for optimization, becoming as reproducible as Finometer (SDD 14 ms vs 14 ms, P = 0.50). At slow heart rate, reproducibility of simple photoplethysmogram-based optimization worsened from 14 to 22 ms (P = 0.028), and Finometer-based optimization from 14 to 26 ms (P = 0.005). Increasing the number of replicates averaged improved reproducibility. For example, SDD of simple photoplethysmogram optimization (using peak) fell from 62 ms with two replicates to 22 ms with eight replicates (P < 0.0001). At 100 bpm, the eight-replicate protocol takes ∼12 minutes. Conclusions : A 12-minute protocol of simple photoplethysmographic AV optimization can be processed fully automatically. Blinded test-retest reproducibility of the optimum AV is good and improves with more replicates. If benefits to some patients are not to be neutralized by harm to others, endpoint studies should first test check narrowness of 'within-patient error bars.' (PACE 2012; 35:948-960) pubtype: Academic Journal doctype: research tables/charts tracings Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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