A whole-body impedance cardiography device (CircMonR, JR Medical Ltd, Tallinn, Estonia), which records the changes in body electrical impedance during cardiac cycles, was used to determine beat-to-beat HR, stroke index (stroke volume in proportion to body surface area, ml/m2), cardiac index (cardiac output/body surface area, l/min/m2), and PWV (m/s)
[29 (link)-31 (link)]. Left cardiac work index (kg*m/min/m2) was calculated by formula 0.0143*(MAP–PAOP)*cardiac index, which has been derived from the equation published by Gorlin et al.
[32 (link)]. MAP is mean radial arterial pressure measured by tonometric sensor, PAOP is pulmonary artery occlusion pressure which is assumed to be normal (default 6 mmHg), and 0.0143 is the factor for the conversion of pressure from mmHg to cmH2O, volume to density of blood (kg/L), and centimetre to metre. Systemic vascular resistance index (systemic vascular resistance/body surface area, dyn*s/cm5/m2) was calculated from the signal of the tonometric BP sensor and cardiac index measured by CircMonR.
To calculate the PWV, the CircMon software measures the time difference between the onset of the decrease in impedance in the whole-body impedance signal and the popliteal artery signal. From the time difference and the distance between the electrodes, PWV can be determined. As the whole-body impedance cardiography slightly overestimates PWV when compared with Doppler ultrasound method, a validated equation was utilized to calculate values that correspond to the ultrasound method (PWV = (PWVimpedance*0.696) + 0.864)
[30 (link)]. PWV was determined only in the supine position because of less accurate timing of left ventricular ejection during head-up tilt
[30 (link)]. A detailed description of the method and electrode configuration has been previously reported
[31 (link)]. PWV was also recorded after the head-up tilt in all subjects, and the average difference between the mean PWV before and after the head-up tilt was 0.024 ± 0.388 m/s (mean ± standard deviation), showing the good repeatability of the method (repeatability index R 98%, Bland-Altman repeatability index 0.8)
[33 ]. The cardiac output values measured with CircMonR are in good agreement with the values measured by the thermodilution method
[31 (link)], and the repeatability and reproducibility of the measurements (including PWV recordings) have been shown to be good
[34 (link),35 (link)].
[29 (link)-31 (link)]. Left cardiac work index (kg*m/min/m2) was calculated by formula 0.0143*(MAP–PAOP)*cardiac index, which has been derived from the equation published by Gorlin et al.
[32 (link)]. MAP is mean radial arterial pressure measured by tonometric sensor, PAOP is pulmonary artery occlusion pressure which is assumed to be normal (default 6 mmHg), and 0.0143 is the factor for the conversion of pressure from mmHg to cmH2O, volume to density of blood (kg/L), and centimetre to metre. Systemic vascular resistance index (systemic vascular resistance/body surface area, dyn*s/cm5/m2) was calculated from the signal of the tonometric BP sensor and cardiac index measured by CircMonR.
To calculate the PWV, the CircMon software measures the time difference between the onset of the decrease in impedance in the whole-body impedance signal and the popliteal artery signal. From the time difference and the distance between the electrodes, PWV can be determined. As the whole-body impedance cardiography slightly overestimates PWV when compared with Doppler ultrasound method, a validated equation was utilized to calculate values that correspond to the ultrasound method (PWV = (PWVimpedance*0.696) + 0.864)
[30 (link)]. PWV was determined only in the supine position because of less accurate timing of left ventricular ejection during head-up tilt
[30 (link)]. A detailed description of the method and electrode configuration has been previously reported
[31 (link)]. PWV was also recorded after the head-up tilt in all subjects, and the average difference between the mean PWV before and after the head-up tilt was 0.024 ± 0.388 m/s (mean ± standard deviation), showing the good repeatability of the method (repeatability index R 98%, Bland-Altman repeatability index 0.8)
[33 ]. The cardiac output values measured with CircMonR are in good agreement with the values measured by the thermodilution method
[31 (link)], and the repeatability and reproducibility of the measurements (including PWV recordings) have been shown to be good
[34 (link),35 (link)].
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