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Hemodynamic modelling in the calf — A pilot study
Matějková, M. ; Jurák, Pavel ; Soukup, L. ; Halámek, Josef ; Viščor, Ivo ; Langer, P. ; Vondra, Vlastimil
With increasing age, the cardiovascular system loses its efficiency. The goal of this work was to investigate the hemodynamic system response to a head-up tilt test in two groups of different aged people. We used a model for describing this response in the right calf based on a non-invasive, non-occlusive, bioimpedance signal measurement technique. A decrease in the bioimpedance value in the calf during the head-up tilt test is associated with the accumulation of blood in the calf, which can be expressed by a model parameter. Subjects were examined in both a head-up tilt test and a supine position. 50 healthy non-smoking volunteers were divided into two groups according to age. The impedance signal during the tilt test for each subject was fitted by a model exponential function: Z0 model EF(t) =A exp(-t/B)+C, where Z0 model EF(t) is the calculated model of electrical impedance in the calf by an exponential function, A is the amplitude of impedance change, B is the time constant of the impedance decrease, C is the value of the steady state after the tilt test and t denotes time. A lower time constant B shows a faster filling of the vascular system in the investigated part. The Mann-Whitney test (p-value<;0.005) revealed that the time constant B for the older group was significantly lower than for the young group (145.24+/- 80.28 vs. 239.23+/-136.59 sec.). A lower time constant value means a faster response to blood filling in the lower limbs and directly reflects decreased vessel elasticity. This time constant was lower in the older group. The results show increased vessel stiffness in old age and could lead to a non-invasive evaluating the cardiovascular system state.
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Biventricular pacing optimization by means of the dyssynchrony parameter
Jurák, Pavel ; Leinveber, P. ; Halámek, Josef ; Plešinger, Filip ; Postránecká, T. ; Lipoldová, J. ; Novák, M.
To improve Cardiac Resynchronization Therapy (CRT), different interventricular delay (VVD) settings can be used. However, relatively small VVD induced hemodynamic changes cannot be measured by standard echocardiographic methods. The QRS complex duration (QRSd) is mostly the main criterion. Here we introduce a new dyssynchrony parameter (DYS) that is able to more accurately detect improved electrical synchrony. Methods: 12-lead 5 kHz ECG during 3-10 minute rest period was measured in 46 patients with CRT OFF and CRT ON with VVD 0 ms (CRT0) and -20 ms (CRT20). We detected QRSd and the dyssynchrony parameter DYS as the time difference between 500-1000 Hz averaged envelopes positions in the V1 and V6 leads in the QRS complex region. Results: 32 of 46 patients had a positive CRT response manifested by QRSd shortening and a DYS decrease. 28 of 32 patients had a positive LV pre-excitation effect: additional QRSd shortening of 4.7+/-.9 ms and a DYS decrease of 12.6+/-7.5 ms. The correlation coefficient of QRSd and DYS changes (CRT 0 vs CRT 20) was 0.23 and indicates information diversity. The DYS parameter differs from QRSd and provides a significantly higher response to VVdelay changes (p <; 0.001).
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