Development of forearm impedance plethysmography for the minimally invasive monitoring of cardiac pumping function

DOI: 10.4236/jbise.2011.42018   PDF   HTML     5,748 Downloads   10,519 Views   Citations


It is essential to continuously and non-invasively monitor the cardiac pumping function in clinical setting. Thus, the study aimed to explore a regional impedance phethysmographic method to assess the changes in stroke volume. To do this, we developed a plethysmographic device that was capable of delivering a single-frequency current with constant amplitude and of recording electrical impedance signals of biological tissue. The electrical impedance plethy- smographic waveform form the lower arm was measured with the impedance plethysmographic device, and simultaneously the end-systolic and end- diastolic volumes of the left ventricle were obtained with a two-dimension echocardiographic system in fourteen healthy subjects before and immediately after a thirty-second breath-hold maneuver. For the 14 subjects, a linear correlation coefficient of 0.79 (p < 0.001) was obtained between the changes in peak amplitude of the forearm impedance waveform and the changes in stroke volume before and just after the breath-hold test. In addition, the changes in the mean area under the impedance curve and the change in stroke volume were also correlated linearly (r = 0.71, p < 0.005). In summary, the forearm impedance plethysmography may be employed to evaluate the beat-to-beat alteration in cardiac stroke volume, suggesting its potential for long-term monitoring cardiac pumping performance.

Share and Cite:

Wang, J. , Hu, W. , Kao, T. , Liu, C. and Lin, S. (2011) Development of forearm impedance plethysmography for the minimally invasive monitoring of cardiac pumping function. Journal of Biomedical Science and Engineering, 4, 122-129. doi: 10.4236/jbise.2011.42018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Absi, M.A., Lutterman, J. and Wetzel, G.T. (2010) Noninvasive cardiac output monitoring in the pediatric cardiac Intensive Care Unit. Current Opinion in Cardiology, 25, 77-79. doi:10.1097/HCO.0b013e3283362452
[2] Cohen, A.J., Arnaudov, D., Zabeeda, D., Schultheis, L., Lashinger, J. and Schachner, A. (1998) Non-invasive measurement of cardiac output during coronary artery bypass grafting. European Journal of Cardio-Thoracic Surgery, 14, 64-69. doi:10.1016/S1010-7940(98)00135-3
[3] Cotter, G., Schachner, A., Sasson, L., Dekel, H. and Moshkovitz, Y. (2006) Impedance cardiography revisited. Physiological Measurement, 27, 817-827. doi:10.1088/0967-3334/27/9/005
[4] Peng, Z.Y., Critchley, L.A., Fok, B.S. and James, A.E. (2004) Evaluation of impedance based indices of cardiac contractility in dogs. Journal of Clinical Monitoring and Computing, 18, 103-109. doi:10.1023/B:JOCM.0000032720.02801.e6
[5] Woltjer, H.H., Bogaard, H.J., Scheffer, G.J., van der Spoel, H.I., Huybregts, M.A. and de Vries, P.M. (1996) Standardization of non-invasive impedance cardiography for assessment of stroke volume: comparison with thermodilution. British Journal of Anaesthesia, 77, 748-752.
[6] Atallah, M.M. and Demain, A.D. (1995) Cardiac output measurement: lack of agreement between thermodilution and thoracic electric bioimpedance in two clinical settings. Journal of Clinical Anesthesia, 7, 182-185. doi:10.1016/0952-8180(94)00050-E
[7] Hahn, G., Sipinkova, I., Baisch, F. and Hellige, G. (1995) Changes in the thoracic impedance distribution under different ventilatory conditions. Physiological Measurement, 16, A161-A173. doi:10.1088/0967-3334/16/3A/016
[8] Imhoff, M., Lehner, J.H. and Lohlein, D. (2000) Noninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients. Critical Care Medicine, 28, 2812-2818. doi:10.1097/00003246-200008000-00022
[9] Kubicek, W.G., Kottke, J., Ramos, M.U., Patterson, R.P., Witsoe, D.A., Labree, J.W., Remole, W., Layman, T.E., Schoening, H. and Garamela, J. T. (1974) The Minnesota impedance cardiograph-theory and applications. Biomedical Engineering, 9, 410-416.
[10] Leitman, M., Sucher, E., Kaluski, E., Wolf, R., Peleg, E., Moshkovitz, Y., Milo-Cotter, O., Vered, Z. and Cotter, G. (2006) Non-invasive measurement of cardiac output by whole-body bio-impedance during dobutamine stress echocardiography: clinical implications in patients with left ventricular dysfunction and ischaemia. European Journal of Heart Failure, 8, 136-140. doi:10.1016/j.ejheart.2005.06.006
[11] Cotter, G., Moshkovitz, Y., Kaluski, E., Cohen, A., Miller, J. H., Goor, D. and Vered, Z. (2004) Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest, 125, 1431-1440. doi:10.1378/chest.125.4.1431
[12] Critchley, L.A., Peng, Z.Y., Fok, B.S. and James, A.E. (2005) The effect of peripheral resistance on impedance cardiography measurements in the anesthetized dog. Anesthesia and Analgesia, 100, 1708-1712. doi:10.1213/01.ANE.0000150602.40554.EB
[13] Wong, K.L. and Hou, P.C. (1996) The accuracy of bioimpedance cardiography in the measurement of cardiac output in comparison with thermodilution method. Acta Anaesthesiologica Sinica, 34, 55-59.
[14] Nyboer, J. (1960) Regional pulse volume and perfusion flow measurements: electrical impedance plethysmography. Archives of Internal Medicine, 105, 264-276.
[15] Patterson, R.P., Wang, L. and Raza, S.B. (1991) Impedance cardiography using band and regional electrodes in supine, sitting, and during exercise. IEEE Transactions on Biomedical Engineering, 38, 393-400. doi:10.1109/10.81557
[16] Adamicza, A., Tutsek, L., Daroczy, B., Bari, F. and Nagy, S. (1994) The measurement of cardiac output in dogs by impedance cardiography with different electrode arrangements. Acta Physiological Hungarica, 82, 37-52.
[17] Paredes, O.L., Shite, J., Shinke, T., Watanabe, S., Otake, H., Matsumoto, D., Imuro, Y., Ogasawara, D., Sawada, T. and Yokoyama, M. (2006) Impedance cardiography for cardiac output estimation: reliability of wrist-to-ankle electrode configuration. Circulation Journal, 70, 1164-1168. doi:10.1253/circj.70.1164
[18] Wtorek, J. and Plinski, A. (2005) The contribution of blood-flow-induced conductivity changes to measured impedance,” IEEE Transactions on Biomedical Engineering, 52, 41-49. doi:10.1109/TBME.2004.839633
[19] Miles, D.S., Gotshall, R.W., Quinones, J.D., Wulfeck, D.W. and Kreitzer, R.D. (1990) Impedance cardiography fails to measure accurately left ventricular ejection fraction. Critical Care Medicine, 18, 221-228. doi:10.1097/00003246-199002000-00019
[20] Stout, C.L., Van de Water, J.M., Thompson, W.M., Bowers, E.W., Sheppard, S.W., Tewari, A.M. and Dalton M.L. (2006) Impedance cardiography: can it replace thermodilution and the pulmonary artery catheter? The American Surgeon, 72, 728-732.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.