Signal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension

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dc.contributor.authorFerreira, Eloara M. [UNIFESP]
dc.contributor.authorOta-Arakaki, Jaquelina S. [UNIFESP]
dc.contributor.authorBarbosa, Priscila B. [UNIFESP]
dc.contributor.authorSiqueira, Ana Cristina B. [UNIFESP]
dc.contributor.authorBravo, Daniela M. [UNIFESP]
dc.contributor.authorKapins, Carlos Eduardo B. [UNIFESP]
dc.contributor.authorSilva, Celia Maria C. [UNIFESP]
dc.contributor.authorNery, Luiz Eduardo [UNIFESP]
dc.contributor.authorAlberto Neder, J. [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:27:40Z
dc.date.available2016-01-24T14:27:40Z
dc.date.issued2012-09-01
dc.description.abstractBackground Haemodynamic responses to exercise are related to physical impairment and worse prognosis in patients with pulmonary arterial hypertension (PAH). It is clinically relevant, therefore, to investigate the practical usefulness of non-invasive methods of monitoring exercise haemodynamics in this patient population. Methods Using a novel impedance cardiography (ICG) approach that does not require basal impedance estimations and relies on a morphological analysis of the impedance signal (Signal-Morphology-ICG (TM)), stroke volume (SV) and cardiac index (CI) were evaluated in 50 patients and 21 age-matched controls during a ramp-incremental cardiopulmonary exercise testing. Results Technically unacceptable readings were found in 12 of 50 (24%) patients. in the remaining subjects, early decrease (N = 9) or a plateau in SV (N = 8) and Delta (peak-unloaded exercise) SV <10 ml were markers of more advanced PAH (P<0.05). Delta CI = 1.5-fold and early estimated lactate threshold were the only independent predictors of a severely reduced peak oxygen uptake ((V) over dotO(2)) in patients (R-2 = 0.71, P<0.001). the finding of Delta CI = 1.5-fold plus peak (V) over dot O-2 < 50% predicted was associated with a number of clinical and functional markers of disease severity (P<0.001). in addition, abnormal SV responses and Delta CI = 1.5-fold were significantly related to 1-year frequency of PAH-related adverse events (death and balloon atrial septostomy, N = 8; P<0.05). Conclusions Qualitative and semi-quantitative signal-morphology impedance cardiography (TM) (PhysioFlow (TM)) during incremental exercise provided clinically useful information to estimate disease severity and short-term prognosis in patients with PAH in whom acceptable impedance signals could be obtained.en
dc.description.affiliationFed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, Pulm Funct & Clin Exercise Physiol Unit, São Paulo, Brazil
dc.description.affiliationFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, Haemodynam Evaluat Unit, São Paulo, Brazil
dc.description.affiliationUnifespFed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, Pulm Funct & Clin Exercise Physiol Unit, São Paulo, Brazil
dc.description.affiliationUnifespFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, Haemodynam Evaluat Unit, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent343-352
dc.identifierhttp://dx.doi.org/10.1111/j.1475-097X.2012.01135.x
dc.identifier.citationClinical Physiology and Functional Imaging. Hoboken: Wiley-Blackwell, v. 32, n. 5, p. 343-352, 2012.
dc.identifier.doi10.1111/j.1475-097X.2012.01135.x
dc.identifier.issn1475-0961
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/35257
dc.identifier.wosWOS:000307002400003
dc.language.isoeng
dc.publisherWiley-Blackwell
dc.relation.ispartofClinical Physiology and Functional Imaging
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licensehttp://olabout.wiley.com/WileyCDA/Section/id-406071.html
dc.subjectcardiac outputen
dc.subjectexertionen
dc.subjecthaemodynamicsen
dc.subjectimpedance cardiographyen
dc.subjectpulmonary hypertensionen
dc.titleSignal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertensionen
dc.typeinfo:eu-repo/semantics/article
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