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A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis.

Galiatsatos P, Parakh K, Monti J, Thavarajah S, Aneke-Ogbu H, Watson A, Kim D, Wang NY, Shafi T, Silber HA - BMC Nephrol (2015)

Bottom Line: Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 6.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l.Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003).The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. panagis@jhmi.edu.

ABSTRACT

Background: A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis.

Methods: We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically.

Results: Twenty-seven subjects (21 Males) ages 25-75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 6.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01).

Conclusion: An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis.

No MeSH data available.


Related in: MedlinePlus

A typical photoplethysmography (PPG) waveform response during the Valsava maneuver: a Before hemodialysis and b After hemodialysis. Pulse amplitude ratio (PAR) is calculated as the pulse amplitude of the waveform at the end of 10 s of Valsalva (PAV) divided by the average pulse amplitude of several cycles at baseline (PAB). In this example, PAR = 0.81 before hemodialysis and PAR = 0.67 after hemodialysis. The automated algorithm acquiring the data allows a maximum of 3 s for the subject’s expiratory effort to equal or exceed 20 mmHg in order for the data to be accepted and stored
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Fig1: A typical photoplethysmography (PPG) waveform response during the Valsava maneuver: a Before hemodialysis and b After hemodialysis. Pulse amplitude ratio (PAR) is calculated as the pulse amplitude of the waveform at the end of 10 s of Valsalva (PAV) divided by the average pulse amplitude of several cycles at baseline (PAB). In this example, PAR = 0.81 before hemodialysis and PAR = 0.67 after hemodialysis. The automated algorithm acquiring the data allows a maximum of 3 s for the subject’s expiratory effort to equal or exceed 20 mmHg in order for the data to be accepted and stored

Mentions: Figure 1 shows an example of simultaneously recorded photoplethysmography and expiratory pressure effort waveforms. Also shown is how PAR is obtained.Fig. 1


A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis.

Galiatsatos P, Parakh K, Monti J, Thavarajah S, Aneke-Ogbu H, Watson A, Kim D, Wang NY, Shafi T, Silber HA - BMC Nephrol (2015)

A typical photoplethysmography (PPG) waveform response during the Valsava maneuver: a Before hemodialysis and b After hemodialysis. Pulse amplitude ratio (PAR) is calculated as the pulse amplitude of the waveform at the end of 10 s of Valsalva (PAV) divided by the average pulse amplitude of several cycles at baseline (PAB). In this example, PAR = 0.81 before hemodialysis and PAR = 0.67 after hemodialysis. The automated algorithm acquiring the data allows a maximum of 3 s for the subject’s expiratory effort to equal or exceed 20 mmHg in order for the data to be accepted and stored
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536782&req=5

Fig1: A typical photoplethysmography (PPG) waveform response during the Valsava maneuver: a Before hemodialysis and b After hemodialysis. Pulse amplitude ratio (PAR) is calculated as the pulse amplitude of the waveform at the end of 10 s of Valsalva (PAV) divided by the average pulse amplitude of several cycles at baseline (PAB). In this example, PAR = 0.81 before hemodialysis and PAR = 0.67 after hemodialysis. The automated algorithm acquiring the data allows a maximum of 3 s for the subject’s expiratory effort to equal or exceed 20 mmHg in order for the data to be accepted and stored
Mentions: Figure 1 shows an example of simultaneously recorded photoplethysmography and expiratory pressure effort waveforms. Also shown is how PAR is obtained.Fig. 1

Bottom Line: Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 6.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l.Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003).The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. panagis@jhmi.edu.

ABSTRACT

Background: A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis.

Methods: We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically.

Results: Twenty-seven subjects (21 Males) ages 25-75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 6.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01).

Conclusion: An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis.

No MeSH data available.


Related in: MedlinePlus