Abnormal hemodynamics play a central role in the development and perpetuation of high blood pressure. We hypothesized that hypertension therapy guided by noninvasive hemodynamics with impedance cardiography could aid primary care physicians in reducing blood pressure more effectively. Uncontrolled hypertensive patients on 1 to 3 medications were randomized by 3:2 ratio to either a standard arm or hemodynamic arm that used impedance cardiography (BioZ, CardioDynamics). Each patient completed 5 study visits with a 2-week washout period followed by 3 months of treatment. A total of 164 patients from 11 centers completed the study, 95 in the standard arm and 69 in the hemodynamic arm. At baseline and after washout, there were no differences between arms in number of medications or demographic, blood pressure, or hemodynamic characteristics. Systolic blood pressure reductions in the hemodynamic arm were greater from baseline (19 mm Hg versus 11 mm Hg; P <0.01) and after washout (25 mm Hg versus 19 mm Hg; P <0.05). Diastolic blood pressure reductions were also greater in the hemodynamic arm from baseline (12 mm Hg versus 5 mm Hg; P <0.001) and after washout (17 mm Hg versus 10 mm Hg; P <0.001). The hemodynamic arm achieved goal blood pressure (<140/90 mm Hg) more frequently (77% versus 57%; P <0.01) and a more aggressive blood pressure level (<130/85 mm Hg) more frequently (55% versus 27%; P <0.0001). These study results indicate that antihypertensive therapy guided by impedance cardiography in uncontrolled hypertensive patients on ≥1 medications is more effective than standard care.

Value of Noninvasive Hemodynamics to Achieve Blood Pressure Control in Hypertensive Subjects

Impedance cardiography: a potential monitor for hemodialysis.

Intensive regular physical exercise training is associated with a physiological increase in left ventricular (LV) wall thickness, cavity size and mass that have been known as “athlete's heart”1. The extent to which LV dilatation and hypertrophy are altered depends on the type of physical training, endurance or strength. This cardiac remodelling observed in the athletes is associated with the specific haemodynamic requirements of the exercise undertaken. It remains a question whether the athlete's heart is merely a physiologic phenomenon or poses cardiovascular risk.

Studies up to now about athlete's heart primarily includes echocardiographic evaluation to detect morphological and functional changes2,3,4. There were conflicting results of these studies about systolic and diastolic functional changes in athlete's heart5,6,7,8,9. Not much attention has been paid to haemodynamic changes and difference between male and female athletes. Also, cardiac morphologic and haemodynamic changes were studied in different studies. Therefore, we aimed to obtain further data on the morphological and haemodynamic characteristics of the athletic heart in males and females with use of impedance cardiography and echocardiographic examination including tissue Doppler and strain imaging.

Tissue Doppler imaging and strain rate imaging are new echocardiographic modalities based on Doppler tissue imaging and these are capable of assessing systolic and diastolic myocardial functions5,10. Impedance cardiography is a reliable and valid non invasive technique for measuring various haemodynamic indices of cardiovascular function in critical care environments and laboratory settings11. In the previous studies, impedance cardiography was used during active exercise12,13. In this study, we used impedance cardiography in athletes at rest and we aimed to evaluate chronic haemodynamic changes in athletes who are doing intensive regular physical exercise and correlations between chronic haemodynamic changes with cardiac function and morphology in both gender.

Adaptation of heart to training: A comparative study using echocardiography & impedance cardiography in male & female athletes

HEART FAILURE IS A SERIOUS DISORDER THAT AFFECTS 4,700,000 PEOPLE IN THE UNITED STATES.1 DESPITE ADVANCES IN THERAPY, MORBIDITY AND mortality remain high. Cheyne-Stokes (CS) respirations have been observed in 40% of patients with heart failure 2,3 and are felt to be an independent risk factor for death in these patients.4,5 Further research is needed to better understand the pathophysiology of CS respirations and to identify possible modifying factors that may, in turn, impact heart failure morbidity and mortality.

Orthopnea is a cardinal symptom of heart failure and may affect the patient's sleeping angle. In spite of this, not much is known about the effect of sleeping angle on CS respirations and hemodynamics. In 1958, Altschule studied 6 waking subjects with heart failure and found that changing the patient's posture from 60° to 0° caused or exacerbated periodic breathing.6 Altschule studied a heterogeneous small group of awake subjects. The aim of this investigation is to study the response to posture of a larger group of well-described sleeping subjects using modern noninvasive methods of assessing respiratory and cardiac function.

The effect of posture on Cheyne-Stokes respirations and hemodynamics in patients with heart failure.

The objective of the study was to compare thoracic fluid content (TFC) between newborn infants with and without respiratory distress. We tested the hypothesis that TFC would be higher in infants with respiratory distress. A total of 96 newborn infants, gestational age 37.9 (2.6) weeks, were enrolled at birth. TFC by electrical bioimpedance was recorded within 3 h after birth (TFC1) and at 24 h of life (TFC2). TFC1 was higher in infants with respiratory distress at birth (76.8 (24.9) versus 61.6 (16.1) 1 KOhm−1, P<0.0005). The association was independent from gestational age and mode of delivery. TFC2 was independently associated with respiratory distress at 24 h of life (adjusted coefficient b=0.5 (s.d. 0.02), P=0.02). TFC by electric bioimpedance independently correlated with the presence of respiratory distress at birth and at 24 h of life in late preterm and term newborn infants.

Thoracic fluid content by electric bioimpedance correlates with respiratory distress in newborns

Clinical assessment of cardiac status can be difficult and incomplete without an assessment of fluid volume status, especially of the lungs. Now, a new parameter is available, thoracic fluid content (TFC). It is an indicator of total fluid volume, both intracellular and extracellular. Because it is measured noninvasively using impedance cardiography (ICG), it could be a welcome addition to the physician's assessment. An evaluation of TFC was performed beginning with 1) an examination of chest impedance (Z) as an accurate means of following fluid changes, 2) the relationship of TFC to Z using both loop and spot electrodes, and 3) clinical applications of TFC. In 1) 12 dogs, Z was superior (r = 0.935, P < 0.006) to 10 traditional hemodynamic and gas transfer parameters in trending a lactated Ringer's infusion; 2) a plastic model, changes in TFC values derived from Z measurements using both loop and spot electrodes were virtually identical and paralleled infused saline (r = 0.999, P < 0.001); 3) the clinical setting, TFC trended fluid changes well. From these results, we conclude that TFC is a reliable measurement of chest fluid status and of changes in that fluid. Along with cardiac index (CI), also provided by the ICG monitor, TFC can be very helpful to the clinician.

TFC (thoracic fluid content): a new parameter for assessment of changes in chest fluid volume.

Abstract Neurologic deficit after lumbar spine surgery is a rare and serious complication that must be promptly diagnosed and treated to avoid long-term neurologic disability. Anterior lumbar interbody fusion (ALIF) is an effective technique for the treatment of recurrent disc herniation and lumbar disc degeneration. This case report describes a 20-year-old female with L5-S1 recurrent disc herniation and lumbar degeneration. She underwent an L5-S1 ALIF complicated by post-operative lower left extremity paralysis. Revision surgery with downsizing of the ALIF cage was performed with normal neuromonitoring throughout the procedure. The patient displayed persistent post-operative neurologic deficits despite no evidence of central or foraminal compression. Patient was later diagnosed with conversion disorder by neurology during her hospitalization. This case report presents the initial diagnosis of conversion disorder after a routine ALIF procedure, which led to surgical re-exploration and prolonged inpatient hospital stay. Psychiatric diagnoses must be considered when neurologic deficits are present with no apparent organic cause.

/pdf/new-diagnosis-of-conversion-disorder-following-anterior-2tgvff11.pdf

New diagnosis of conversion disorder following anterior lumbar interbody fusion: a case report

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TFC (thoracic fluid content): a new parameter for assessment of changes in chest fluid volume.

New diagnosis of conversion disorder following anterior lumbar interbody fusion: a case report