Panagis galiatsatos md johns hopkins bayview medical center february 2 nd 2013
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A Noninvasive, Hand-Held Device for Assessing Left Ventricular End-Diastolic Pressure Based on Finger Photoplethysmography and the Valsalva Maneuver. Panagis Galiatsatos , MD Johns Hopkins Bayview Medical Center February 2 nd 2013. No Disclosures. Outline. Background information

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Panagis galiatsatos md johns hopkins bayview medical center february 2 nd 2013

A Noninvasive, Hand-Held Device for Assessing Left Ventricular End-Diastolic Pressure Based on Finger Photoplethysmography and the Valsalva Maneuver

PanagisGaliatsatos, MD

Johns Hopkins Bayview Medical Center

February 2nd 2013


No disclosures

No Disclosures Ventricular End-Diastolic Pressure Based on Finger


Outline
Outline Ventricular End-Diastolic Pressure Based on Finger

  • Background information

  • Objective of the study

  • Methods

  • Results

  • Conclusions

  • Future Direction


Background information
Background Information Ventricular End-Diastolic Pressure Based on Finger

  • Knowledge of left ventricular filling pressure useful in certain clinical settings.

  • Non-invasive tools:

    • Physical Exam

    • Chest X-ray

    • Daily weights

    • Bloodwork (pro-BNP)


Background information1
Background Information Ventricular End-Diastolic Pressure Based on Finger

Valsalva Maneuver

- Created by Antonio Maria Valsalva

- Effects on the cardiovascular system


Background information2
Background Information Ventricular End-Diastolic Pressure Based on Finger

Valsalva Maneuver

Phase 1: Initial blood pressure increase

Phase 2: Maintaining the strain – decrease in pressure

Phase 3: Release of the strain – short decrease of arterial pressure

Phase 4: Distinct overshoot of pressure

“Sinusoidal Response”


Background information3
Background Information Ventricular End-Diastolic Pressure Based on Finger

Valsalva Maneuver

Bedside technique with sphygmomanometry

Issue

1. No standardization of technique

2. Does not yield continuous measure


Background information4
Background Information Ventricular End-Diastolic Pressure Based on Finger

“Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure”

Silber HA et al. Am J Physiol Heart Circ Physiol 2012

Photoplethysmograph (PPG)

Pulse Amplitude Ratio (PAR)


Objective
Objective Ventricular End-Diastolic Pressure Based on Finger

Validate a new hand-held, battery-powered device that inputs finger PPG and expiratory pressure signals during the Valsalva maneuver, guides subject performance and calculates PAR automatically.


A Ventricular End-Diastolic Pressure Based on Finger

Mouthpiece / pressure transducer

Photoplethysmography (PPG) probe

User-friendly display

C

B

A

C

B


Methods
Methods Ventricular End-Diastolic Pressure Based on Finger

Patients who were scheduled to undergo a cardiac catheterization including the measurement of LVEDP.

Expiratory pressure during Valsalva was measured by having the subject place a tube in their mouth that was connected to a pressure transducer input into the device.


Methods1
Methods Ventricular End-Diastolic Pressure Based on Finger

The subject was coached to keep the expiratory effort at about 20 mmHg during a 10-second Valsalva maneuver.

The output measure of the device is the ratio of the amplitude of the PPG waveform near the end of Valsalva to the amplitude at baseline


Methods2
Methods Ventricular End-Diastolic Pressure Based on Finger


Results
Results Ventricular End-Diastolic Pressure Based on Finger



Conclusions
Conclusions identifying LVEDP > 15 mmHg.

  • This study represents initial testing of a hand-held, battery-powered device using finger PPG during the Valsalva maneuver for assessing left ventricular filling pressure noninvasively.

  • The output measure of the device, Pulse Amplitude Ratio (PAR), correlated well with LVEDP obtained invasively by cardiac catheterization.


Conclusions1
Conclusions identifying LVEDP > 15 mmHg.

  • PAR > 0.72 was 78% sensitive and 100% specific in identifying LVEDP > 15 mmHg, a clinically meaningful cutoff value in heart failure.

  • Further testing is warranted to explore the clinical utility of this device in heart failure management and other settings.


Future directions
Future Directions identifying LVEDP > 15 mmHg.

  • Use of the device to assess adequate fluid removal from in-patient diuresisin heart failure patients.

  • PAR in the use of fluid removal in hemodialysis.


Acknowledgements
Acknowledgements identifying LVEDP > 15 mmHg.

  • Harry Silber, MD, PhD

    • Principal Investigator

  • Jennifer Monti, MD, MPH

  • Interventional Cardiologists

    • David Bush, MD

    • Jeffrey C. Trost, MD

    • Peter Johnston, MD

  • Colleen Christmas, MD


Questions
Questions identifying LVEDP > 15 mmHg.


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