Correlation between Three Methods of Blood Pressure Measurement (Impedance Cardiography, Sphygmomanometry, and Invasive Methods)

Aims and Objectives: The aims of the study were to find out the correlation between three methods of blood pressure (BP) measurement with impedance cardiography (ICG) device, conventional non-invasive sphygmomanometer, and cath lab-based invasive arterial pressure (AP) study. Patients Materials and Methods: Patients who had definite indications for coronary angiography (CAG) or coronary intervention due to cardiac reasons were selected for the measurement of BP by three methods, namely, by transducer-based invasive central aortic pressure study, by ICG, and by conventional sphygmomanometry. One hundred patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, and echocardiographic evidence of regional wall motion abnormality were selected. Transfemoral or radial access of the ascending aorta allowed the measurement of central aortic pressure during invasive procedure. CAG was done in the cath lab having “Siemens™ Axiom Artis Zee (floor)” equipment. The subjects who were unwilling to participate, who were moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. ICG-derived BP values (systolic BP [SBP], diastolic BP [DBP], mean AP [MAP], and pulse pressure) were recorded for comparison with similar pressure data obtained from two other methods. Results and Analysis: Analysis of results show a comparison of data on SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. The analysis also shows the values of correlation coefficients – all of which are significantly positive correlations. ICG has been found to have positive correlation with both sphygmomanometric and invasive methods of BP measurement. It also shows a graphical presentation of the correlation between SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. Conclusion: There is a significant correlation between three methods of BP measurement with ICG device, conventional noninvasive sphygmomanometer-based method, and cath lab-based invasive AP study

Correlation between Coronary Angiography and Impedance Cardiography

Aims and Objectives: The aims of the study were to find out the correlation between coronary angiographic findings and hemodynamic parameters derived from impedance cardiography (ICG) and echo-Doppler study. Patients, Materials and Methods: A total of 200 patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, echocardiographic evidence of regional wall motion abnormality (RWMA), and coronary angiographic evidence of coronary lesions were recruited. Subjects unwilling to participate, moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. The left ventricular ejection fraction (LVEF), stroke volume (SV), RWMA, diastolic function, etc., were observed. ICG measured LVEDV, LVESV, LVEF, and other parameters particularly amplitudes of the different waves. Coronary angiography (CAG) was done in the Cath Lab having “Siemens™ Axiom Artis Zee (floor)” equipment. Results and Analysis: Results-analysis revealed there is negative correlation (Pearson’s correlation coefficient, r = −0.8) between augmentation pressure and coronary angiographic stenosis percentage and P value is also significant (P = 0.034). Pulse pressure (PP) also is positively correlated (r = −0.78) with coronary angiographic stenosis percentage and P value is also significant (P = 0.027). There is a negative correlation (r = −0.259) between augmentation index (AIx) and coronary angiographic lesions and that is statistically significant (P = 0.03). Conclusion: There is a positive correlation between ICG -derived hemodynamic parameters and the percentage stenosis of coronary arteries. Rise of augmentation pressure and PP in the ICG waveform is associated with coronary artery disease severity. AIx is negatively correlated with severity of coronary arterial stenosis

Correlation between Echo-Doppler Study and Impedance Cardiography in Acute Myocardial Infarction

Introduction: Acute Myocardial Infarction(AMI) is quitecommon and despite lack of adequate infrastructure it isa compulsion for doctors in India to treat patients of AMIeven in the rural hospitals due to lack of transportation andcommunication facilities on round the clock basis. In ruralsetup usually ECG and Troponin biomarker kits are available.Aim and objective of the present study was to validateimpedance cardiography derived haemodynamic parametersagainst echo-doppler study.Material and methods: 200 patients of AMI were subjectedto impedance cardiography and echodoppler study.Results: Echocardiographic Mean±S.D values of LVEDV,LVESV , LVEF, IVCT, IVRT, LVET, Total Diastolic Time,Total Systolic Time & MPI were as follows 80.78±25.554,40.62±13.062, 41.18±15.669, 46.13±8.5, 50±8.907,65.93±12.103, 334.11±38.668, 482.97±83.164, 318.4±32.715& 0.4311±0.0732 respectively. Similarly impedancecardiographic Mean±S.D. values of LVEDV, LVESV , LVEF,IVCT, IVRT, LVET, Total Diastolic Time, Total Systolic Timeand MPI are as follows: 102.813±26.006, 53.048±14.773,39.646±18.095, 40.4786±10.820, 56.953±13.69,67.153±20.0375, 327.2035±23.91123, 449.4202±91.3202,349.8660±56.011 and 0.4106±0.08682 respectively.Conclusion: There was strong positive correlation among allthe haemodynamic parameters of echocardiography and ICGand the P values were significant in all the parameters studied(<0.001). It can be used for haemodynamic assessment ofpatients in rural setup where the facility of echo-doppler studyor invasive haemodynamic monitoring is not available.

Tetanus: still a public health problem in India — observations in an infectious diseases hospital in Kolkata.

Background: Tetanus is a major health problem in many developing countries, including India, with significant morbidity and mortality due to lack of environmental hygiene and health education, incomplete vaccination, high case prevalence and inadequate intensive care facilities. Objectives: To observe the demography, clinical profile and outcomes of tetanus patients. Materials and methods: A total of 282 tetanus patients were screened and closely observed prospectively from January 2010 to December 2011. Results: The mean age of the study patients was 31.15 years (± 14.26) and the majority were unvaccinated or incompletely vaccinated against tetanus. Patients were mainly farmers (140, 49.64%) and children (102, 36.17%). The sources of infection identified were mainly thorn/pin prick in 129 cases (45.7%), cut/lacerated injury in 83 cases (29.4%) and ear infection in 47 cases (16.7%), while definite injury was not detected/remembered in 42 cases (14.8%). The average duration of hospital stay was 17.2 ± (4.7) days and autonomic nervous system dysfunction was the most common complication observed in this study. Death was the outcome in a total of 58 patients (20.6%) mostly due to aspiration pneumonia-induced sepsis, respiratory failure or cardiac complications. Conclusion: Environmental hygiene, basic health education, increased in immunization coverage, proper wound care – even following minor injuries – and more facilities for intensive care units, may reduce the overall incidence of tetanus and mortality following onset of the disease.