Inductance cardiography (thoracocardiography): a novel, noninvasive technique for monitoring left ventricular filling.

PURPOSE: Thoracocardiography noninvasively records left ventricular volume curves by an inductive plethysmographic transducer transversely encircling the chest near the xiphoid process. Amplitudes of thoracocardiographic curves track stroke volume as previously validated by thermodilution. We investigated whether thoracocardiographic curves reflect left ventricular filling. MATERIALS AND METHODS: We studied nine men in horizontal and 30 degrees head-up position during tidal breathing and Valsalva maneuvers. The ratio of peak slope of left ventricular volume curves during early rapid filling relative to that during atrial contraction (E/A ratio) and isovolumic relaxation time (interval from aortic component of second heart sound to early rapid filling onset) were measured with thoracocardiography and compared with Doppler-echocardiographic-derived indices of transmitral flow velocity. RESULTS: Isovolumic relaxation times estimated by the two methods agreed closely (bias = -2 ms, limits of agreement = -28 to +24 ms, 75 comparisons). E/A ratios by thoracocardiography and Doppler echocardiography were significantly correlated (R = 0.53, n = 75, P<.001), but individual values differed. Both methods provided identical trends of changes in E/A ratios with interventions in 50 of 66 (76%) comparisons. CONCLUSIONS: Thoracocardiography reflects characteristics of left ventricular filling similar to Doppler echocardiography. Because it does not require hand-holding a transducer, thoracocardiography has the potential for continuous monitoring of mechanical cardiac performance.

Thoracocardiography: noninvasive monitoring of left ventricular stroke volume.

PURPOSE: Thoracocardiography noninvasively monitors global stroke volume by inductive plethysmographic recording of ventricular volume curves as previously validated by thermodilution. Our purpose was to investigate the potential of thoracocardiography to individually assess stroke volume of the left ventricle. We hypothesized that curves predominantly reflecting left ventricular volume could be obtained by recording waveforms from thoracocardiographic transducers placed at various levels around the chest, and by identifying their origin as the left ventricle if mean expiratory exceeded mean inspiratory stroke volumes during spontaneous breathing. MATERIALS AND METHODS: Stroke volumes obtained by thoracocardiography in normal subjects were compared beat by beat with estimates derived from simultaneous measurements of left ventricular cavity stroke area by echocardiography with automatic boundary detection. Changes in respiratory variations of stroke volumes were analyzed during spontaneous breathing at fixed rate and tidal volume, during mechanical ventilation, and resistive loaded breathing. RESULTS: In 170 comparisons of beat-by-beat stroke volumes, 89% of thoracocardiographic fell within +/-20% of echocardiographic estimates. Changes in tidal volume, resistive loaded breathing, and mechanical ventilation induced respiratory variations of thoracocardiographic derived stroke volumes consistent with the known effect of respiratory changes in intrapleural pressure on left ventricular stroke volumes. CONCLUSIONS: The results suggest that thoracocardiography noninvasively tracks changes in left ventricular stroke volumes. Their absolute value may also be monitored if an initial calibration by an independent technique, such as echocardiography, is performed.

Thoracocardiographic-derived left ventricular systolic time intervals.

Thoracocardiography noninvasively estimates left ventricular performance by recording ventricular volume curves with inductive plethysmography. We studied timing of these curves to evaluate their potential to accurately track systolic time intervals in comparison with standard methods. Thoracocardiographic left ventricular volume curves, carotid pressure pulses determined by applanation tonometry, the phonocardiogram and ECG were recorded simultaneously in ten normal subjects at various body positions achieved with a tilt table. An equation was derived to predict preejection period from onset of ejection in thoracocardiographic curves. Ventricular ejection time was calculated as total electromechanical systole obtained by phonocardiography minus preejection period. The equation was validated prospectively in 31 measurements in critically ill patients. In normal subjects, the interval ECG Q wave to ejection onset in thoracocardiographic curves correlated well with preejection period from applanation tonometry and phonocardiography (r = 0.92; standard error of estimate (SEE), 8 ms; p < 0.001). Thoracocardiographic curves showed a delay that varied with body position according to the regression equation: delay = 40 ms + 10 x sine (tilt angle) (where r = 0.62; SEE, 7 ms; p < 0.001). Application of this equation in the prospective study in patients revealed close agreement in systolic time intervals from thoracocardiography and simultaneous applanation tonometry plus phonocardiography, respectively. The mean difference +/- SD between methods in preejection periods was 3 +/- 7 ms and in the ratios of preejection period to left ventricular ejection time, 0.02 +/- 0.05. Trends of changes in systolic time intervals were identical for the two methods. We conclude that thoracocardiography combined with phonocardiography provides accurate systolic time intervals when corrected for a position-dependent delay of its waveforms.