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Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver.

Publication ,  Journal Article
Galiatsatos, P; Win, TT; Monti, J; Johnston, PV; Herzog, W; Trost, JC; Hwang, C-W; Fridman, GY; Wang, N-Y; Silber, HA
Published in: Am J Cardiol
April 1, 2017

The high rate of re-hospitalization for heart failure might be reduced by improving noninvasive techniques for identifying elevated left ventricular (LV) filling pressure. We previously showed that changes in a finger photoplethysmography (PPG) waveform during the Valsalva maneuver (VM) reflect invasively measured LV end-diastolic pressure (LVEDP). We have since developed a hand-held device that analyzes PPG while guiding the expiratory effort of a VM. Here we assessed the sensitivity and specificity of this device for identifying elevated LVEDP in patients. We tested 82 participants (28 women), aged 40 to 85 years, before a clinically indicated left heart catheterization. Each performed a VM between 18 and 25 mm Hg for 10 seconds into a pressure transducer. PPG was recorded continuously before and during the VM. LVEDP was measured during the catheterization. An equation for calculating LVEDP was derived using (1) ratio of signal amplitudes: minimum during VM to average at baseline, (2) ratio of peak-to-peak time intervals: minimum during VM to average at baseline, and (3) mean blood pressure. Calculated and measured LVEDP were compared. The range of measured LVEDP was 4 to 35 mm Hg. Calculated LVEDP correlated with measured LVEDP (p <0.0001, r = 0.56). A calculated LVEDP >20 mm Hg had a 70% sensitivity and 86% specificity for identifying measured LVEDP >20 mm Hg (area under receiver-operating characteristic curve 0.83). In conclusion, a hand-held device for assessing LV filling pressure had high specificity and good sensitivity for identifying LVEDP >20 mm Hg, a clinically meaningful threshold in heart failure.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 1, 2017

Volume

119

Issue

7

Start / End Page

1053 / 1060

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Valsalva Maneuver
  • Transducers, Pressure
  • Sensitivity and Specificity
  • Photoplethysmography
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Fingers
 

Citation

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Galiatsatos, P., Win, T. T., Monti, J., Johnston, P. V., Herzog, W., Trost, J. C., … Silber, H. A. (2017). Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver. Am J Cardiol, 119(7), 1053–1060. https://doi.org/10.1016/j.amjcard.2016.11.063
Galiatsatos, Panagis, Theingi Tiffany Win, Jennifer Monti, Peter V. Johnston, William Herzog, Jeffrey C. Trost, Chao-Wei Hwang, Gene Y. Fridman, Nae-Yuh Wang, and Harry A. Silber. “Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver.Am J Cardiol 119, no. 7 (April 1, 2017): 1053–60. https://doi.org/10.1016/j.amjcard.2016.11.063.
Galiatsatos P, Win TT, Monti J, Johnston PV, Herzog W, Trost JC, et al. Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver. Am J Cardiol. 2017 Apr 1;119(7):1053–60.
Galiatsatos, Panagis, et al. “Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver.Am J Cardiol, vol. 119, no. 7, Apr. 2017, pp. 1053–60. Pubmed, doi:10.1016/j.amjcard.2016.11.063.
Galiatsatos P, Win TT, Monti J, Johnston PV, Herzog W, Trost JC, Hwang C-W, Fridman GY, Wang N-Y, Silber HA. Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver. Am J Cardiol. 2017 Apr 1;119(7):1053–1060.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 1, 2017

Volume

119

Issue

7

Start / End Page

1053 / 1060

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Valsalva Maneuver
  • Transducers, Pressure
  • Sensitivity and Specificity
  • Photoplethysmography
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Fingers