Noninvasive Calibration of Cardiac Pressure Transducers in Patients With Heart Failure: An Aid to Implantable Hemodynamic Monitoring and Therapeutic Guidance

Mcclean, Dougal; Aragon, Joseph; Jamali, Aamer; Kar, Saibal; Ritzema-Carter, Jay; Troughton, Richard; Krum, Henry; Doughty, Robert; Abraham, William T.; Whiting, James S.; Eigler, Neal

doi:10.1016/j.cardfail.2006.06.002

« Previous Next »Journal of Cardiac Failure
Volume 12, Issue 7 , Pages 568-576, September 2006

Noninvasive Calibration of Cardiac Pressure Transducers in Patients With Heart Failure: An Aid to Implantable Hemodynamic Monitoring and Therapeutic Guidance

Dougal Mcclean, MD
- From the Division of Cardiology, Department of Medicine, and the Research Institute at Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California
Joseph Aragon, MD
- From the Division of Cardiology, Department of Medicine, and the Research Institute at Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California
Aamer Jamali, MD
- From the Division of Cardiology, Department of Medicine, and the Research Institute at Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California
Saibal Kar, MD
- From the Division of Cardiology, Department of Medicine, and the Research Institute at Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California
Jay Ritzema-Carter, MD
- Division of Cardiology, Christchurch Hospital, Christchurch, New Zealand
Richard Troughton, MD
- Division of Cardiology, Christchurch Hospital, Christchurch, New Zealand
Henry Krum, MD
- Monash University and the Alfred Hospital, Melbourne, Australia
Robert Doughty, MD
- Department of Medicine, Auckland University, Auckland, New Zealand
William T. Abraham, MD
- Divison of Cardiology, The Ohio State University School of Medicine
James S. Whiting, PhD
- From the Division of Cardiology, Department of Medicine, and the Research Institute at Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California
Neal Eigler, MD
- From the Division of Cardiology, Department of Medicine, and the Research Institute at Cedars-Sinai Medical Center, and the UCLA School of Medicine, Los Angeles, California
- Reprint requests: Neal Eigler, MD, 10780 Santa Monica Boulevard, Suite 401, Los Angeles, CA 90025.

Received 14 July 2005; received in revised form 25 March 2006; accepted 1 June 2006.

Los Angeles, California; Christchurch, New Zealand; Melbourne, Australia; Auckland, New Zealand; Columbus, Ohio

Abstract

Background

Implantable cardiac pressure monitors require assurance of calibration. This study evaluated if airway pressure responses during Valsalva maneuver (VM) can be used for calibrating intracardiac pressure transducers.

Methods and Results

Thirty-eight heart failure patients performed VMs while cardiac and airway pressures were recorded. Patients were designated as Lower (L) if baseline PCW was <20 mm Hg (n = 17); otherwise, they were categorized as Higher (H) (n = 21). VMs were repeated in 9 H patients after nitroglycerin. Procedural success was 92% and there were no complications. Differences between filling pressure and airway pressure (effective pressure) were eliminated during VM (RA_eff = −0.9 ± 1.3, RVED_eff = 1.2 ± 1.1, PCW_eff = 2.1 ± 2.8, and LVED_eff = 0.9 ± 1.6 mm Hg), and filling pressures were highly correlated with airway pressure r = 0.94. On average, group H had higher PCW_eff and LVED_eff than L patients by 1.8 and 2.5 mm Hg (P ≤ .002), respectively, but after nitrates their responses were identical.

Conclusion

The relationships between cardiac filling pressure and airway pressure during the Valsalva maneuver are sufficiently reliable to be considered as a new, noninvasive method for establishing the calibration of cardiac pressure sensors in patients with heart failure.

Key Words: Valsalva maneuver, Filling pressure, Airway pressure, Effective pressure