A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver c...
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Gespeichert in:

Autor*in:	Galiatsatos, Panagis [verfasserIn] Parakh, Kapil Monti, Jennifer Thavarajah, Sumeska Aneke-Ogbu, Harriet Watson, Amaris Kim, Daniel Wang, Nae-Yuh Shafi, Tariq Silber, Harry A.

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2015

Schlagwörter:	Valsalva Left ventricular filling pressure Volume status Hemodialysis

Anmerkung:	© Galiatsatos et al. 2015

Übergeordnetes Werk:	Enthalten in: BMC nephrology - London : BioMed Central, 2000, 16(2015), 1 vom: 14. Aug.
Übergeordnetes Werk:	volume:16 ; year:2015 ; number:1 ; day:14 ; month:08

Links:	Volltext

DOI / URN:	10.1186/s12882-015-0135-0

Katalog-ID:	SPR027513955

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520			\|a Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis.
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allfields	10.1186/s12882-015-0135-0 doi (DE-627)SPR027513955 (SPR)s12882-015-0135-0-e DE-627 ger DE-627 rakwb eng Galiatsatos, Panagis verfasserin aut A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Galiatsatos et al. 2015 Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. Valsalva (dpeaa)DE-He213 Left ventricular filling pressure (dpeaa)DE-He213 Volume status (dpeaa)DE-He213 Hemodialysis (dpeaa)DE-He213 Parakh, Kapil aut Monti, Jennifer aut Thavarajah, Sumeska aut Aneke-Ogbu, Harriet aut Watson, Amaris aut Kim, Daniel aut Wang, Nae-Yuh aut Shafi, Tariq aut Silber, Harry A. aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 14. Aug. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:14 month:08 https://dx.doi.org/10.1186/s12882-015-0135-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 14 08
spelling	10.1186/s12882-015-0135-0 doi (DE-627)SPR027513955 (SPR)s12882-015-0135-0-e DE-627 ger DE-627 rakwb eng Galiatsatos, Panagis verfasserin aut A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Galiatsatos et al. 2015 Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. Valsalva (dpeaa)DE-He213 Left ventricular filling pressure (dpeaa)DE-He213 Volume status (dpeaa)DE-He213 Hemodialysis (dpeaa)DE-He213 Parakh, Kapil aut Monti, Jennifer aut Thavarajah, Sumeska aut Aneke-Ogbu, Harriet aut Watson, Amaris aut Kim, Daniel aut Wang, Nae-Yuh aut Shafi, Tariq aut Silber, Harry A. aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 14. Aug. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:14 month:08 https://dx.doi.org/10.1186/s12882-015-0135-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 14 08
allfields_unstemmed	10.1186/s12882-015-0135-0 doi (DE-627)SPR027513955 (SPR)s12882-015-0135-0-e DE-627 ger DE-627 rakwb eng Galiatsatos, Panagis verfasserin aut A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Galiatsatos et al. 2015 Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. Valsalva (dpeaa)DE-He213 Left ventricular filling pressure (dpeaa)DE-He213 Volume status (dpeaa)DE-He213 Hemodialysis (dpeaa)DE-He213 Parakh, Kapil aut Monti, Jennifer aut Thavarajah, Sumeska aut Aneke-Ogbu, Harriet aut Watson, Amaris aut Kim, Daniel aut Wang, Nae-Yuh aut Shafi, Tariq aut Silber, Harry A. aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 14. Aug. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:14 month:08 https://dx.doi.org/10.1186/s12882-015-0135-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 14 08
allfieldsGer	10.1186/s12882-015-0135-0 doi (DE-627)SPR027513955 (SPR)s12882-015-0135-0-e DE-627 ger DE-627 rakwb eng Galiatsatos, Panagis verfasserin aut A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Galiatsatos et al. 2015 Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. Valsalva (dpeaa)DE-He213 Left ventricular filling pressure (dpeaa)DE-He213 Volume status (dpeaa)DE-He213 Hemodialysis (dpeaa)DE-He213 Parakh, Kapil aut Monti, Jennifer aut Thavarajah, Sumeska aut Aneke-Ogbu, Harriet aut Watson, Amaris aut Kim, Daniel aut Wang, Nae-Yuh aut Shafi, Tariq aut Silber, Harry A. aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 14. Aug. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:14 month:08 https://dx.doi.org/10.1186/s12882-015-0135-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 14 08
allfieldsSound	10.1186/s12882-015-0135-0 doi (DE-627)SPR027513955 (SPR)s12882-015-0135-0-e DE-627 ger DE-627 rakwb eng Galiatsatos, Panagis verfasserin aut A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis 2015 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Galiatsatos et al. 2015 Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. Valsalva (dpeaa)DE-He213 Left ventricular filling pressure (dpeaa)DE-He213 Volume status (dpeaa)DE-He213 Hemodialysis (dpeaa)DE-He213 Parakh, Kapil aut Monti, Jennifer aut Thavarajah, Sumeska aut Aneke-Ogbu, Harriet aut Watson, Amaris aut Kim, Daniel aut Wang, Nae-Yuh aut Shafi, Tariq aut Silber, Harry A. aut Enthalten in BMC nephrology London : BioMed Central, 2000 16(2015), 1 vom: 14. Aug. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:16 year:2015 number:1 day:14 month:08 https://dx.doi.org/10.1186/s12882-015-0135-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2015 1 14 08
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Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. 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author	Galiatsatos, Panagis
spellingShingle	Galiatsatos, Panagis misc Valsalva misc Left ventricular filling pressure misc Volume status misc Hemodialysis A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis
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topic_title	A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis Valsalva (dpeaa)DE-He213 Left ventricular filling pressure (dpeaa)DE-He213 Volume status (dpeaa)DE-He213 Hemodialysis (dpeaa)DE-He213
topic	misc Valsalva misc Left ventricular filling pressure misc Volume status misc Hemodialysis
topic_unstemmed	misc Valsalva misc Left ventricular filling pressure misc Volume status misc Hemodialysis
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title	A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis
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title_full	A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis
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author_browse	Galiatsatos, Panagis Parakh, Kapil Monti, Jennifer Thavarajah, Sumeska Aneke-Ogbu, Harriet Watson, Amaris Kim, Daniel Wang, Nae-Yuh Shafi, Tariq Silber, Harry A.
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title_sort	finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis
title_auth	A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis
abstract	Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. © Galiatsatos et al. 2015
abstractGer	Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. © Galiatsatos et al. 2015
abstract_unstemmed	Background A noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis. © Galiatsatos et al. 2015
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title_short	A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis
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We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis. Methods We tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically. Results Twenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01). Conclusion An index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. 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A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

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