The Study On Application Of Noninvasive Cardiac Output Monitoring In The Congestive Heart Failure

Background Chronic heart failure(CHF) is a main diseases to threaten the human health,and slways the end-stage presentation in many cardiovascular diseases.Due to the intervention of the technics of intervene,operation and the medication,many patients in the acute stage of cardiac arrhythmia and acute myocardial infarction survive,however,the incidence of the CHF is becoming higher and higher,forcing us to focus on the early and correct diagnosis and treatment of heart failure,thus we can improve the span and quality of life in the patients.Cardiopulmonary Exercise testing(CPX)and Passive Leg Raising(PLR) are important methods to estimate the heart pump function.The recent study has shown that it is not enough to diagnose heart failure only by CPX and PLR for the reason of lack of a continuous noninvasive cardiac output monitoring to get the real CO.So the monitoring becomes important.The NICOM is a new noninvasive cardiac output monitoring.CO measured by NICOM can not only be used in diagnosing and estimation of CHF but also in improving the personal treatment of CHF.Many studies have proved the close associativity between the CO measured by NICOM and degree of left ventricular reconstitution in CHF patients. Nevertheless,in our country,there are rare studies on the CO measurement by NICOM,and no data and proof of NICOM by ourselves have been provided.To observe the associativity between the CO measured by NICOM and the severity of CHF,and to determine the affection of age,sex,NYHA grade on the CO measured by NICOM,,We performed echocardiography in SHF and DHF patients and momitored CO by NICOM as well.The comparision of the two methods were made.Methods Echocardiography was performed in the subjects with DHF (LVEF＞50%,n=206),and in those with heart failure and systolic dysfunction (LVEF＜45%,n=123) and healthy senile adults(n=98) who were age and gender-matched to the DHF and SHF group.Left ventricular(LV) thickness and dimension were derived from M-mode echocardiography,LV volume and LVEF were calculated with Simpson's biplane method.Pulsed wave Doppler imaging was used to obtain the transmitral flow velocities:E wave and A wave Decelerating time(DT) and A duration(AD) were measured,the right upper pulmonary vein S wave(PVs),D wave(PVd) and a reversal wave(PVa).PVa duration(PVaD) wre measured.The early diastolic flow propagation velocity in left ventricle(Vp) was measured using color M-mode echocardiography.Within One hour before or after echo exam,CPX,6MWT or PLR were performed in a11 subjects.NICOM was used to measure HR,SV,CO and VET,before,during and after exercise testing.The relation between data measured by NICOM and by Doppler were analyzed by statistic software.Results 1.Compared with the controls,The DHF and SHF patients present significant ventricular dilatation and overt atrial enlargement with evident hypertrophy.2.There was no statistical difference(P＞0.05) between the SV measured by NICOM and by UCG..3.In DHF and SHF group,HR,SV,CO,were statistically decreased(p＜0.05) both at exercise and rest,compared with normal group.Conclusion 1.The volume of the left atria and left ventricle increased significantly in DHF and SHF,and systolic function was evidently decreased in patients diagnosed as DHF and SHF.2.There were significant relationship between the parameters of diastolic function and those of systolic function in DHF group.3.Compared with normal group,the parameters measured by NICOM in the SHF and DHF group were obviously decreased.4.NICOM can be used to identify CHF,and they might add modest value in differentiating DHF from SHF.5.NICOM might play a role in detection and evaluation of treatment of CHF.