Systolic and diastolic time intervals in the critically ill patient.
OBJECTIVE
The waveform of the first derivative of thoracic electrical bioimpedance was used to calculate systolic time intervals of the cardiac cycle, preejection period/left ventricular ejection time ratio, and diastolic time intervals, isovolumic relaxation period/filling time ratio.


METHODS
Prospective clinical study. Waveforms were examined from 913 normal and abnormal tracings from a thoracic electrical bioimpedance monitor. This monitor was coupled to a two-channel strip-chart recorder that identified preejection period/LV ejection time and isovolumic relaxation period/filling time in 86% of the tracings.


METHODS
Two university-affiliated hospitals and one community hospital.


METHODS
We assessed 100 subjects (ranging in age from 17 to 93 yrs) under various conditions.


RESULTS
Data from 15 normal subjects were used as a reference series to define normative values. Preejection period/left ventricular ejection time ratio was 0.35 +/- 0.1 (SD) and was consistent with data from systolic time intervals derived from simultaneous study of the ECG recording, carotid artery tracing, and phonocardiography. The diastolic time ratio (isovolumic relaxation period/filling time) was 0.4 +/- 0.2, in agreement with normal values derived by echocardiography and angiography. In a subgroup of 17 critically ill patients, a correlative study of simultaneously measured thoracic electrical bioimpedance, nuclear stethoscope, and radionuclide ventriculography was conducted. Systolic functions were compared by the ejection fraction derived by preejection period/left ventricular ejection time ratio displayed on the thoracic electrical bioimpedance monitor and by the radionuclide technique, and were found to be 57 +/- 13.8% and 58 +/- 8.6%, respectively (r2 = .49; y = 4.06x + 0.94; p less than .02; n = 17). Increased diastolic time ratios with normal or near-normal systolic time intervals were documented in nine (53%) of 17 critically ill patients with low systolic index.


CONCLUSIONS
Both systolic and diastolic time intervals can be investigated noninvasively at the bedside by the thoracic electrical bioimpedance technique to provide a better understanding of left heart function.
Intensive Care Unit, Hospital Sao Luiz, Sao Paulo, Brazil.
J A
JA
Máttar
W C
WC
Shoemaker
D
D
Diament
A
A
Lomar
A C
AC
Lopes
E
E
De Freitas
F P
FP
Stella
L A
LA
Factore
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002307:Cardiography, Impedance; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D003971:Diastole / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D013318:Stroke Volume; D013599:Systole / Q000502:physiology*