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 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 ± 6.0 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).


CONCLUSIONS
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.
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. panagis@jhmi.edu.
Panagis
P
Galiatsatos
Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. kparakh1@jhmi.edu.
Kapil
K
Parakh
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. Jennifer.Monti@uphs.upenn.edu.
Jennifer
J
Monti
Division of Nephrology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. sthavara1@jhmi.edu.
Sumeska
S
Thavarajah
Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. harriet.aneke.08@aberdeen.ac.uk.
Harriet
H
Aneke-Ogbu
Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. awatso26@jhmi.edu.
Amaris
A
Watson
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. dkim34@jhmi.edu.
Daniel
D
Kim
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. naeyuh@jhmi.edu.
Nae-Yuh
NY
Wang
Division of Nephrology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. tshafi@jhmi.edu.
Tariq
T
Shafi
Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. hsilber@jhmi.edu.
Harry A
HA
Silber
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001810:Blood Volume; D001835:Body Weight; D005260:Female; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography / Q000379:methods; D006435:Renal Dialysis; D014636:Valsalva Maneuver / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*