Zheng Dingchang, Allen John, Murray Alan
Medical Physics Department, Newcastle University, Freeman Hospital, Newcastle upon Tyne, UK.
Physiol Meas. 2008 Dec;29(12):1411-9. doi: 10.1088/0967-3334/29/12/005. Epub 2008 Oct 30.
Ectopic beats are common in patients who have heart disease and are associated with reduced peripheral pulse amplitude. This study determined the start of the peripheral pulse increase and from it the opening of the aortic valve. The left ventricular peak filling rate was also estimated from the peripheral pulse. Results were compared with published invasive and cardiac imaging data. Twenty-five subjects with ectopic beat electrocardiograms (ECGs) were studied. The ECGs and the peripheral pulses, detected optically at the right index finger by a simple photoplethysmography (PPG) technique, were recorded for subsequent analysis. Peripheral pulse amplitudes for ectopic beats, post-ectopic sinus beats and normal sinus beats were determined. Ectopic beats induced a mean 68% decrease in pulse amplitude in comparison with sinus beats (p < 0.001). In contrast, the mean pulse amplitude for post-ectopic sinus beats increased by 20% (p < 0.01). Pulse amplitude changes were comparable with the published stroke volume differences for ectopic beats and post-ectopic sinus beats. The range of shortest coupling interval (CI) for ectopic beats with observable pulses was from 373 to 531 ms, with the mean value equivalent to 55% of the mean sinus RR interval, comparable with the opening of the aortic valve. Finally, as the CI increased, the pulse amplitude increased quickly from zero. The average rate of increase was equivalent to 4.8 times the normal sinus amplitude in 1 s, equal to 50% filling in 208 ms, showing diastolic rapid filling, comparable with published left ventricular peak filling rate data. In conclusion, the effect of ectopic beat CI on peripheral pulse amplitude has been determined, providing useful information for developing a technique to determine the opening of the aortic valve and the peak filling rate non-invasively and peripherally in patients with frequent ectopic beats.
异位搏动在患有心脏病且外周脉搏振幅降低的患者中很常见。本研究确定了外周脉搏增加的起始点，并由此确定了主动脉瓣的开放情况。还从外周脉搏估计了左心室峰值充盈率。将结果与已发表的侵入性和心脏成像数据进行了比较。对25名有异位搏动心电图（ECG）的受试者进行了研究。通过简单的光电容积脉搏波描记术（PPG）技术在右手食指光学检测到的ECG和外周脉搏被记录下来以供后续分析。确定了异位搏动、异位后窦性搏动和正常窦性搏动的外周脉搏振幅。与窦性搏动相比，异位搏动导致脉搏振幅平均降低68%（p<0.001）。相比之下，异位后窦性搏动的平均脉搏振幅增加了20%（p<0.01）。脉搏振幅变化与已发表的异位搏动和异位后窦性搏动的每搏量差异相当。具有可观察到的脉搏的异位搏动的最短耦合间期（CI）范围为373至531毫秒，其平均值相当于平均窦性RR间期的55%，与主动脉瓣的开放情况相当。最后，随着CI增加，脉搏振幅从零迅速增加。平均增加速率相当于正常窦性振幅在1秒内的4.8倍，等于在208毫秒内充盈50%，显示舒张期快速充盈，与已发表的左心室峰值充盈率数据相当。总之，已经确定了异位搏动CI对外周脉搏振幅的影响，为开发一种在频繁异位搏动患者中无创且外周地确定主动脉瓣开放和峰值充盈率的技术提供了有用信息
