Developing a Non-Invasive Method to Monitor Cardiovascular Control during Orthostatic Challenge Considering the Limitation of the FinometerTM

Abstract

Sensations of dizziness or fainting (pre-syncope or syncope) on standing up from a lying or a seated position are usually associated with impaired blood pressure regulation leading to inadequate perfusion of the brain. The purpose of this project was to develop a simple method to provide scientists and doctors a convenient way to monitor cardiovascular control during orthostatic stress with the non-invasive FinometerTM device. This apparatus provides a continuous estimate of arterial blood pressure (BP) contour from the finger and computes brachial blood pressure contours (systolic (SBP) and diastolic (DBP) blood pressure), heart rate (HR), stroke volume and cardiac output (Q) from the Modelflow equation. In this thesis, a method was implemented to obtain an estimate of central venous pressure (CVP) to provide greater insight into cardiovascular control. The accuracy and potential errors resulting from measurement of finger arterial pressure were also evaluated. The thesis first examined whether key variables essential to monitor cardiovascular control can be reliably measured by the FinometerTM in comparison to independent methods. HR was accurate and precise at rest and during stress (difference between methods: 0.05± 0.18 beats/min). According to standards established by the American Association for the Advancement of Medical Instrumentation (AAMI); at rest, DBP was accurate but not precise (1.6± 8.8 mmHg) and SBP was not accurate but precise (14.2± 8.0 mmHg). These errors could be due to an improper use of our reference method. The post-test correction for individual characteristics proposed by the FinometerTM developers did improve overall Q estimation (0.255± 0.441 L/min (6.9%) instead of 0.797± 0.441 L/min (22.4%)) when compared with Doppler ultrasound but did not account for the increasing error with a greater orthostatic stress induced by lower body negative pressure. Using finger BP instead of aortic BP to calculate Q did not explain this error as revealed by a new approach that compared the simultaneous pulse contours from different methods. Indeed, there was no significant difference between the error of the estimation of Q from the finger arterial pulse compared to the estimation of Q from the independent measurement by tonometry on the brachial artery at rest (-1.13± 14.67%) and at the maximum orthostatic stress used (-0.61± 9.33%) (p>0.05). Using brachial BP to calculate Q did not improve the result found with finger BP. The first hypothesis of this thesis that CVP could be estimated from outputs of the FinometerTM compared to direct venous pressure measurement was supported for the individual (0.2± 1.7 mmHg) and test specific (0.1± 1.2 mmHg) equations. The general equations derived from group data were accurate but not precise enough (0.4± 2.8 mmHg) to be used in clinical and research setting. The success of the individual equations suggests that it might be possible to derive a personal equation that will be useful over a long period for similar tests by using a catheter only once. The second and third hypotheses related to the cause of discrepancy between Q from FinometerTM and Q from Doppler, were not supported by the data. However, a new contour analysis method introduced here in a graphical format might provide an opportunity for systematic analyses of the deviation between methods. It could reveal sources of error allowing future improvements in the accuracy and precision of Q from FinometerTM during orthostatic or physical stress.