Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin
IntroductionThe life-sustaining treatment of hemodialysis (HD) induces recurrent and cumulative systemic circulatory stress resulting in cardiovascular injury. These recurrent insults compound preexisting cardiovascular sequalae leading to the development of myocardial injury and resulting in extrem...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-07-01
|
| Series: | Frontiers in Nephrology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneph.2023.1124130/full |
| _version_ | 1797782956154028032 |
|---|---|
| author | Jarrin D. Penny Jarrin D. Penny Jarrin D. Penny Lisa Hur Lisa Hur Fabio R. Salerno Fabio R. Salerno Dickson Wong M. Hussain Jan Christopher W. McIntyre Christopher W. McIntyre Christopher W. McIntyre Christopher W. McIntyre |
| author_facet | Jarrin D. Penny Jarrin D. Penny Jarrin D. Penny Lisa Hur Lisa Hur Fabio R. Salerno Fabio R. Salerno Dickson Wong M. Hussain Jan Christopher W. McIntyre Christopher W. McIntyre Christopher W. McIntyre Christopher W. McIntyre |
| author_sort | Jarrin D. Penny |
| collection | DOAJ |
| description | IntroductionThe life-sustaining treatment of hemodialysis (HD) induces recurrent and cumulative systemic circulatory stress resulting in cardiovascular injury. These recurrent insults compound preexisting cardiovascular sequalae leading to the development of myocardial injury and resulting in extremely high morbidity/mortality. This is largely a consequence of challenged microcirculatory flow within the myocardium (evidenced by detailed imaging-based studies). Currently, monitoring during HD is performed at the macrovascular level. Non-invasive monitoring of organ perfusion would allow the detection and therapeutic amelioration of this pathophysiological response to HD. Non-invasive percutaneous perfusion monitoring of the skin (using photoplethysmography—PPG) has been shown to be predictive of HD-induced myocardial stunning (a consequence of segmental ischemia). In this study, we extended these observations to include a dynamic assessment of skin perfusion during HD compared with directly measured myocardial perfusion during dialysis and cardiac contractile function.MethodsWe evaluated the intradialytic microcirculatory response in 12 patients receiving conventional HD treatments using continuous percutaneous perfusion monitoring throughout HD. Cardiac echocardiography was performed prior to the initiation of HD, and again at peak-HD stress, to assess the development of regional wall motion abnormalities (RWMAs). Myocardial perfusion imaging was obtained at the same timepoints (pre-HD and peak-HD stress), utilizing intravenous administered contrast and a computerized tomography (CT)-based method. Intradialytic changes in pulse strength (derived from PPG) were compared with the development of HD-induced RWMAs (indicative of myocardial stunning) and changes in myocardial perfusion.ResultsWe found an association between the lowest pulse strength reduction (PPG) and the development of RWMAs (p = 0.03) and also with changes in global myocardial perfusion (CT) (p = 0.05). Ultrafiltration rate (mL/kg/hour) was a significant driver of HD-induced circulatory stress [(associated with the greatest pulse strength reduction (p = 0.01), a reduction in global myocardial perfusion (p = 0.001), and the development of RWMAs (p = 0.03)].DiscussionPercutaneous perfusion monitoring using PPG is a useful method of assessing intradialytic hemodynamic stability and HD-induced circulatory stress. The information generated at the microcirculatory level of the skin is reflective of direct measures of myocardial perfusion and the development of HD-induced myocardial stunning. This approach for the detection and management of HD-induced cardiac injury warrants additional evaluation. |
| first_indexed | 2024-03-13T00:19:15Z |
| format | Article |
| id | doaj.art-494896e6527d4a7c9c8146cacae6681b |
| institution | Directory Open Access Journal |
| issn | 2813-0626 |
| language | English |
| last_indexed | 2024-03-13T00:19:15Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nephrology |
| spelling | doaj.art-494896e6527d4a7c9c8146cacae6681b2023-07-11T18:16:49ZengFrontiers Media S.A.Frontiers in Nephrology2813-06262023-07-01310.3389/fneph.2023.11241301124130Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skinJarrin D. Penny0Jarrin D. Penny1Jarrin D. Penny2Lisa Hur3Lisa Hur4Fabio R. Salerno5Fabio R. Salerno6Dickson Wong7M. Hussain Jan8Christopher W. McIntyre9Christopher W. McIntyre10Christopher W. McIntyre11Christopher W. McIntyre12The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, CanadaDepartment of Medical Biophysics, Western University, London, ON, CanadaLawson Health Research Institute, London, ON, CanadaThe Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, CanadaDepartment of Medical Biophysics, Western University, London, ON, CanadaThe Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, CanadaDepartment of Medical Biophysics, Western University, London, ON, CanadaThe Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, CanadaThe Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, CanadaThe Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, CanadaDepartment of Medical Biophysics, Western University, London, ON, CanadaLawson Health Research Institute, London, ON, CanadaDivision of Nephrology, London Health Sciences Centre, London, ON, CanadaIntroductionThe life-sustaining treatment of hemodialysis (HD) induces recurrent and cumulative systemic circulatory stress resulting in cardiovascular injury. These recurrent insults compound preexisting cardiovascular sequalae leading to the development of myocardial injury and resulting in extremely high morbidity/mortality. This is largely a consequence of challenged microcirculatory flow within the myocardium (evidenced by detailed imaging-based studies). Currently, monitoring during HD is performed at the macrovascular level. Non-invasive monitoring of organ perfusion would allow the detection and therapeutic amelioration of this pathophysiological response to HD. Non-invasive percutaneous perfusion monitoring of the skin (using photoplethysmography—PPG) has been shown to be predictive of HD-induced myocardial stunning (a consequence of segmental ischemia). In this study, we extended these observations to include a dynamic assessment of skin perfusion during HD compared with directly measured myocardial perfusion during dialysis and cardiac contractile function.MethodsWe evaluated the intradialytic microcirculatory response in 12 patients receiving conventional HD treatments using continuous percutaneous perfusion monitoring throughout HD. Cardiac echocardiography was performed prior to the initiation of HD, and again at peak-HD stress, to assess the development of regional wall motion abnormalities (RWMAs). Myocardial perfusion imaging was obtained at the same timepoints (pre-HD and peak-HD stress), utilizing intravenous administered contrast and a computerized tomography (CT)-based method. Intradialytic changes in pulse strength (derived from PPG) were compared with the development of HD-induced RWMAs (indicative of myocardial stunning) and changes in myocardial perfusion.ResultsWe found an association between the lowest pulse strength reduction (PPG) and the development of RWMAs (p = 0.03) and also with changes in global myocardial perfusion (CT) (p = 0.05). Ultrafiltration rate (mL/kg/hour) was a significant driver of HD-induced circulatory stress [(associated with the greatest pulse strength reduction (p = 0.01), a reduction in global myocardial perfusion (p = 0.001), and the development of RWMAs (p = 0.03)].DiscussionPercutaneous perfusion monitoring using PPG is a useful method of assessing intradialytic hemodynamic stability and HD-induced circulatory stress. The information generated at the microcirculatory level of the skin is reflective of direct measures of myocardial perfusion and the development of HD-induced myocardial stunning. This approach for the detection and management of HD-induced cardiac injury warrants additional evaluation.https://www.frontiersin.org/articles/10.3389/fneph.2023.1124130/fullhemodialysiscardiovascular injurymyocardial stunningperfusionischemic injury |
| spellingShingle | Jarrin D. Penny Jarrin D. Penny Jarrin D. Penny Lisa Hur Lisa Hur Fabio R. Salerno Fabio R. Salerno Dickson Wong M. Hussain Jan Christopher W. McIntyre Christopher W. McIntyre Christopher W. McIntyre Christopher W. McIntyre Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin Frontiers in Nephrology hemodialysis cardiovascular injury myocardial stunning perfusion ischemic injury |
| title | Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin |
| title_full | Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin |
| title_fullStr | Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin |
| title_full_unstemmed | Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin |
| title_short | Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin |
| title_sort | non invasive intradialytic percutaneous perfusion monitoring a view to the heart through the skin |
| topic | hemodialysis cardiovascular injury myocardial stunning perfusion ischemic injury |
| url | https://www.frontiersin.org/articles/10.3389/fneph.2023.1124130/full |
| work_keys_str_mv | AT jarrindpenny noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT jarrindpenny noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT jarrindpenny noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT lisahur noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT lisahur noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT fabiorsalerno noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT fabiorsalerno noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT dicksonwong noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT mhussainjan noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT christopherwmcintyre noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT christopherwmcintyre noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT christopherwmcintyre noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin AT christopherwmcintyre noninvasiveintradialyticpercutaneousperfusionmonitoringaviewtotheheartthroughtheskin |