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Clinical Significance of EC Parameters

Parameter Abbrev. Definition and Clinical Normal Range Derivation/Formula


Significance
Heart Rate HR Number of heart beats each 55 - 80 (beats per minute) Measurement of the R-R interval on the
minute. ECG and extrapolation to bpm.

Since HR x SV = CO, HR will


often increase to compensate for
inadequate SV.
Mean Arterial Pressure MAP Average pressure exerted by the 84 – 100 mmHg 1. If SBP and DBP values manually
(SBP & DBP) blood on the arterial walls. entered, the formula for MAP =
(SBP – DBP)*KP) + DBP
If MAP is too high, it could be 2. If automatic BP (oscillometric
due to one or more of the method is used), MAP is measured
following, excessive: directly and SBP and DBP are
output/contractility (CO/CI, ACI, derived.
VI), vascular resistance
(SVR/SVRI), and/or fluids Note: The two methods are both
(TFC). Increased MAP results in clinically accepted, but may yield
increased myocardial oxygen different actual values for SBP, DBP,
demands, which may not be met and MAP.
if patient has heart disease
(e.g., angina, CHF)

Cardiac Output CO Amount of blood pumped by the 4.8 – 7.2 l/min (liters per CO = SV x HR
left ventricle each minute. minute)

Adequate CO is necessary to
support life. Supra-normal values
are often desirable for critically ill
patients. If abnormal, assess its
determinants – HR and SV.
Parameter Abbrev. Definition and Clinical Normal Range Derivation/Formula
Significance
Cardiac Index CI Cardiac Output normalized for 2.5 - 4.0 l/min (liters per CI = CO / BSA
body surface area. minute)

CO is the absolute volume of


blood pumped per minute and CI
is adjusted for body size. Most
clinicians prefer CI.
Stroke Volume SV Amount of blood pumped by the 60 – 130 ml (milliliters) Z MARC Algorithm
left ventricle each heartbeat. SV  VEPT  LVET  VI

One of the two determinants of


CO. HR will often compensate
for low SV by increasing to
obtain adequate CO.
Stroke Index SI Stroke volume normalized for 35 - 65 ml/beat/m2 SV
body surface area. (milliliters per heart beat SI 
BSA
per meter squared)
SV and SI will usually show
significant changes before CO
and CI.
Systemic Vascular SVR The resistance to the flow of 742 – 1378 dynes / sec /
SVR  80 
MAP  CVP 
Resistance blood in the arterial system (often cm -5 (dynes per second
CO
referred to as “Afterload”). per centimeter to the
negative fifth power)
If abnormal, vasodilators can
lower and vasoconstrictors can
increase.
Systemic Vascular SVRI The resistance to the flow of 1337 - 2483 dynes / sec /
SVRI  80 
MAP  CVP 
Resistance Index blood in the arterial system cm-5 / m2 (dynes per
CI
normalized for body surface area. second per centimeter to
the negative fifth power
SVRI is often used by researchers per meter squared)
and SVR by clinicians.
Parameter Abbrev. Definition and Clinical Normal Range Derivation/Formula
Significance
Index Contractility ICON Peak acceleration of blood flow 40 - 60 dZ / dt Max
in the aorta, which occurs within ICON TM 
the first 10 - 40 milliseconds after Z0
the opening of the aortic valve.

This is considered to be an index


of left ventricular contractility.
The stronger the ventricle, the
higher the ICON. This also
appears to provide early
indication of LV failure – as the
LV starts to fail, this will fall,
prior to SV, which falls prior to
CO.

Parameter Abbrev. Definition and Clinical Normal Range Derivation/Formula


Significance
Thoracic Fluid Index TFI The electrical conductivity of the 25 - 35  -1 1
chest cavity, which is primarily TFI 
Z0
determined by the intravascular,
intraalveolar, and interstitial
fluids in the thorax.

This is a gross indicator of the


amount of fluid in the patient’s
chest cavity. The more fluid in
the chest, the higher the TFC and
the lower the amplitude of the
impedance waveform. If the
.com cannot obtain hemodynamic
data and the amplitude of the
impedance waveform is very
small, this suggests excessive
fluid in the chest. This can be
assessed by auscultation and
chest X-ray.
Left Cardiac Work LCW An indicator of the amount of 5.4 - 10 kg m (kilogram LCW  MAP  PAOP  CO  0.0144
work the left ventricle must meter)
perform to pump blood each
minute.

CHF patients will typically have


an abnormally low LCW, usually
due to a low CO.
Left Cardiac Work LCWI LCW normalized for body 3.0 - 5.5 kg m m-2 LCWI  MAP  PAOP  CI  0.0144
Index surface area. (kilogram meter per meter
squared)

Parameter Abbrev. Definition and Clinical Normal Range Derivation/Formula


Significance
Systolic Time Ratio STR The ratio of the electrical and 0.3 - 0.5 PEP
mechanical systole. STR 
LVET
An excellent parameter to
evaluate electro-mechanical
performance of the heart,
especially in heart failure. An
‘athletic heart’ will typically
have a low STR and a failing
heart will have a high STR.
Some physicians may be more
familiar with STI or Systolic
Time Interval, which is PEP +
LVET. STR is a much more
useful clinical parameter than STI
– for example, in heart failure,
PEP increases and LVET
decreases and STI typically
doesn’t change much, but because
STR is the ratio of PEP and
LVET, it changes significantly.

Parameter Abbrev. Definition and Clinical Normal Range Derivation/Formula


Significance
Pre Ejection Period PEP The time interval from the Depends on HR Time interval from the beginning of the
beginning of electrical Q wave on the ECG to the B point on the
stimulation of the ventricles to dZ/dt waveform
the opening of the aortic valve
(electrical systole).

An extremely sensitive parameter


to cardiac function. As a heart
starts to fail, it takes longer to
develop enough pressure to open
the aortic valve; consequently
PEP increases (and causes STR to
increase also).
Left Ventricular LVET The time interval from the Depends on HR Time interval from the B point to the X
Ejection Time opening to the closing of the point on the dZ/dt waveform
aortic valve (mechanical systole).
When a heart starts to fail, the
heart cannot maintain an
adequate pressure to keep the
aortic valve open as long as a
healthy heart, so LVET decreases
(and STR increases).

VEPT Volume of Electrically Participating Tissue (volume conductor for size of thorax affected by height, weight, and sex)
TFI Thoracic Fluid Index, which is the baseline thoracic impedance, Z0
SBP/DBP Systolic Blood Pressure/Diastolic Blood Pressure
KP A variable which is dependant on pulse pressure ratio, usually varying between 0.25 – 0.33
BSA Body Surface Area
dZ/dtMAX Maximum of the first time derivative of delta Z
CVP Central Venous Pressure, the BP in the thoracic vena cava and right atrium (default value of 6 mm Hg)
PAOP Pulmonary Artery Occlusion Pressure or “wedge” pressure (default value of 10 mm Hg)

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