Cardiac Output and Left Atrial Pressure Monitoring by Right Ventricular Pressure Waveform Analysis for Potential Implantable Device Application

A well-tested and safe implantable device is now available for long-term ambulatory monitoring of the right ventricular pressure (RVP) waveform of congestive heart failure patients. However, cardiac output (CO) and left atrial pressure (LAP) are more useful for assessing cardiac function and managing volume status. We developed a new technique to estimate relative CO change and LAP by long time interval analysis of the RVP waveform. To demonstrate feasibility, we performed four chronic canine experiments in which the RVP waveform and accurate reference measurements were simultaneously recorded during common hemodynamic interventions. The overall root-mean-squared-errors of the estimated relative CO change and LAP were 16.0% and 2.0 mm Hg. For comparison, the corresponding errors for the previously proposed intra-beat RVP waveform analysis techniques were 21% and 160% higher. With further successful testing, the new technique may potentially be employed with an established implantable device for chronic monitoring of essential hemodynamic variables.