Comparative measures of systolic ejection during treadmill exercise by impedance cardiography and Doppler echocardiography

Abstract Measurements of systolic ejection dynamics by impedance cardiography were compared with simultaneous Doppler echocardiography in normal subjects and coronary artery disease patients. Patients with chest pain admitted for elective coronary angiography were monitored by simultaneous impedance cardiography and Doppler echocardiography before, during, and after treadmill exercise. Ensemble-averaged ECG, impedance cardiogram (ICG), the first derivative of ICG (d Z /d t ), and Doppler waveforms were analyzed to identify systolic ejection variables. The timing of aortic valve opening was well correlated ( r = 0.78) the timing of peak ejection velocity was very well correlated ( r = 0.86), and the timing of aortic valve closure was moderately correlated ( r = 0.69 and r = 0.73) in these subjects. The thoracic electrical impedance acceleration and normalized impedance acceleration indices were moderately correlated with Doppler model acceleration ( r = 0.74, r = 0.79). The impedance cardiogram waveforms are of complex origin and are related to both aortic blood velocity and aortic blood acceleration. Users of d Z /d t timing features for determining aortic valvular events might consider alternative impedance features to improve ejection time accuracy.