Computer cardiokymography. On its way to long-term noninvasive monitoring of cardiac performance in daly life

摘要

A functioning heart generates low-frequency and low-amplitude movements (up to 40 (mrn) of soft tissues in the percardial area. Since the 1950-s of the XX-th century cardiologists have studied these movements to employ them in the diagnostics of ischemic heart disease (IHD). Indeed, changes of the movements have found their diagnostic application in this field. If blood supply to a certain area of ventricular myocardium is insufficient the contractions in this area diminish and even ceases. After systolic increase in ventricular pressure this area dilates and forces intercostal tissues out, causing a "bulge" wave on the record. For recording the patient must be in supine position and hold the breath. High frequency electromagnetic field generator was used in an attempt to examine the heart movements. It was found that such instrument measures the thickness of the air-gap that serves as a dielectric or a "capacitor" which forms between the skin and approaching it flat inductive coil. Nevertheless, such an instrument (cardiokymograph, CKG) can reveal changes in contractions of ischemic myocardium and markedly increases the sensitivity of the exercise ECG test. However, CKG can be recorded only after termination of the test. This principal disadvantage has been overcome by software that allowed the recording of CKG during the test. A low-frequency capacitance transducer developed recently by Chinese researchers has provided a simultaneous recording of several CKG. After modifying the transducer, we have established that 1) the shape of CKGs is the same as that CKGs recorded by all our predecessors, 2) CKGs are reproducible even within a 3-month interval, 3) the enormous mechanical interference caused by respiratory movements and, to a greater extent, by the vigorous movements of the legs and trunk during veloergometry can be eliminated by digital processing of the transducer signals, and 4) pathological changes appear in CKG of patients with IHD, which enables one to stop veloergometry at lower loads, thus increasing the safety of the test. Since for large medical insurance companies very simple and inexpensive cardiokymograph are quite unprofitable, their commercially production in USA and in Germany has been stopped. However, the goal of cardiokymography: a real-time, beat-to-beat, long-term monitoring of cardiac function in daily life, remains the major factor determining the future of the method.