Journal of Clinical Monitoring and Computing

, Volume 21, Issue 6, pp 345–351 | Cite as

Multi-Channel Electrical Bioimpedance: A New Noninvasive Method To Simultaneously Measure Cardiac And Peripheral Blood Flow

  • Alfred W. H. StanleyJr
  • Jeffery W. Herald
  • Constantine L. Athanasuleas
  • Saji C. Jacob
  • Scott W. Sims
  • Alfred A. Bartolucci
  • Alexander N. Tsoglin



We sought to assess the ability of a new multi-channel electrical bioimpedance (MEB) methodology to accurately measure both cardiac blood flow and peripheral limb blood flow.


Cardiac output is the primary determinant of peripheral blood flow; however, optimal regional tissue perfusion is ultimately dependent on the patency of the arterial conduits that transport that flow. A complete understanding of regional tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations.


Cardiac blood flow (cardiac output) was measured by MEB in 30 healthy volunteers and was compared to a 2D-Echo Doppler cardiac output. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in 15 healthy volunteers. The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index).


There was good correlation between the mean cardiac index by MEB (3.08 l/min/m2) and by Echo Doppler (3.13 l/min/m2) and bias and precision was 0.051 (1.6%) and ±0.52 l/min/m2 (±17%), respectively. The close correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (p < 0.05) with a sensitivity of 100% and specificity of 100%.


MEB methodology can precisely measure cardiac output and peripheral limb flow in healthy volunteers.

Key Words

bioimpedance noninvasive cardiac output multi-channel electrical bioimpedance noninvasive measurement of flow 


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  1. 1.
    Gheorghiade M, Bonow RO. Chronic heart failure in the United States: a manifestation of coronary artery disease. Circulation 1998; 97: 282–289PubMedGoogle Scholar
  2. 2.
    Sheehan P. Peripheral arterial disease in patients with diabetes. In: Abela GS, ed, Peripheral vascular disease-basic diagnostic and therapeutic approaches. Philadelphia: Lippincott, Williams and Wilkins, 2004:62–75Google Scholar
  3. 3.
    Criqui MH, Denenberg JO, Langer RD, Fronek A. The epidemiology of peripheral arterial disease: importance of identifying the population at risk. Vasc Med 1997; 2: 221–226PubMedGoogle Scholar
  4. 4.
    Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286: 1317–1324PubMedCrossRefGoogle Scholar
  5. 5.
    Criqui MH. Peripheral arterial disease–epidemiological aspects. Vasc Med 2001; 6:3–7PubMedCrossRefGoogle Scholar
  6. 6.
    Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381–386PubMedCrossRefGoogle Scholar
  7. 7.
    Kedrov AA. An attempt of the quantify assessment of the central and peripheral circulation by electrometrical method. Klin Med 1948; 26: 32–51Google Scholar
  8. 8.
    Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH. Development and evaluation of an impedance cardiac output system. Aerosp Med 1966; 37: 1208–1212PubMedGoogle Scholar
  9. 9.
    Kubicek WG, From AH, Patterson RP, et al. Impedance cardiography as a noninvasive means to monitor cardiac function. J Assoc Adv Med Instrum 1970; 4: 79–84PubMedGoogle Scholar
  10. 10.
    Kubicek WG, Kottke J, Ramos MU, et al. The Minnesota impedance cardiograph-theory and applications. Biomed Eng 1974; 9: 410–416PubMedGoogle Scholar
  11. 11.
    Bernstein DP. Continuous noninvasive real-time monitoring of stroke volume and cardiac output by thoracic electrical bioimpedance. Crit Care Med 1986; 14: 898–901PubMedGoogle Scholar
  12. 12.
    Denniston JC, Maher JT, Reeves JT, Cruz JC, Cymerman A, Grover RF. Measurement of cardiac output by electrical impedance at rest and during exercise. J Appl Physiol 1976; 40: 91–95PubMedGoogle Scholar
  13. 13.
    Goldstein DS, Cannon RO III, Zimlichman R, Keiser HR. Clinical evaluation of impedance cardiography. Clin Physiol 1986; 6: 235–251PubMedGoogle Scholar
  14. 14.
    Cotter G, Moshkovitz Y, Kaluski E, et al. Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest 2004; 125: 1431–1440PubMedCrossRefGoogle Scholar
  15. 15.
    Baker LE. Principles of impedance technique. IEEE Eng Med Biol 1989; 3: 11–15CrossRefGoogle Scholar
  16. 16.
    Dittmann H, Voelker W, Karsch KR, Seipel L. Influence of sampling site and flow area on cardiac output measurements by Doppler echocardiography. J Am Coll Cardiol 1987; 10: 818–823PubMedCrossRefGoogle Scholar
  17. 17.
    Henry WL, DeMaria A, Gramiak R, et al. Report of the American Society of Echocardiography Committee on nomenclature and standards in two-dimensional echocardiography. Circulation 1980; 62: 212–217PubMedGoogle Scholar
  18. 18.
    Lewis JF, Kuo LC, Nelson JG, Limacher MC, Quinones MA. Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation 1984; 70: 425–431PubMedGoogle Scholar
  19. 19.
    Hatle L, Angelsen B. Doppler ultrasound in cardiology. 2nd Edition. Philadelphia: Lea and Febiger, 1985Google Scholar
  20. 20.
    Strandess DE Jr., Bell JW. Peripheral vascular disease: diagnosis and objective evaluation using a mercury strain gauge. Ann Surg 1965; April, 161(Suppl-4):4–35Google Scholar
  21. 21.
    Bernstein EF, Fronek A. Current status of noninvasive tests in the diagnosis of peripheral arterial disease. Surg Clin North Am 1982; 62: 473–487PubMedGoogle Scholar
  22. 22.
    Mauney KA. Peripheral vascular disease: basic diagnostic and therapeutic approaches. 1st Edition. Philadelphia: Lippincott, Williams and Wilkins, 2004: 215Google Scholar
  23. 23.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310PubMedGoogle Scholar
  24. 24.
    Cooke GA, Marshall P, al-Timman JK, et al. Physiological cardiac reserve: development of a non-invasive method and first estimates in man. Heart 1998; 79: 289–294PubMedGoogle Scholar
  25. 25.
    Garrard CL Jr, Weissler AM, Dodge HT. The relationship of alterations in systolic time intervals to ejection fraction in patients with cardiac disease. Circulation 1970; 42:455–462PubMedGoogle Scholar
  26. 26.
    Tan LB, Littler WA. Measurement of cardiac reserve in cardiogenic shock: implications for prognosis and management. Br Heart J 1990; 64:121–128PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Alfred W. H. StanleyJr
    • 1
    • 2
    • 3
  • Jeffery W. Herald
    • 2
    • 3
  • Constantine L. Athanasuleas
    • 1
    • 3
    • 4
  • Saji C. Jacob
    • 2
    • 3
  • Scott W. Sims
    • 2
    • 3
  • Alfred A. Bartolucci
    • 5
  • Alexander N. Tsoglin
    • 6
  1. 1.Kemp-Carraway Heart InstituteBirminghamUSA
  2. 2.Cardiovascular Consultants of AlabamaBirminghamUSA
  3. 3.Physicians Medical Center CarrawayBirminghamUSA
  4. 4.Norwood ClinicBirminghamUSA
  5. 5.Department of BiostatisticsUniversity of AlabamaBirminghamUSA
  6. 6.Delta Segments Technology, Inc.BirminghamUSA

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