The Non-Invasive Cardiac System - Cardiac Surveyor (NICaS CS) - An Ambulatory Tool for the Diagnosis of Asymptomatic Coronary Artery Disease

Login or register to view PDF.

Over half of those who succumb annually to coronary artery disease (CAD) in the US die a sudden cardiac death (SCD) before they are ever diagnosed or treated. The two main causes of these deaths are fatal arrhythmias borne by left ventricular systolic dysfunction (LVSD) associated with viable (hibernating) myocardium, and acute infarctions of silent ischemia. The common denominators of these diagnostic entities are that they are asymptomatic in their pre-clinical phase, and that they have the same therapeutic solution, which is revascularization in a timely manner. In this article we describe: a new ambulatory impedance apparatus, the Non-Invasive Cardiac System ├óÔé¼ÔÇ£ Cardiac Surveyor (NICaS CS), to be used by the family doctor in the community to diagnose these cardiac conditions while still asymptomatic, at a very low cost; the first two case reports that led to the new discovery; and the diagnostic results of a series of tests performed with the NICaS CS on 518 people in a private clinic (at the cost of $50 each).

Coronary artery disease, sudden cardiac death, left ventricular systolic dysfunction, ambulatory impedance apparatus, Non-Invasive Cardiac System ├óÔé¼ÔÇ£ Cardiac Surveyor (NICaS CS)

Disclosure: Daniel A Goor, MD, is a shareholder in NI Medical. Samuel Sclarovsky, MD, has no conflicts of interest to declare.
Received: February 2, 2010 Accepted: February 24, 2010 Citation: US Cardiology, 2010;7(1):57├óÔé¼ÔÇ£60
Correspondence: Daniel A Goor, MD, 47 King David boulevard, Tel Aviv, Israel.

According to Myerburg and Costellanos, the introduction of cardiac revascularization to medicine (coronary artery bypass grafting [CABG]) almost 50 years ago led to a decline in the age-adjusted mortality from coronary artery disease (CAD),1 but brought no change to the fraction of coronary deaths that are sudden and unexpected.1 Of the 650,000 who die annually in the US of CAD, 300,000├óÔé¼ÔÇ£350,000 succumb to sudden cardiac death (SCD),1,2 and another 57,000 to end-stage systolic congestive heart failure (CHF).3 This prognostic picture has not changed since the era before the introduction of revascularization by CABG operations in the late 1960s. With the new technology described here, the responsibility for timely diagnosis of asymptomatic CAD can be transferred from costly medical institutions to primary care physicians (PCPs) in the community. This alternative strategy of cost-effective early diagnosis will facilitate at long last the completion of the revolution of revascularization that began half a century ago.

The Technology

Three consecutive models of the current technology were developed, the first being the Non-Invasive Cardiac System (NICaS). This was an impedance cardiographic (ICG) monitor for non-invasive measurement of the cardiac output (CO) and its derivatives.4

To register to view full article click here


  1. Myerburg RJ, Castellanos A, Cardiac arrest and sudden cardiac death. In: Braunwald E (ed.), Heart Disease. A Textbook of Cardiovascular Medicine, 8th Edition, Philadelphia: Saunders Elsevier, 2008:933├óÔé¼ÔÇ£74.
  2. Rosamond W, Flegal K, Friday G, et al., and for the American Heart Association Statistics Committee, Heart and stroke statistics ├óÔé¼ÔÇ£ 2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Circulation, 2007;115(5):e172.
  3. Rosamond W, Flegal K, Furie K, et al., American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics ├óÔé¼ÔÇ£ 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Circulation, 2008;117(4):e25├óÔé¼ÔÇ£146.
  4. Cohen AJ, Arnaudov D, Zabeeda D, et al., Non-invasive measurement of cardiac output during coronary artery bypass grafting, Eur J Cardiothorac Surg, 1998;14:64├óÔé¼ÔÇ£9.
  5. Hardy CJ, Assessment of arterial elasticity by cardiovascular MRI, In: Kwong RY, Libby P (eds), Cardiovascular Magnetic Resonance Imaging (Contemporary Cardiology), Totowa, New Jersey: Humana Press, 2008;695├óÔé¼ÔÇ£710.
  6. Cotter G, Schachner A, Sasson L, et al., Impedance cardiography revisited, Physiol Meas, 2006;27:817├óÔé¼ÔÇ£27.
  7. Paredes OL, Shite J, Shinke T, et al., Impedance cardiography for cardiac output estimation: reliability of wrist-to-ankle electrode configuration, Circ J, 2006;70:164├óÔé¼ÔÇ£85.
  8. Drazner MH, Thompson B, Rosenberg PB, et al., Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy, Am J Cardiol, 2002;89:993├óÔé¼ÔÇ£5.
  9. Leslie SJ, McKee S, Newby DE, et al., Non-invasive measurement of cardiac output in patients with chronic heart failure, Blood Press Monit, 2004;9(5):277├óÔé¼ÔÇ£80.
  10. Van De Water JM, Miller TW, Vogel RL, et al., Impedance cardiography ├óÔé¼ÔÇ£ the next vital sign technology?, Chest, 2003;123:2028├óÔé¼ÔÇ£33.
  11. Koobi T, Kaukinen S, Turjanmaa VMH, et al., Whole-body impedance cardiography in the measurement of cardiac output, Crit Care Med, 1997;25:779├óÔé¼ÔÇ£85.
  12. Chatterjee K, Matloff JM, Swan HJ, et al., Abnormal regional metabolism and mechanical function in patients with ischemic heart diseases: improvement after successful regional revascularization by aortocoronary bypass, Circulation, 1975;52:390├óÔé¼ÔÇ£99.
  13. Cohen M, Charney R, Hershman R, et al., Reversal of chronic ischemic myocardial dysfunction after transluminal coronary angioplasty, J Am Coll Cardiol, 1988;12:1193├óÔé¼ÔÇ£8.
  14. Pagano D, Lewis ME, Townend JN, et al., Coronary revascularization for postischaemic heart failure: how myocardial viability affects survival, Heart, 1999;82:684├óÔé¼ÔÇ£8.
  15. Gheoghriade M, Bonow RO, Chronic heart failure in the United States: a manifestation of coronary artery disease, Circulation, 1998;97(3):282├óÔé¼ÔÇ£9.
  16. Rizzello V, Poldermans D, Schinkel AFL, et al., Long term prognostic value of myocardial viability and ischaemia during dobutamine stress echocardiography in patients with ischaemic cardiomyopathy undergoing coronary revascularization, Heart, 2006; 92:923├óÔé¼ÔÇ£4.
  17. Heather LW, A comparison of cardiac output values by the impedance cardiograph and dye dilution techniques in cardiac patients, In: Development of an Impedance Cardiographic System, NASA, 1969, Report NAS 9-4500.
  18. Ranaei RN, Heywood JT, Elatre WA, Assessment of myocardial contractility and total arterial compliance by impedance cardiography determined parameters, J Card Fail, 2002;8:S97.
  19. Feng S, Okuda N, Fujinami T, et al., Detection of impaired left ventricular function in coronary artery disease with acceleration index in the first derivative of the transthoracic impedance change, Clin Cardiol, 1988;11:843├óÔé¼ÔÇ£7.
  20. Thompson B, Drazner MH, Dries DL, et al., Is impedance cardiography-derived systolic time ratio a useful method to determine left ventricular systolic dysfunction in heart failure?, J Card Fail, 2004;10:S38.
  21. Wang TJ, Levy D, Benjamin EJ, et al., The epidemiology of ├óÔé¼┼øasymptomatic├óÔé¼┼Ñ left ventricular systolic dysfunction: implications for screening, Ann Intern Med, 2003;138:907├óÔé¼ÔÇ£16.
  22. Rozenman Y, Goor DA, Rotzak R, Progress report on noninvasive diagnosis of asymptomatic left ventricular systolic dysfunction, J Card Fail, 2009;15:68.
  23. Hedberg P, Lonnberg I, Jonason T, et al., Left ventricular systolic dysfunction in 75-year-old men and women; a population-based study, Eur Heart J, 2001;22:676├óÔé¼ÔÇ£83.
  24. Frigerio M, Olivia F, Turazza FM, et al., Prevention and management of chronic heart failure in management of asymptomatic patients, Am J Cardiol, 2003;91:4F├óÔé¼ÔÇ£9F.
  25. Allman KC, Shaw LJ, Hachamovitch R, et al., Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis, J Am Coll Cardiol, 2002;39:1151├óÔé¼ÔÇ£8.
  26. Birnbaum Y, Sheffy K, Sclarovsky S, et al., Peripheral arterial tonometry ├óÔé¼ÔÇ£ a novel sensitive noninvasive method for the detection of silent myocardial ischemia in unstable angina, Proc Eur Soc Cardiol, 1999;20:280.
  27. Goor DA, Sheffy J, Schnall RP, et al., Peripheral arterial tonometry: a diagnostic method for detection of myocardial ischemia induced during mental stress test: a pilot study, Clin Cardiol, 2004;27:137├óÔé¼ÔÇ£41.