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Heart-failure (HF) is a severe medical condition. Physicians need new tools to monitor the health status of their HF patients outside the hospital or medical supervision areas, to better know the evolution of their patients’ main biomarker values, necessary to evaluate their health status. Bioimpedance (BI) represents a good technology for sensing physiological variables and processes on the human body. BI is a non-expensive and non-invasive technique for sensing a wide variety of physiological parameters, easy to be implemented on biomedical portable systems, also called “wearable devices”. In this systematic review, we address the most important specifications of wearable devices based on BI used in HF real-time monitoring and how they must be designed and implemented from a practical and medical point of view. The following areas will be analyzed: the main applications of BI in heart failure, the sensing technique and impedance specifications to be met, the electrode selection, portability of wearable devices: size and weight (and comfort), the communication requests and the power consumption (autonomy). The different approaches followed by biomedical engineering and clinical teams at bibliography will be described and summarized in the paper, together with results derived from the projects and the main challenges found today.

Background: Heart failure (HF) represents a frequent cause of hospital admission, with fluid overload directly contributing to decompensations. Bioimpedance (BI), a physical parameter linked to tissue hydration status, holds promise in monitoring congestion and improving prognosis. This systematic review aimed to assess the clinical relevance of BI-based wearable devices for HF fluid monitoring. Methods: A systematic review of the published literature was conducted in five medical databases (PubMed, Scopus, Cochrane, Web of Science, and Embase) for studies assessing wearable BI-measuring devices on HF patients following PRISMA recommendations on February 4th, 2024. The risk of bias was evaluated using the ROBINS tool. Results: The review included 10 articles with 535 participants (mean age 66.7 ± 8.9 years, males 70.4%). Three articles identified significant BI value differences between HF patients and controls or congestive vs non-congestive HF patients. Four articles focused on the devices' ability to predict HF worsening-related events, revealing an overall sensitivity of 70.0 (95% CI 68.8–71.1) and specificity of 89.1 (95% CI 88.3–89.9). One article assessed prognosis, showing that R80kHz decrease was related to all-cause-mortality with a hazard ratio (HR) of 5.51 (95% CI 1.55–23.32; p = 0.02) and the composite all-cause-mortality and HF admission with a HR of 4.96 (95% CI 1.82–14.37; p = 0.01). Conclusions: BI-measuring wearable devices exhibit efficacy in detecting fluid overload and hold promise for HF monitoring. However, further studies and technological improvements are required to optimize their impact on prognosis compared to standard care before they can be routinely implemented in clinical practice. PROSPERO Registration: The search protocol was registered at PROSPERO (CRD42024509914).

Obtaining cell concentration measurements from a culture assay by using bioimpedance is a very useful method that can be used to translate impedances to cell concentration values. The purpose of this study was to find a method to obtain the cell concentration values of a given cell culture assay in real time by using an oscillator as the measurement circuit. From a basic cell–electrode model, enhanced models of a cell culture immersed in a saline solution (culture medium) were derived. These models were used as part of a fitting routine to estimate the cell concentration in a cell culture in real time by using the oscillation frequency and amplitude delivered by the measurement circuits proposed by previous authors. Using real experimental data (the frequency and amplitude of oscillations) that were obtained by connecting the cell culture to an oscillator as the load, the fitting routine was simulated, and real-time data of the cell concentration were obtained. These results were compared to concentration data that were obtained by using traditional optical methods for counting. In addition, the error that we obtained was divided and analyzed in two parts: the first part of the experiment (when the few cells were adapting to the culture medium) and the second part of the experiment (when the cells exponentially grew until they completely covered the well). Low error values were obtained during the growth phase of the cell culture (the relevant phase); therefore, the results obtained were considered promising and show that the fitting routine is valid and that the cell concentration can be measured in real time by using an oscillator.

Biological Impedance is a physical property related to the state and inherent evolution of biological samples. Among the existing impedance measurement methods, Oscillation-Based (OB) tests are a simple and smart solution to indirectly measure impedance correlated with the amplitude and frequency of the generated oscillation which are proportional to the sample under test. An OB test requires tuning of the system blocks to specifications derived from every measurement problem. The OB setup must be done to obtain the optimum measurement sensitivity for the specific constraints imposed by the system under test, electronic interfaces, and electrodes employed for test. This work proposes the extension of OB measurement systems to spectroscopy test, enabling a completely new range of applications for this technology without the restrictions imposed by setting a fixed frequency on the electrical oscillator. Some examples will be presented to the measurement of cell cultures samples, considering the corresponding circuit interfaces and electric models for the electrode-cell system. The proposed analysis method allows the selection of the best oscillator elements for optimum sensitivity range in amplitude and frequency oscillation values, when a specific cell culture is monitored for the OB system.

A smart sensor system for cell culture real-time supervision is proposed, allowing for a significant reduction in human effort applied to this type of assay. The approach converts the cell culture under test into a suitable “biological” oscillator. The system enables the remote acquisition and management of the “biological” oscillation signals through a secure web interface. The indirectly observed biological properties are cell growth and cell number, which are straightforwardly related to the measured bio-oscillation signal parameters, i.e., frequency and amplitude. The sensor extracts the information without complex circuitry for acquisition and measurement, taking advantage of the microcontroller features. A discrete prototype for sensing and remote monitoring is presented along with the experimental results obtained from the performed measurements, achieving the expected performance and outcomes.

This paper proposes a new yet efficient method allowing a significant improvement in the on-line analysis of biological cell growing and evolution. The procedure is based on an empirical-mathematical approach for calibration and fitting of any cell-electrode electrical model. It is valid and can be extrapolated for any type of cellular line used in electrical cell-substrate impedance spectroscopy (ECIS) tests. Parameters of the bioimpedance model, acquired from ECIS experiments, vary for each cell line, which makes obtaining results difficult and—to some extent-renders them inaccurate. We propose a fitting method based on the cell line initial characterization, and carry out subsequent experiments with the same line to approach the percentage of well filling and the cell density (or cell number in the well). To perform our calibration technique, the so-called oscillation-based test (OBT) approach is employed for each cell density. Calibration results are validated by performing other experiments with different concentrations on the same cell line with the same measurement technique. Accordingly, a bioimpedance electrical model of each cell line is determined, which is valid for any further experiment and leading to a more precise electrical model of the electrode-cell system. Furthermore, the model parameters calculated can be also used by any other measurement techniques. Promising experimental outcomes for three different cell-lines have been achieved, supporting the usefulness of this technique.

To follow up the restenosis in arteries stented during an angioplasty is an important current clinical problem. A new approach to monitor the growth of neointimal tissue inside the stent is proposed on the basis of electrical impedance spectroscopy (EIS) sensors and the oscillation-based test (OBT) circuit technique. A mathematical model was developed to analytically describe the histological composition of the neointima, employing its conductivity and permittivity data. The bioimpedance model was validated against a finite element analysis (FEA) using COMSOL Multiphysics software. A satisfactory correlation between the analytical model and FEA simulation was achieved in most cases, detecting some deviations introduced by the thin “double layer” that separates the neointima and the blood. It is hereby shown how to apply conformal transformations to obtain bioimpedance electrical models for stack-layered tissues over coplanar electrodes. Particularly, this can be applied to characterize the neointima in real-time. This technique is either suitable as a main mechanism for restenosis follow-up or it can be combined with proposed intelligent stents for blood pressure measurements to auto-calibrate the sensibility loss caused by the adherence of the tissue on the micro-electro-mechanical sensors (MEMSs).