Noninvasive measures of pulsatility and blood pressure during continuous-flow left ventricular assist device support

Research output: Contribution to journalArticle

Abstract

The reliability and validity of a palpable pulse and other noninvasive measures of pulsatility in patients on continuous-flow (CF) left ventricular assist device (LVAD) support have not been rigorously evaluated. We prospectively enrolled 23 patients who had CF-LVAD and an arterial catheter for blood pressure (BP) monitoring. Pulse pressure (PP) via the arterial line was compared with three noninvasive measures of pulsatility: presence of a palpable pulse, pulsatility index (PI), and aortic valve opening (AVO). In addition, the relationship between Doppler BP (DopBP) and arterial line pressures was evaluated. The study group comprised 30% females, 73% nonischemic cardiomyopathy, 87% axial flow device (HeartMate II [HMII]), and 13% centrifugal flow device (HeartWare ventricular assist device [HVAD]) support. Among four practitioners, the interobserver agreement for the presence of a palpable pulse was moderate (k = 0.41; 95% CI, 0.28-0.60). If the PP was ≥15 mm Hg, a radial pulse was palpated 82% of the time, whereas when the PP was <15 mm Hg, a radial pulse was palpated only 35% of the time. In subjects with a palpable pulse, there was a strong correlation between DopBP and systolic BP (SBP) (r = 0.94; 95% CI, 0.82-0.99), whereas the correlation between DopBP and mean arterial pressure (MAP) was much weaker (r = 0.42; 95% CI, 0.19-0.96). In subjects without a palpable pulse, there was a strong correlation between both the DopBP and SBP (r = 0.94; 95% CI, 0.80-1.0) and DopBP and MAP (r = 0.87; 95% CI, 0.77-1.00). Finally, PP was significantly associated with PI (odds ratio [OR], 0.3; 95% CI, 0.14-0.45; p = 0.0002) but not AVO (OR, 1.41: 95% CI, 0.70-2.83; p = 0.33). The presence of a palpable pulse has good interobserver agreement and allows for dichotomization of the DopBP to reflect the SBP in its presence and the MAP in its absence. This simple measure should be incorporated into BP management algorithms for CF-LVADs. The PI shows a modest correlation to PP.

Original languageEnglish (US)
Pages (from-to)241-246
Number of pages6
JournalASAIO Journal
Volume65
Issue number3
DOIs
StatePublished - Mar 1 2019

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Left ventricular assist devices
Heart-Assist Devices
Blood pressure
Pulse
Blood Pressure
Arterial Pressure
Axial flow
Catheters
Vascular Access Devices
Aortic Valve
Odds Ratio
Monitoring
Equipment and Supplies
Cardiomyopathies
Reproducibility of Results

Keywords

  • Doppler blood pressure
  • palpable pulse
  • pulsatility
  • pulsatility index
  • pulse pressure

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Cite this

@article{e5d8cb422fda4d5b895f47543220f108,
title = "Noninvasive measures of pulsatility and blood pressure during continuous-flow left ventricular assist device support",
abstract = "The reliability and validity of a palpable pulse and other noninvasive measures of pulsatility in patients on continuous-flow (CF) left ventricular assist device (LVAD) support have not been rigorously evaluated. We prospectively enrolled 23 patients who had CF-LVAD and an arterial catheter for blood pressure (BP) monitoring. Pulse pressure (PP) via the arterial line was compared with three noninvasive measures of pulsatility: presence of a palpable pulse, pulsatility index (PI), and aortic valve opening (AVO). In addition, the relationship between Doppler BP (DopBP) and arterial line pressures was evaluated. The study group comprised 30{\%} females, 73{\%} nonischemic cardiomyopathy, 87{\%} axial flow device (HeartMate II [HMII]), and 13{\%} centrifugal flow device (HeartWare ventricular assist device [HVAD]) support. Among four practitioners, the interobserver agreement for the presence of a palpable pulse was moderate (k = 0.41; 95{\%} CI, 0.28-0.60). If the PP was ≥15 mm Hg, a radial pulse was palpated 82{\%} of the time, whereas when the PP was <15 mm Hg, a radial pulse was palpated only 35{\%} of the time. In subjects with a palpable pulse, there was a strong correlation between DopBP and systolic BP (SBP) (r = 0.94; 95{\%} CI, 0.82-0.99), whereas the correlation between DopBP and mean arterial pressure (MAP) was much weaker (r = 0.42; 95{\%} CI, 0.19-0.96). In subjects without a palpable pulse, there was a strong correlation between both the DopBP and SBP (r = 0.94; 95{\%} CI, 0.80-1.0) and DopBP and MAP (r = 0.87; 95{\%} CI, 0.77-1.00). Finally, PP was significantly associated with PI (odds ratio [OR], 0.3; 95{\%} CI, 0.14-0.45; p = 0.0002) but not AVO (OR, 1.41: 95{\%} CI, 0.70-2.83; p = 0.33). The presence of a palpable pulse has good interobserver agreement and allows for dichotomization of the DopBP to reflect the SBP in its presence and the MAP in its absence. This simple measure should be incorporated into BP management algorithms for CF-LVADs. The PI shows a modest correlation to PP.",
keywords = "Doppler blood pressure, palpable pulse, pulsatility, pulsatility index, pulse pressure",
author = "Sabarivinoth Rangasamy and Shivank Madan and Omar Saeed and Goldstein, {Daniel J.} and Jorde, {Ulrich P.} and Abdissa Negassa and Patel, {Snehal R.}",
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T1 - Noninvasive measures of pulsatility and blood pressure during continuous-flow left ventricular assist device support

AU - Rangasamy, Sabarivinoth

AU - Madan, Shivank

AU - Saeed, Omar

AU - Goldstein, Daniel J.

AU - Jorde, Ulrich P.

AU - Negassa, Abdissa

AU - Patel, Snehal R.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - The reliability and validity of a palpable pulse and other noninvasive measures of pulsatility in patients on continuous-flow (CF) left ventricular assist device (LVAD) support have not been rigorously evaluated. We prospectively enrolled 23 patients who had CF-LVAD and an arterial catheter for blood pressure (BP) monitoring. Pulse pressure (PP) via the arterial line was compared with three noninvasive measures of pulsatility: presence of a palpable pulse, pulsatility index (PI), and aortic valve opening (AVO). In addition, the relationship between Doppler BP (DopBP) and arterial line pressures was evaluated. The study group comprised 30% females, 73% nonischemic cardiomyopathy, 87% axial flow device (HeartMate II [HMII]), and 13% centrifugal flow device (HeartWare ventricular assist device [HVAD]) support. Among four practitioners, the interobserver agreement for the presence of a palpable pulse was moderate (k = 0.41; 95% CI, 0.28-0.60). If the PP was ≥15 mm Hg, a radial pulse was palpated 82% of the time, whereas when the PP was <15 mm Hg, a radial pulse was palpated only 35% of the time. In subjects with a palpable pulse, there was a strong correlation between DopBP and systolic BP (SBP) (r = 0.94; 95% CI, 0.82-0.99), whereas the correlation between DopBP and mean arterial pressure (MAP) was much weaker (r = 0.42; 95% CI, 0.19-0.96). In subjects without a palpable pulse, there was a strong correlation between both the DopBP and SBP (r = 0.94; 95% CI, 0.80-1.0) and DopBP and MAP (r = 0.87; 95% CI, 0.77-1.00). Finally, PP was significantly associated with PI (odds ratio [OR], 0.3; 95% CI, 0.14-0.45; p = 0.0002) but not AVO (OR, 1.41: 95% CI, 0.70-2.83; p = 0.33). The presence of a palpable pulse has good interobserver agreement and allows for dichotomization of the DopBP to reflect the SBP in its presence and the MAP in its absence. This simple measure should be incorporated into BP management algorithms for CF-LVADs. The PI shows a modest correlation to PP.

AB - The reliability and validity of a palpable pulse and other noninvasive measures of pulsatility in patients on continuous-flow (CF) left ventricular assist device (LVAD) support have not been rigorously evaluated. We prospectively enrolled 23 patients who had CF-LVAD and an arterial catheter for blood pressure (BP) monitoring. Pulse pressure (PP) via the arterial line was compared with three noninvasive measures of pulsatility: presence of a palpable pulse, pulsatility index (PI), and aortic valve opening (AVO). In addition, the relationship between Doppler BP (DopBP) and arterial line pressures was evaluated. The study group comprised 30% females, 73% nonischemic cardiomyopathy, 87% axial flow device (HeartMate II [HMII]), and 13% centrifugal flow device (HeartWare ventricular assist device [HVAD]) support. Among four practitioners, the interobserver agreement for the presence of a palpable pulse was moderate (k = 0.41; 95% CI, 0.28-0.60). If the PP was ≥15 mm Hg, a radial pulse was palpated 82% of the time, whereas when the PP was <15 mm Hg, a radial pulse was palpated only 35% of the time. In subjects with a palpable pulse, there was a strong correlation between DopBP and systolic BP (SBP) (r = 0.94; 95% CI, 0.82-0.99), whereas the correlation between DopBP and mean arterial pressure (MAP) was much weaker (r = 0.42; 95% CI, 0.19-0.96). In subjects without a palpable pulse, there was a strong correlation between both the DopBP and SBP (r = 0.94; 95% CI, 0.80-1.0) and DopBP and MAP (r = 0.87; 95% CI, 0.77-1.00). Finally, PP was significantly associated with PI (odds ratio [OR], 0.3; 95% CI, 0.14-0.45; p = 0.0002) but not AVO (OR, 1.41: 95% CI, 0.70-2.83; p = 0.33). The presence of a palpable pulse has good interobserver agreement and allows for dichotomization of the DopBP to reflect the SBP in its presence and the MAP in its absence. This simple measure should be incorporated into BP management algorithms for CF-LVADs. The PI shows a modest correlation to PP.

KW - Doppler blood pressure

KW - palpable pulse

KW - pulsatility

KW - pulsatility index

KW - pulse pressure

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