Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices

Troy J. Cross, Pavol Sajgalik, Vratislav Fabian, Lukas Matera, Sudhir S. Kushwaha, Simon Maltais, John M. Stulak, John A. Schirger, Bruce David Johnson

Research output: Contribution to journalArticle

Abstract

Introduction: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the ‘cuff pulsatility index’. Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m−2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.

Original languageEnglish (US)
JournalInternational Journal of Artificial Organs
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Blood pressure
Arterial Pressure
Arm
Pressure
Monitoring
Blood Pressure
Radial Artery
Patient Safety
Body Mass Index
Heart Failure
Heart Rate

Keywords

  • Left ventricular assist device
  • non-invasive
  • pulsatility index

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

Cite this

Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices. / Cross, Troy J.; Sajgalik, Pavol; Fabian, Vratislav; Matera, Lukas; Kushwaha, Sudhir S.; Maltais, Simon; Stulak, John M.; Schirger, John A.; Johnson, Bruce David.

In: International Journal of Artificial Organs, 01.01.2019.

Research output: Contribution to journalArticle

Cross, Troy J. ; Sajgalik, Pavol ; Fabian, Vratislav ; Matera, Lukas ; Kushwaha, Sudhir S. ; Maltais, Simon ; Stulak, John M. ; Schirger, John A. ; Johnson, Bruce David. / Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices. In: International Journal of Artificial Organs. 2019.
@article{adf98ea0a71e47b99611103497a01cb6,
title = "Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices",
abstract = "Introduction: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the ‘cuff pulsatility index’. Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m−2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.",
keywords = "Left ventricular assist device, non-invasive, pulsatility index",
author = "Cross, {Troy J.} and Pavol Sajgalik and Vratislav Fabian and Lukas Matera and Kushwaha, {Sudhir S.} and Simon Maltais and Stulak, {John M.} and Schirger, {John A.} and Johnson, {Bruce David}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0391398819868236",
language = "English (US)",
journal = "International Journal of Artificial Organs",
issn = "0391-3988",
publisher = "Wichtig Publishing",

}

TY - JOUR

T1 - Non-invasive assessment of arterial pulsatility in patients with continuous-flow left ventricular assist devices

AU - Cross, Troy J.

AU - Sajgalik, Pavol

AU - Fabian, Vratislav

AU - Matera, Lukas

AU - Kushwaha, Sudhir S.

AU - Maltais, Simon

AU - Stulak, John M.

AU - Schirger, John A.

AU - Johnson, Bruce David

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the ‘cuff pulsatility index’. Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m−2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.

AB - Introduction: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the ‘cuff pulsatility index’. Purpose: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. Methods: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m−2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient’s dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). Results: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. Conclusions: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.

KW - Left ventricular assist device

KW - non-invasive

KW - pulsatility index

UR - http://www.scopus.com/inward/record.url?scp=85071431571&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071431571&partnerID=8YFLogxK

U2 - 10.1177/0391398819868236

DO - 10.1177/0391398819868236

M3 - Article

C2 - 31411101

AN - SCOPUS:85071431571

JO - International Journal of Artificial Organs

JF - International Journal of Artificial Organs

SN - 0391-3988

ER -