Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting

CHEST critical care Pub Date : 2025-02-12 DOI:10.1016/j.chstcc.2025.100138

Jon-Emile S. Kenny MD , Geoffrey Clarke MEng , Sarah Atwi PhD , Isabel Kerrebijn MSc , Tracy Savery MASc , Meredith Knott BSN , Chelsea E. Munding PhD , Mai Elfarnawany PhD , Andrew M. Eibl BComm , Joseph K. Eibl PhD , Bhanu Nalla MD , Rony Atoui MD

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Abstract

Background

As a measure of preload responsiveness (PR), change in carotid artery corrected flow time (ccFT_Δ) is a surrogate for change in stroke volume (SV_Δ). However, the optimal threshold and accuracy of ccFT_Δ to detect SV_Δ are inconsistent in previous reports.

Research Question

Does ccFT_Δ from a wireless, wearable Doppler ultrasound accurately detect a 10% SV_Δ measured by transesophageal echocardiography?

Study Design and Methods

This was a prospective, single-center study of adult patients after elective coronary artery bypass grafting. PR was defined as ≥ 10% augmentation in transesophageal echocardiography left ventricular outflow tract velocity time integral (as a surrogate for SV_Δ) during Trendelenburg positioning. Synchronous carotid Doppler imaging was captured by a wireless, wearable Doppler ultrasound. The optimal ccFT_Δ threshold to detect PR, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Linear correlation between ccFT_Δ and SV_Δ was assessed by Pearson correlation coefficient. We also evaluated the effect of the number of consecutively averaged cardiac cycles on ccFT_Δ accuracy.

Results

This analysis included 30 patients; 7 patients showed a ≥ 10% SV_Δ during Trendelenburg positioning. The optimal ccFT_Δ thresholds were +6.6 ms or 2.2% with sensitivities of 100%, specificities of 70%, and AUCs of 0.89 and 0.88, respectively. A strong, linear correlation between ccFT_Δ and SV_Δ was found (r = 0.70; P < .001). The mean AUC increased from 0.68 to 0.87 when using 1 vs 20 consecutively averaged cardiac cycles.

Interpretation

After cardiopulmonary bypass, ccFT_Δ measured by wireless, wearable ultrasound detected SV_Δ during Trendelenburg positioning with high accuracy. The AUC improved as a function of consecutively averaged cardiac cycles. As a surrogate for preload-induced SV_Δ, ccFT_Δ can direct fluid therapy in the postoperative period.

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可穿戴式多普勒超声测量颈动脉校正血流时间与经食管超声心动图测量的冠状动脉搭桥术后脑卒中容量变化

背景：作为负荷前反应性（PR）的测量指标，颈动脉校正血流时间的变化（ccFTΔ）可以替代脑卒中量的变化（SVΔ）。然而，在以往的报道中，ccFTΔ检测SVΔ的最佳阈值和准确率并不一致。研究问题ccFTΔ从无线，可穿戴多普勒超声准确检测10% SVΔ经食管超声心动图测量？研究设计和方法：本研究是一项前瞻性、单中心研究，研究对象为择期冠状动脉旁路移植术后的成年患者。PR定义为Trendelenburg定位时经食管超声心动图左心室流出道速度时间积分（代替SVΔ）增加≥10%。同步颈动脉多普勒成像由无线、可穿戴多普勒超声捕获。计算最佳ccFTΔ阈值检测PR、灵敏度、特异性和受试者工作特征曲线下面积（AUC）。采用Pearson相关系数评价ccFTΔ与SVΔ之间的线性相关性。我们还评估了连续平均心动周期数对ccFTΔ准确性的影响。结果本分析纳入30例患者；7例患者在Trendelenburg定位时出现≥10% SVΔ。最佳ccFTΔ阈值为+6.6 ms或2.2%，灵敏度为100%，特异性为70%，auc分别为0.89和0.88。ccFTΔ和SVΔ之间存在很强的线性相关(r = 0.70；P & lt;措施)。当使用1 vs 20个连续平均心动周期时，平均AUC从0.68增加到0.87。体外循环后，通过无线测量ccFTΔ，可穿戴超声在Trendelenburg定位时检测SVΔ，精度高。AUC作为连续平均心动周期的函数而改善。作为预负荷诱导SVΔ的替代品，ccFTΔ可以指导术后的液体治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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