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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However, the optimal threshold and accuracy of ccFT<sub>Δ</sub> to detect SV<sub>Δ</sub> are inconsistent in previous reports.</div></div><div><h3>Research Question</h3><div>Does ccFT<sub>Δ</sub> from a wireless, wearable Doppler ultrasound accurately detect a 10% SV<sub>Δ</sub> measured by transesophageal echocardiography?</div></div><div><h3>Study Design and Methods</h3><div>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<sub>Δ</sub>) during Trendelenburg positioning. Synchronous carotid Doppler imaging was captured by a wireless, wearable Doppler ultrasound. The optimal ccFT<sub>Δ</sub> threshold to detect PR, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Linear correlation between ccFT<sub>Δ</sub> and SV<sub>Δ</sub> was assessed by Pearson correlation coefficient. We also evaluated the effect of the number of consecutively averaged cardiac cycles on ccFT<sub>Δ</sub> accuracy.</div></div><div><h3>Results</h3><div>This analysis included 30 patients; 7 patients showed a ≥ 10% SV<sub>Δ</sub> during Trendelenburg positioning. The optimal ccFT<sub>Δ</sub> 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<sub>Δ</sub> and SV<sub>Δ</sub> was found (<em>r</em> = 0.70; <em>P</em> < .001). The mean AUC increased from 0.68 to 0.87 when using 1 vs 20 consecutively averaged cardiac cycles.</div></div><div><h3>Interpretation</h3><div>After cardiopulmonary bypass, ccFT<sub>Δ</sub> measured by wireless, wearable ultrasound detected SV<sub>Δ</sub> during Trendelenburg positioning with high accuracy. The AUC improved as a function of consecutively averaged cardiac cycles. As a surrogate for preload-induced SV<sub>Δ</sub>, ccFT<sub>Δ</sub> can direct fluid therapy in the postoperative period.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100138"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting\",\"authors\":\"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. 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PR was defined as ≥ 10% augmentation in transesophageal echocardiography left ventricular outflow tract velocity time integral (as a surrogate for SV<sub>Δ</sub>) during Trendelenburg positioning. Synchronous carotid Doppler imaging was captured by a wireless, wearable Doppler ultrasound. The optimal ccFT<sub>Δ</sub> threshold to detect PR, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Linear correlation between ccFT<sub>Δ</sub> and SV<sub>Δ</sub> was assessed by Pearson correlation coefficient. We also evaluated the effect of the number of consecutively averaged cardiac cycles on ccFT<sub>Δ</sub> accuracy.</div></div><div><h3>Results</h3><div>This analysis included 30 patients; 7 patients showed a ≥ 10% SV<sub>Δ</sub> during Trendelenburg positioning. The optimal ccFT<sub>Δ</sub> thresholds were +6.6 ms or 2.2% with sensitivities of 100%, specificities of 70%, and AUCs of 0.89 and 0.88, respectively. 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引用次数: 0
摘要
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。
Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting
Background
As a measure of preload responsiveness (PR), change in carotid artery corrected flow time (ccFTΔ) is a surrogate for change in stroke volume (SVΔ). However, the optimal threshold and accuracy of ccFTΔ to detect SVΔ are inconsistent in previous reports.
Research Question
Does ccFTΔ from a wireless, wearable Doppler ultrasound accurately detect a 10% SVΔ 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 SVΔ) during Trendelenburg positioning. Synchronous carotid Doppler imaging was captured by a wireless, wearable Doppler ultrasound. The optimal ccFTΔ threshold to detect PR, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Linear correlation between ccFTΔ and SVΔ was assessed by Pearson correlation coefficient. We also evaluated the effect of the number of consecutively averaged cardiac cycles on ccFTΔ accuracy.
Results
This analysis included 30 patients; 7 patients showed a ≥ 10% SVΔ during Trendelenburg positioning. The optimal ccFTΔ 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 ccFTΔ and SVΔ 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, ccFTΔ measured by wireless, wearable ultrasound detected SVΔ during Trendelenburg positioning with high accuracy. The AUC improved as a function of consecutively averaged cardiac cycles. As a surrogate for preload-induced SVΔ, ccFTΔ can direct fluid therapy in the postoperative period.
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