Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points
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...
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Elsevier
2025-06-01
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| Series: | CHEST Critical Care |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949788425000115 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Jon-Emile S. Kenny, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1e2328d79ade4ca68ed0dcaea4cdc370 |
| institution | Kabale University |
| issn | 2949-7884 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | CHEST Critical Care |
| spelling | doaj-art-1e2328d79ade4ca68ed0dcaea4cdc3702025-08-20T03:51:58ZengElsevierCHEST Critical Care2949-78842025-06-013210013810.1016/j.chstcc.2025.100138Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home PointsJon-Emile S. Kenny, MD0Geoffrey Clarke, MEng1Sarah Atwi, PhD2Isabel Kerrebijn, MSc3Tracy Savery, MASc4Meredith Knott, BSN5Chelsea E. Munding, PhD6Mai Elfarnawany, PhD7Andrew M. Eibl, BComm8Joseph K. Eibl, PhD9Bhanu Nalla, MD10Rony Atoui, MD11Department of Clinical Research, Health Sciences North Research Institute Walford Site, Greater Sudbury, ON, Canada; Flosonics Medical, Greater Sudbury and Toronto, ON, Canada; CORRESPONDENCE TO: Jon-Emile S. Kenny, MDDepartment of Clinical Research, Health Sciences North Research Institute Walford Site, Greater Sudbury, ON, Canada; Flosonics Medical, Greater Sudbury and Toronto, ON, CanadaFlosonics Medical, Greater Sudbury and Toronto, ON, CanadaFlosonics Medical, Greater Sudbury and Toronto, ON, CanadaFlosonics Medical, Greater Sudbury and Toronto, ON, CanadaFlosonics Medical, Greater Sudbury and Toronto, ON, CanadaFlosonics Medical, Greater Sudbury and Toronto, ON, CanadaFlosonics Medical, Greater Sudbury and Toronto, ON, CanadaDepartment of Clinical Research, Health Sciences North Research Institute Walford Site, Greater Sudbury, ON, Canada; Flosonics Medical, Greater Sudbury and Toronto, ON, CanadaDepartment of Medical Sciences, NOSM University, Greater Sudbury, ON, Canada; Flosonics Medical, Greater Sudbury and Toronto, ON, CanadaDepartment of Anesthesiology, NOSM University, Greater Sudbury, ON, CanadaDepartment of Cardiac Surgery, NOSM University, Greater Sudbury, ON, CanadaBackground: 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.http://www.sciencedirect.com/science/article/pii/S2949788425000115fluid responsivenessfunctional hemodynamic monitoringtransesophageal echocardiographycarotid artery corrected flow timecarotid Dopplervelocity time integral |
| spellingShingle | 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 Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points CHEST Critical Care fluid responsiveness functional hemodynamic monitoring transesophageal echocardiography carotid artery corrected flow time carotid Doppler velocity time integral |
| title | Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points |
| title_full | Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points |
| title_fullStr | Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points |
| title_full_unstemmed | Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points |
| title_short | Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass GraftingTake-Home Points |
| title_sort | carotid artery corrected flow time measured by wearable doppler ultrasound detects stroke volume change measured by transesophageal echocardiography after coronary artery bypass graftingtake home points |
| topic | fluid responsiveness functional hemodynamic monitoring transesophageal echocardiography carotid artery corrected flow time carotid Doppler velocity time integral |
| url | http://www.sciencedirect.com/science/article/pii/S2949788425000115 |
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