Feasibility evaluation of non-invasive cardiac function technology during echocardiography-based cardiac stress testing
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Evaluation of cardiac function during periods of stress is of key importance for the perioperative setting. Non-invasive hemodynamic monitors provide markers of cardiac function. This pilot study sought to evaluate the ability of a non-invasive hemodynamic monitor to detect cardiac stress during formal stress echocardiography testing. The primary goal was to compare the change in hemodynamic values during the pre/during/post phases of stress echocardiography testing in patients who had results negative versus positive for myocardial ischemia. Adult patients scheduled for outpatient cardiac stress testing were screened. Only patients scheduled for stress-echocardiography testing were consented. Patients with history of arrhythmias were excluded. During the testing, patients wore a cuff-based hemodynamic sensor (Nexfin system, Edwards Lifesciences). Data from the hemodynamic sensor were compared to the findings of the stress study. A total of 37 patients were enrolled, with 31 patients included for analysis. Five patients had stress studies positive for coronary ischemia. Comparison of the hemodynamic variables between patients who had a positive stress study versus negative showed a significant reduction in the percentage change in dP/dt and stroke volume from baseline (p < 0.05). This pilot study indicates that patients who have abnormal stress echocardiograms also have significantly reduced values from a noninvasive hemodynamic monitor. Further evaluation of the clinical utility of this technology, to assist in the care of patients at risk for cardiac ischemia, should be carried out.
KeywordsCardiac stress testing Non-invasive hemodynamic monitoring Preoperative cardiac function evaluation Preoperative testing Preoperative risk-stratification
Briahnna Austin, BS: Department of Anesthesiology & Perioperative Care, Loma Linda University Medical Center. Roll: Biostatistician.
This project was departmentally supported.
Compliance with ethical standards
Conflict of interest
Davinder Ramsingh, MD—Consultant and Funded Research from Edwards Lifesciences, Consultant for Fujifilm Sonosite, Funded research from General Electric on Point of Care Ultrasound and Anesthesia Delivery Systems, Funded research from Merck Pharmaceuticals, Funded research from Pacira Pharmaceuticals, Funded research from Masimo Corporation. Maxime Cannesson, MD, PhD—Ownership interest in Sironis, a company developing closed-loop systems, Consultant and Funded Research from Edwards Lifesciences, Consultant for Masimo Corp, Funded Research from National Institutes of Health: Grant Nos. R01 GM117622 (“Machine Learning of Physiological Variables to Predict Diagnose and Treat Cardiorespiratory Instability”) and R01 NR013912 (“Predicting Patient Instability Noninvasively for Nursing Care-Two [PPINNC-2]”).
- 2.Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215–45.CrossRefGoogle Scholar
- 14.Bruce RA, Blackmon JR, Jones JW, Strait G. Exercising testing in adult normal subjects and cardiac patients. Pediatrics. 1963;32(SUPPL):742–56.Google Scholar
- 16.Grise EM, Adeoye O, Lindsell C, Alwell K, Moomaw C, Kissela B, Woo D, Flaherty M, Ferioli S, Khatri P, Broderick J, Kleindorfer D. Emergency department adherence to American Heart Association guidelines for blood pressure management in acute ischemic stroke. Stroke. 2012;43:557–9.CrossRefGoogle Scholar
- 17.McCormick B, Ottesen RA, Hughes ME, Javid SH, Khan SA, Mortimer J, Niland JC, Weeks JC, Edge SB. Impact of guideline changes on use or omission of radiation in the elderly with early breast cancer: practice patterns at National Comprehensive Cancer Network institutions. J Am Coll Surg. 2014;219:796–802.CrossRefGoogle Scholar