Cross Troy J, Sajgalik Pavol, Fabian Vratislav, Matera Lukas, Kushwaha Sudhir S, Maltais Simon, Stulak John M, Schirger John A, Johnson Bruce D
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.
Int J Artif Organs. 2020 Feb;43(2):99-108. doi: 10.1177/0391398819868236. Epub 2019 Aug 14.
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'.
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.
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) 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).
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 a given patient across repeated measurements.
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.
长期使用连续流左心室辅助装置可能会对自主神经、心血管和胃肠功能产生负面影响。因此，有人提出，对使用左心室辅助装置的患者进行动脉搏动性的非侵入性监测对于确保患者安全和寿命至关重要。我们开发了一种新颖的、基于频域的半自动动脉搏动性指数，该指数是在上臂收缩期以上闭塞期间获得的：“袖带搏动性指数”。
本研究的目的是评估袖带搏动性指数与使用左心室辅助装置患者经有创测定的动脉搏动性之间的关系。
本研究招募了23例患有终末期心力衰竭的左心室辅助装置患者（6名女性：年龄=65±9岁；体重指数=30.5±3.7 kg/m）。在患者优势侧的上臂进行收缩期以上闭塞，从中获取袖带压力波形。从对侧手臂的桡动脉获取动脉血压。测量重复进行三次。使用相干分析在频域中评估袖带压力与动脉血压波形之间的关系。采用混合效应方法评估袖带搏动性指数与经有创测定的动脉搏动性（即脉压）之间的关系。
袖带压力和动脉血压波形在心脏频率（心率）的五阶谐波之前显示出高度相干性。在给定患者的重复测量中，袖带搏动性指数准确跟踪了动脉脉压的变化。
袖带搏动性指数有望作为一种非侵入性指数，用于长期监测使用左心室辅助装置患者的残余动脉搏动性。
