Comparison between radial artery tonometry pulse analyzer and pulsed-Doppler echocardiography derived hemodynamic parameters in cardiac surgery patients: a pilot study

Abstract

BackgroundBedside non-invasive techniques, such as radial artery tonometry, to estimate hemodynamic parameters have gained increased relevance as an attractive alternative and efficient method to measure hemodynamics in outpatient departments. For our pilot study, we sought to compare cardiac output (CO), and stroke volume (SV) estimated from a radial artery tonometry blood pressure pulse analyzer (BPPA) (DMP-Life, DAEYOMEDI Co., Gyeonggi-do, South Korea) to pulsed-wave Doppler (PWD) echocardiography derived parameters.MethodsFrom January 2015 to December 2016, all patients scheduled for coronary artery bypass (CABG) surgery at our department were screened. Exclusion criteria were, inter alia, moderate to severe aortic- or Mitral valve disease and peripheral arterial disease (PAD) > stage II. One hundred and seven patients were included (mean age 66.1 ± 9.9, 15 females, mean BMI 27.2 ± 4.1 kg/m2). All patients had pre-operative transthoracic echocardiography (TTE). We measured the hemodynamic parameters with the BPPA from the radial artery, randomly before or after TTE. For the comparison between the measurement methods we used the Bland-Altman test and Pearson correlation.ResultsMean TTE-CO was 5.1 ± 0.96 L/min, and the mean BPPA-CO was 5.2 ± 0.85 L/min. The Bland-Altman analysis for CO revealed a bias of −0.13 L/min and SD of 0.90 L/min with upper and lower limits of agreement of −1.91 and +1.64 L/min. The correlation of CO measurements between DMP-life and TTE was poor (r = 0.501, p < 0.0001). The mean TTE-SV was 71.3 ± 16.2 mL and the mean BPPA-SV was 73.8 ± 19.2 mL. SV measurements correlated very well between the two methods (r = 0.900, p < 0.0001). The Bland-Altman analysis for SV revealed a bias of −2.54 mL and SD of ±8.42 mL and upper and lower limits of agreement of −19.05 and +13.96 mL, respectively.ConclusionOur study shows for the first time that the DMP-life tonometry device measures SV and CO with reasonable accuracy and precision of agreement compared with TTE in preoperative cardiothoracic surgery patients. Tonometry BPPA are relatively quick and simple measuring devices, which facilitate the collection of cardiac and hemodynamic information. Further studies with a larger number of patients and with repeated measurements are in progress to test the reliability and repeatability of DMP-Life system.

Cardiac output estimation using pulse wave analysis—physiology, algorithms, and technologies: a narrative review

“…68 The DMP-Life system (DAEYOMEDI Co., Ansan, South Korea) uses an array of piezoresistive semiconductor transducer sensors adjusted by an actuator. 69 The T-Line system estimates CO using PWA with a nonlinear mathematical model comprising biometric and demographic data and AP waveform characteristics (SAP, DAP, MAP, PP, beat-to-beat interval, maximal slope within systole, and systolic area). 70 The DMP-Life system estimates CO using a modified Kouchoukos algorithm 71 analysing the systolic part of the AP waveform and considering biometric and demographic data.…”

Radial Artery Tonometry to Monitor Blood Pressure and Hemodynamics in Ambulatory Left Ventricular Assist Device Patients in Comparison With Doppler Ultrasound and Transthoracic Echocardiography: A Pilot Study

“…Other radial pulse tonometry devices do not include an integrated mechanical control system, such as the N‐500 (Nellcor Inc.) and the SphygmoCor (PWV Medical), and require a prior calibration by oscillometric BP measurement to be able to determine arterial compliance or central augmentation index . In contrast, the DMP‐Life system does not need any further calibration by other BP devices, because it includes precise actuating system, which can control the applied pressure value and measure BP directly .…”

“…Another important advantage of our method is the simultaneous measurement of cardiac output and blood pressure using a tonometric sensor .…”

“…The pulse was measured by a radial artery tonometry device DMP‐Life (DAEYOMEDI Co., Ltd.). A bracelet with the pressure sensor cartridge was placed on the patient’s wrist over the radial artery, as previously described (Fig. A).…”

“…When the optimal signal was available, the DMP-Life monitor provided a continuous arterial waveform (Figs. 2 and 3) (19).…”