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Noninvasive Measures of Pulsatility and Blood Pressure During Continuous-Flow Left Ventricular Assist Device Support

Rangasamy, Sabarivinoth*; Madan, Shivank*; Saeed, Omar*; Goldstein, Daniel J.; Jorde, Ulrich P.*; Negassa, Abdissa; Patel, Snehal R.*

doi: 10.1097/MAT.0000000000000805
Adult Circulatory Support
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The reliability and validity of a palpable pulse and other noninvasive measures of pulsatility in patients on continuous-flow (CF) left ventricular assist device (LVAD) support have not been rigorously evaluated. We prospectively enrolled 23 patients who had CF-LVAD and an arterial catheter for blood pressure (BP) monitoring. Pulse pressure (PP) via the arterial line was compared with three noninvasive measures of pulsatility: presence of a palpable pulse, pulsatility index (PI), and aortic valve opening (AVO). In addition, the relationship between Doppler BP (DopBP) and arterial line pressures was evaluated. The study group comprised 30% females, 73% nonischemic cardiomyopathy, 87% axial flow device (HeartMate II [HMII]), and 13% centrifugal flow device (HeartWare ventricular assist device [HVAD]) support. Among four practitioners, the interobserver agreement for the presence of a palpable pulse was moderate (k = 0.41; 95% CI, 0.28–0.60). If the PP was ≥15 mm Hg, a radial pulse was palpated 82% of the time, whereas when the PP was <15 mm Hg, a radial pulse was palpated only 35% of the time. In subjects with a palpable pulse, there was a strong correlation between DopBP and systolic BP (SBP) (r = 0.94; 95% CI, 0.82–0.99), whereas the correlation between DopBP and mean arterial pressure (MAP) was much weaker (r = 0.42; 95% CI, 0.19–0.96). In subjects without a palpable pulse, there was a strong correlation between both the DopBP and SBP (r = 0.94; 95% CI, 0.80–1.0) and DopBP and MAP (r = 0.87; 95% CI, 0.77–1.00). Finally, PP was significantly associated with PI (odds ratio [OR], 0.3; 95% CI, 0.14–0.45; p = 0.0002) but not AVO (OR, 1.41: 95% CI, 0.70–2.83; p = 0.33). The presence of a palpable pulse has good interobserver agreement and allows for dichotomization of the DopBP to reflect the SBP in its presence and the MAP in its absence. This simple measure should be incorporated into BP management algorithms for CF-LVADs. The PI shows a modest correlation to PP.

From the *Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

Department of Epidemiology and Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York.

Submitted for consideration September 2017; accepted for publication in revised form March.

Disclosure: The authors have no conflicts of interest to report.

This study was supported by intramural research funds.

Relationship with industry: Daniel J. Goldstein and Ulrich P. Jorde are nonpaid consultants for Abbott in their roles as National PIs for Abbott Studies.

Correspondence: Snehal R. Patel, Division of Cardiology, Heart Failure, Cardiac Transplantation and Mechanical Circulatory Support, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Medical Arts Pavilion, 7th Floor, Bronx, New York 10467. Email: snepatel@montefiore.org.

Copyright © 2019 by the American Society for Artificial Internal Organs