A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Elective coronary artery bypass surgery (n=2). Intervention: Wireless wearable carotid Doppler ultrasound patch vs. Trans-esophageal echocardiography (TEE). Primary outcome: Diagnostic accuracy (AUROC) of changing common carotid artery velocity time integral (ccVTIΔ) at detecting a ≥10% change in stroke volume (SVΔ) measured by TEE (AUROC 0.89 (single-beat), 0.91 (3-beat), 0.95 (10-beat)).

Q: What does this research mean for the field?

A wireless wearable carotid Doppler ultrasound accurately detects clinically significant changes in stroke volume compared to trans-esophageal echocardiography, with diagnostic performance improving when averaging multiple consecutive cardiac cycles. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jon‐Émile S. Kenny; Geoffrey D. Clarke; Matt Myers; Mai Elfarnawany; Andrew M. Eibl; Joseph K. Eibl; Bhanu Nalla; Rony Atoui

doi:10.3390/bioengineering8120203

December 8, 2021BioengineeringOpen Access

A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery

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Key result

Wearable carotid Doppler ultrasound accurately detects stroke volume changes vs. TEE with up to ~0.95 AUROC.

AUROC 0.89 (single-beat), 0.91 (3-beat), 0.95 (10-beat)
n=2

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Why the study?

A novel wireless wearable carotid Doppler ultrasound biosensor may serve as a functional hemodynamic monitor, but needed comparison against trans-esophageal echocardiography.

Does a wireless wearable carotid Doppler ultrasound patch accurately detect a ≥10% change in stroke volume compared to trans-esophageal echocardiography in patients undergoing elective coronary artery bypass surgery?

Key Points

To assess the feasibility and accuracy of a wearable wireless carotid Doppler ultrasound patch for detecting clinically significant changes in stroke volume compared to trans-esophageal echocardiography.
Studied two patients (N=2; aged 79 and 81 years, including one with atrial fibrillation) undergoing elective coronary artery bypass surgery.
Synchronously captured carotid Doppler spectra with an adhesive wearable neck sensor and left ventricular outflow tract Doppler via trans-esophageal echocardiography at baseline and during Trendelenburg positioning.
Generated receiver operating characteristic curves across single-beat, 3-consecutive-beat, and 10-consecutive-beat averages to evaluate detection of a ≥ 10% change in stroke volume.
For single-beat analysis (4695 combinations), a common carotid velocity time integral change ≥ 16% detected a ≥ 10% stroke volume change with an AUROC of 0.89 (69% sensitivity, 97% specificity).
For 3-beat averages (4287 combinations), a velocity time integral change ≥ 14% identified stroke volume changes with an AUROC of 0.91 (75% sensitivity, 98% specificity).
For 10-beat averages (2985 combinations), a velocity time integral change ≥ 22% detected stroke volume changes with an AUROC of 0.95 (89% sensitivity, 100% specificity).

Study Design

Type

Observational (n=2)

Multicenter

No

Structured PICO

Does a wireless wearable carotid Doppler ultrasound patch accurately detect a ≥10% change in stroke volume compared to trans-esophageal echocardiography in patients undergoing elective coronary artery bypass surgery?

P

Population

2 older men (aged 79 and 81 years, 1 with atrial fibrillation) undergoing elective coronary artery bypass surgery, monitored for 120 seconds (30 seconds baseline and 90 seconds Trendelenburg positioning).

I

Intervention

Wireless, wearable, continuous-wave 4 MHz Doppler ultrasound patch adhered to the neck over the common carotid artery to measure changing common carotid artery velocity time integral (ccVTIΔ) during a 30-second supine baseline and 90-second 15-degree Trendelenburg maneuver.

C

Comparator

Synchronously-obtained trans-esophageal echocardiography (TEE) using a 2.9 MHz probe in the trans-gastric window measuring left ventricular outflow tract (LVOT) velocity time integral (VTI) as the reference standard for stroke volume change (SVΔ).

O

Outcome

Area under the receiver operator curve (AUROC), sensitivity, and specificity of ccVTIΔ for detecting a clinically significant (+10%) change in stroke volume (SVΔ) measured by LVOT VTI on TEE across single-beat, 3-consecutive beat, and 10-consecutive beat averages.surrogate

Main Result

Effect estimate: AUROC 0.89 (single-beat), 0.91 (3-beat), 0.95 (10-beat)

This proof-of-principle study demonstrates that a hands-free wireless carotid Doppler patch can synchronously track stroke volume changes measured by TEE during cardiac surgery, especially when averaging 10 consecutive heartbeats.

Limitations

Small sample size (2 patients); no definitive clinical conclusions can be drawn.
Neglecting the diameter of the carotid artery precludes measurement of total flow.
Paradigm is limited to functional hemodynamic monitoring restricted to rapid pre-post measurements (60-120 seconds).
Small sample size (n=2) as a proof-of-principle study, precluding definitive clinical conclusions
Omission of carotid artery diameter measurement precludes calculation of total carotid flow
Restricted to rapid pre-post functional hemodynamic monitoring measurements over 60-120 seconds

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Implication

Supports wearable carotid Doppler feasibility for perioperative stroke volume tracking; leaves open prospective validation before clinical adoption.

Abstract

Background: A novel, wireless, ultrasound biosensor that adheres to the neck and measures real-time Doppler of the carotid artery may be a useful functional hemodynamic monitor. A unique experimental set-up during elective coronary artery bypass surgery is described as a means to compare the wearable Doppler to trans-esophageal echocardiography (TEE). Methods: A total of two representative patients were studied at baseline and during Trendelenburg position. Carotid Doppler spectra from the wearable ultrasound and TEE were synchronously captured. Areas under the receiver operator curve (AUROC) were performed to assess the accuracy of changing common carotid artery velocity time integral (ccVTI∆) at detecting a clinically significant change in stroke volume (SV∆). Results: Synchronously measuring and comparing Doppler spectra from the wearable ultrasound and TEE is feasible during Trendelenburg positioning. In two representative cardiac surgical patients, the ccVTI∆ accurately detected a clinically significant SV∆ with AUROCs of 0.89, 0.91, and 0.95 when single-beat, 3-consecutive beat and 10-consecutive beat averages were assessed, respectively. Conclusion: In this proof-of-principle research communication, a wearable Doppler ultrasound system is successfully compared to TEE. Preliminary data suggests that the diagnostic accuracy of carotid Doppler ultrasonography at detecting clinically significant SV∆ is enhanced by averaging more cardiac cycles.

Discussion

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Cite This Study

Kenny et al. (2021) conducted an observational in Elective coronary artery bypass surgery (n=2). Wireless wearable carotid Doppler ultrasound patch vs. Trans-esophageal echocardiography (TEE) was evaluated on Diagnostic accuracy (AUROC) of changing common carotid artery velocity time integral (ccVTIΔ) at detecting a ≥10% change in stroke volume (SVΔ) measured by TEE (AUROC 0.89 (single-beat), 0.91 (3-beat), 0.95 (10-beat)). A wireless wearable carotid Doppler ultrasound detected clinically significant stroke volume changes (≥10%) with AUROCs of 0.89, 0.91, and 0.95 for 1-, 3-, and 10-beat averages compared to TEE.

synapsesocial.com/papers/6a73245864cdd4095c2c1857 https://doi.org/10.3390/bioengineering8120203

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A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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