Key result
Critical closing pressure measured by fundamental harmonic Fourier filtering during normal sinus rhythm agreed with the rapid ventricular pacing gold standard (slope 1.05; 95% CI 0.72-1.38).
Why the study?
Critical closing pressure techniques using diffuse correlation spectroscopy had not been assessed in gold standard experiments.
Can critical closing pressure (CrCP) be accurately measured using diffuse correlation spectroscopy (DCS) during normal sinus rhythm compared to rapid ventricular pacing in adults undergoing electrophysiology procedures?
Observational (n=5)
Can critical closing pressure (CrCP) be accurately measured using diffuse correlation spectroscopy (DCS) during normal sinus rhythm compared to rapid ventricular pacing in adults undergoing electrophysiology procedures?
Effect estimate: slope 1.05 (95% CI 0.72 to 1.38)
p-value: p=<0.001
DCS-measured critical closing pressure can be accurately acquired during normal sinus rhythm using fundamental harmonic Fourier filtering, avoiding the need for induced ventricular arrhythmias.
May enable CCP measurement without pacing; leaves open prospective validation before clinical use.
Significance: The critical closing pressure (CrCP) of cerebral circulation, as measured by diffuse correlation spectroscopy (DCS), is a promising biomarker of intracranial hypertension. However, CrCP techniques using DCS have not been assessed in gold standard experiments.Aim: CrCP is typically calculated by examining the variation of cerebral blood flow (CBF) during the cardiac cycle (with normal sinus rhythm). We compare this typical CrCP measurement with a gold standard obtained during the drops in arterial blood pressure (ABP) caused by rapid ventricular pacing (RVP) in patients undergoing invasive electrophysiologic procedures.Approach: Adults receiving electrophysiology procedures with planned ablation were enrolled for DCS CBF monitoring. CrCP was calculated from CBF and ABP data by three methods: (1) linear extrapolation of data during RVP (CrCPRVP; the gold standard); (2) linear extrapolation of data during regular heartbeats (CrCPLinear); and (3) fundamental harmonic Fourier filtering of data during regular heartbeats (CrCPFourier).Results: CBF monitoring was performed prior to and during 55 episodes of RVP in five adults. CrCPRVP and CrCPFourier demonstrated agreement (R = 0.66, slope = 1.05 (95%CI, 0.72 to 1.38). Agreement between CrCPRVP and CrCPLinear was worse; CrCPLinear was 8.2 ± 5.9 mmHg higher than CrCPRVP (mean ± SD; p < 0.001).Conclusions: Our results suggest that DCS-measured CrCP can be accurately acquired during normal sinus rhythm.
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Lafontant et al. (2022) conducted an observational in Patients undergoing invasive electrophysiologic procedures (n=5). DCS-measured critical closing pressure (CrCP) during regular heartbeats vs. CrCP during rapid ventricular pacing (gold standard) was evaluated on Agreement of CrCP measured during regular heartbeats with the gold standard (CrCPRVP) (slope 1.05, 95% CI 0.72 to 1.38, p=<0.001). Critical closing pressure measured by fundamental harmonic Fourier filtering during normal sinus rhythm agreed with the rapid ventricular pacing gold standard (slope 1.05; 95% CI 0.72-1.38).
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