A novel sphygmomanometer for central venous pressure assessment during stress echocardiography

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf StressEcho 2030 study group Background. Central venous pressure (CVP) is important in the hemodynamic phenotyping of failing heart, and the usual invasive assessment can be surrogated by a sphygmomanometer for venous pressure (SVEN) which has been recently prototyped and validated. Aim To assess the technical success rate and correlates of CVP measurements by SVEN during stress echocardiography (SE) Methods We evaluated 22 consecutive patients (age 66 ±11 years, 15 men, ejection fraction 60 ±6%) referred for clinically-driven dipyridamole (n = 20, for chest pain) or treadmill (n = 2, for dyspnea) SE with ABCDE protocol (score range from 0= all steps normal, to 5= all steps abnormal). Step A assesses regional wall motion abnormalities (RWMA); step B, B-lines (diastolic function); step C, left ventricular contractile reserve based on force; step D, coronary flow velocity reserve (CFVR) in left anterior descending artery; step E, heart rate reserve (HRR). In each patient, the usual setting of echocardiographic, electrocardiographic and arterial blood pressure monitoring was integrated with CVP measurement by SVEN (right arm, contralateral to the arterial sphygmomanometer arm) with personalized cuff sizes. SVEN measurements of CVP were obtained at rest and peak stress. Results. SVEN preparation and automated analysis required < 5 minutes for positioning, inflation-deflation, acquisition and off-line reading for single measurement. SVEN success rate was 22/22 (100%). CVP did not change during SE (rest = 2.4 ± 0.5 vs stress= 3.7 ± 0.8 mmHg, p = 0.106). Resting CVP was correlated inversely to ejection fraction at rest (r=-0.489, p = 0.021) and at peak stress (r=-0.545, p = 0.001), CFVR (r=-0.505, p = 0.023), HRR (r=-0.503, p = 0.017) and directly to RWMA (r = 0.431, p = 0.045), B-lines at peak stress (r= 0.626, p = 0.002) and left atrial volume index at rest (r= 0.552, p =0.012) and at peak stress (r = 0.648, p = 0.002). CVP was significantly higher in patients with B-Lines at peak stress (Figure). ABCDE score was directly related to CVP (r = 0.560, p = 0.007). Conclusion. SVEN assessment is feasible at rest and during stress with extremely high success rate and only minimal increase in preparation and analysis time. Changes observed are consistent with the expected hemodynamic profile, with CVP increase associated with more B-lines (a sign of pulmonary congestion and elevated pulmonary capillary wedge pressure) and larger left atrium (an integrated barometer of left ventricular end-diastolic pressure). Abstract Figure.