PS-BPR02-3: NOVEL PULSE WAVEFORM INDEX OBTAINED BY ABPM DEVICE COULD ESTIMATE CARDIAC FUNCTION IN A PATIENT WITH FULMINANT MYOCARDITIS

Abstract

Introduction: In this case report regarding a patient with fulminant myocarditis who underwent mechanical hemodynamic support including extracorporeal membrane oxygenation (ECMO), our developed novel hemodynamic index calculated from pulse waveform obtained by ambulatory blood pressure monitoring (ABPM) device was useful for estimation of the improvement of cardiac function. We obtained volumetric pulse waveform from diastolic phase of BP measurement by our recently developed device, a Multisensor-ABPM device (TM-2441, A&D Co., Tokyo). This pulse waveform is divided into ejection wave and reflex wave. The area of the ejection part is square forward pulse wave (Sf), which is related with cardiac ejection volume. Second, amplitude measured pulse wave (Am) of the pulse waveform is a parameter defined by central artery compliance, peripheral artery properties, and cuff compliance. We then calculated Sf/Am as follows: Sf was divided by Am to eliminate the effect of arterial and cuff compliance from the area of the ejection wave, which would indicate left ventricular ejective function. Case report: A 43-year-old Asian female presented dyspnea and fever and developed cardiogenic shock. She was transferred from the primary hospital to our intensive care unit. Laboratory test and chest x-ray revealed elevated c-reactive protein, creatine kinase MB, and N-terminal-pro-brain natriuretic peptide and pulmonary edema. Electrocardiogram showed an ST-elevation and there was no stenosis in coronary artery on cardiac catheter examination. Based on these findings, she was diagnosed as viral myocarditis. Her echocardiographic left ventricular ejection fraction (LVEF) decreased less than 20% and hemodynamics were disrupted. Then, she was urgently initiated mechanical support including management of ECMO and intraaortic balloon pumping (IABP). During six-days initiating these mechanical supports, her cardiac function was improved, i.e., LVEF was improved from 6% (almost akinesis) to 64%, and she was able to withdraw from ECMO. We prospectively assessed the changes in the cuff waveform index Sf/Am from during the management of ECMO and IABP. The values of Sf/Am increased in parallel with the improved of LVEF (Figure). Conclusion: This case report highlighted that the novel cuff pulse waveform index Sf/Am obtained by the recent our developed Multisensor-ABPM device was useful for estimation of cardiac function in a patient with fulminant myocarditis who had severe cardiac dysfunction and were needed full mechanical support including ECMO. This case indicated that BP measurement device using the cuff-oscillometric method is useful for evaluation of cardiac function even in intensive care settings.