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Di Santo P, Harnett DT, Simard T, Ramirez FD, Pourdjabbar A, Yousef A, Moreland R, Bernick J, Wells G, Dick A, Le May M, Labinaz M, So D, Motazedian P, Jung RG, Chandrasekhar J, Mehran R, Chong AY, Hibbert B. Photoplethysmography using a smartphone application for assessment of ulnar artery patency: a randomized clinical trial. CMAJ 2019; 190:E380-E388. [PMID: 29615421 DOI: 10.1503/cmaj.170432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Radial artery access is commonly performed for coronary angiography and invasive hemodynamic monitoring. Despite limitations in diagnostic accuracy, the modified Allen test (manual occlusion of radial and ulnar arteries followed by release of the latter and assessment of palmar blush) is used routinely to evaluate the collateral circulation to the hand and, therefore, to determine patient eligibility for radial artery access. We sought to evaluate whether a smartphone application may provide a superior alternative to the modified Allen test. METHODS We compared the modified Allen test with a smartphone heart rate-monitoring application (photoplethysmography readings detected using a smartphone camera lens placed on the patient's index finger) in patients undergoing a planned cardiac catheterization. Test order was randomly assigned in a 1:1 fashion. All patients then underwent conventional plethysmography of the index finger, followed by Doppler ultrasonography of the radial and ulnar arteries (the diagnostic standard). The primary outcome was diagnostic accuracy of the heart rate-monitoring application. RESULTS Among 438 patients who were included in the study, we found that the heart rate-monitoring application had a superior diagnostic accuracy compared with the modified Allen test (91.8% v. 81.7%, p = 0.002), attributable to its greater specificity (93.0% v. 82.8%, p = 0.001). We also found that this application had greater diagnostic accuracy for assessment of radial or ulnar artery patency in the ipsilateral and contralateral wrist (94.0% v. 84.0%, p < 0.001). INTERPRETATION A smartphone application used at the bedside was diagnostically superior to traditional physical examination for confirming ulnar patency before radial artery access. This study highlights the potential for smartphone-based diagnostics to aid in clinical decision-making at the patient's bedside. Trial registration: Clinicaltrials.gov, no. NCT02519491.
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Affiliation(s)
- Pietro Di Santo
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - David T Harnett
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Trevor Simard
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - F Daniel Ramirez
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Ali Pourdjabbar
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Altayyeb Yousef
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Robert Moreland
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Jordan Bernick
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - George Wells
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Alexander Dick
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Michel Le May
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Marino Labinaz
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Derek So
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Pouya Motazedian
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Richard G Jung
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Jaya Chandrasekhar
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Roxana Mehran
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Aun-Yeong Chong
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
| | - Benjamin Hibbert
- Division of Cardiology (Di Santo, Harnett, Simard, Ramirez Pourdjabbar, Youssef, Dick, Le May, Labinaz, So, Chong, Hibbert); CAPITAL Research Group (Di Santo, Harnett, Simard, Ramirez, Youssef, Moreland, Dick, Le May, Labinaz, So, Motazedian, Jung, Chong, Hibbert); Vascular Biology and Experimental Medicine Laboratory (Simard, Jung, Hibbert); Cardiovascular Research Methods Centre (Bernick, Wells), University of Ottawa Heart Institute; Department of Cellular and Molecular Medicine (Simard, Hibbert); Department of Radiology (Moreland); School of Epidemiology, Public Health and Preventive Medicine (Ramirez, Wells), University of Ottawa, Ottawa, Ont.; Division of Cardiovascular Medicine (Pourdjabbar), Sulpizio Cardiovascular Center, University of California, San Diego, CA; Icahn School of Medicine at Mount Sinai ( Chandrasekhar, Mehran), New York, NY
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