RT Journal Article
SR Electronic
T1 Photoplethysmography using a smartphone application for assessment of ulnar artery patency: a randomized clinical trial
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E380
OP E388
DO 10.1503/cmaj.170432
VO 190
IS 13
A1 Di Santo, Pietro
A1 Harnett, David T.
A1 Simard, Trevor
A1 Ramirez, F. Daniel
A1 Pourdjabbar, Ali
A1 Yousef, Altayyeb
A1 Moreland, Robert
A1 Bernick, Jordan
A1 Wells, George
A1 Dick, Alexander
A1 Le May, Michel
A1 Labinaz, Marino
A1 So, Derek
A1 Motazedian, Pouya
A1 Jung, Richard G.
A1 Chandrasekhar, Jaya
A1 Mehran, Roxana
A1 Chong, Aun-Yeong
A1 Hibbert, Benjamin
YR 2018
UL http://www.cmaj.ca/content/190/13/E380.abstract
AB 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.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.180269