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Blood pressure changes during routine transthoracic echocardiography
Mazhar Kadwalwala1, Brian Downey1, Ayan Patel1
1Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Insights
Blood pressure (BP) drops significantly during transthoracic echocardiography (TTE). This variability means a single BP reading may not accurately assess afterload for valvular heart disease diagnosis.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Increased afterload impacts flow-dependent metrics in transthoracic echocardiography (TTE), particularly for valvular heart disease evaluation.
- A single blood pressure (BP) measurement may not accurately represent the afterload during TTE imaging.
- Assessing BP changes during TTE is crucial for accurate interpretation of flow-dependent assessments.
Purpose of the Study:
- To evaluate the magnitude of blood pressure changes at discrete timepoints during routine transthoracic echocardiography.
- To determine if a single BP measurement accurately reflects the afterload during TTE.
- To investigate the implications of BP variability on valvular heart disease assessment.
Main Methods:
- Prospective study design.
- Automated BP measurements taken at 10-minute intervals during clinically indicated TTE.
- Inclusion of 50 participants (66% male, mean age 64 years).
Main Results:
- 80% of participants experienced a >10 mmHg drop in systolic BP within 10 minutes.
- Significant decreases observed in both systolic (mean 20.0 ± 12.8 mmHg) and diastolic BP (mean 15.7 ± 13.2 mmHg) at 10 minutes (P < 0.05).
- Systolic BP remained significantly different from baseline throughout the study duration.
Conclusions:
- Blood pressure recorded immediately before TTE is not a reliable indicator of afterload during the procedure.
- BP variability during TTE can lead to under- or over-estimation of valvular heart disease severity.
- Current TTE imaging protocols relying on flow-dependent metrics may require adjustments to account for intra-study BP fluctuations.
Background:
Increased afterload affects many of the flow dependent metrics assessed during transthoracic echocardiography (TTE) especially in the evaluation valvular disease. A single timepoint blood pressure (BP) may not accurately reflect the afterload present at the time of flow-dependent imaging and quantification. We assessed the magnitude of change in BP at discrete timepoints during routine TTE.
Method:
We conducted a prospective study where participants underwent automated BP measurement while undergoing a clinically indicated TTE. The first reading was obtained right after the patient lay supine and subsequent readings were taken at 10-min intervals during image acquisition.
Result:
We included 50 participants (66% were male, with a mean age of 64 years). After 10 min, 40 (80%) participants had a drop in systolic BP of >10 mmHg. Compared to the baseline, there was a significant drop in systolic BP (mean decrease 20.0 ± 12.8 mmHg; P < 0.05), and diastolic BP (mean decrease 15.7 ± 13.2 mmHg; P < 0.05) at 10 min. The systolic BP remained different from the baseline value throughout the duration of the study (average decrease from baseline to study end was 12.4 ± 16.0 mmHg, p < 0.05).
Conclusion:
BP recorded just prior to TTE does not accurately reflect the afterload present during most of the study. This finding has important implications for valvular heart disease imaging protocols that incorporate flow dependent metrics, where the presence or absence of hypertension may lead to under- or over-estimation of disease severity.
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