Using pulse oximetry waveforms to detect coarctation of the aorta

• Type of Material: Article
• Authors: Matthew W. Sorensen, Childrens Healthcare Atlanta; Ismail Sadiq, Emory University; Gari Clifford, Emory University; Kevin Maher, Emory University; Matthew Oster, Emory University
• Language: English
• Date: 2020-05-14
• Publisher: BMC Journals
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12938-020-00775-2
• Title of Journal or Parent Work: BioMedical Engineering Online
• Volume: 19
• Issue: 1
• Start Page: 31
• End Page: 31
• Grant/Funding Information: Supported by the Orefice Family Foundation.
• Keywords: Coarctation; Pulse oximetry; Waveform analysis; Science & Technology; Disease; Diagnosis; Engineering; Technology; Critical congenital heart disease screening; Engineering, Biomedical
• Research Categories: Health Sciences, Health Care Management; Engineering, Biomedical

Abstract

Background: Coarctation of the aorta is a common form of critical congenital heart disease that remains challenging to diagnose prior to clinical deterioration. Despite current screening methods, infants with coarctation may present with life-threatening cardiogenic shock requiring urgent hospitalization and intervention. We sought to improve critical congenital heart disease screening by using a novel pulse oximetry waveform analysis, specifically focused on detection of coarctation of the aorta. Methods and results: Over a 2-year period, we obtained pulse oximetry waveform data on 18 neonates with coarctation of the aorta and 18 age-matched controls hospitalized in the cardiac intensive care unit at Children's Healthcare of Atlanta. Patients with coarctation were receiving prostaglandin E1 and had a patent ductus arteriosus. By analyzing discrete features in the waveforms, we identified statistically significant differences in the maximum rate of fall between patients with and without coarctation. This was accentuated when comparing the difference between the upper and lower extremities, with the lower extremities having a shallow slope angle when a coarctation was present (p-value 0.001). Postoperatively, there were still differences in the maximum rate of fall between the repaired coarctation patients and controls; however, these differences normalized when compared with the same individual's upper vs. lower extremities. Coarctation patients compared to themselves (preoperatively and postoperatively), demonstrated waveform differences between upper and lower extremities that were significantly reduced after successful surgery (p-value 0.028). This screening algorithm had an accuracy of detection of 72% with 0.61 sensitivity and 0.94 specificity. Conclusions: We were able to identify specific features in pulse oximetry waveforms that were able to accurately identify patients with coarctation and further demonstrated that these changes normalized after surgical repair. Pulse oximetry screening for congenital heart disease in neonates may thus be improved by including waveform analysis, aiming to identify coarctation of the aorta prior to critical illness. Further large-scale testing is required to validate this screening model among patients in a newborn nursery setting who are low risk for having coarctation.