2023年12月29日金曜日
Assessment of Cardiovascular Parameters during Meditation with Mental Targeting in Varsity Swimmers
Abstract and Figures
. Athletes who develop an immunosuppressed state because of intensive training get upper respiratory infections (URIs) and may respond to meditation. Reflective exercise (RE), a westernized form of Qigong, combines meditation, breathing, and targeted mental attention to an internal pulsatile sensation, previously shown to protect varsity swimmers from URIs during the height of training. We report here the evaluation of cardiovascular parameters measured during meditation combined with targeted imagery (interoception) in a cohort of varsity swimmers taught RE. Methods . Thirteen subjects were enrolled on a prospective protocol that used the CareTaker, a noninvasive cardiovascular monitor before, during, and after RE training. Questionnaires regarding targeted mental imagery focusing on a pulsatile sensation were collected. The cardiovascular parameters include heart rate, blood pressure, and heart rate variability (HRV). Results . Increased variance in the subjects’ BP and HRV was observed over the training period of 8 weeks. In nine subjects there was an increased low frequency (LF) HRV that was significantly ( p < 0.05 ) associated with the subject’s awareness of the pulsatile sensation that makes up a basic part of the RE practice. Summary . These data support further evaluation of HRV measurements in subjects while meditating with mental imagery. This direction could contribute to better understanding of neurocardiac mechanisms that relate meditation to enhanced immunity.
Velocity/Pressure Response Curve Characterization of the Arterial Path of the P3 Iliac Reflection During Hemorrhage Simulation
Abstract and Figures
A new approach to tracking blood pressure, and pulse pressure specifically is presented that is based on a new form of pulse pressure wave analysis called Pulse Decomposition Analysis (PDA). The premise of the PDA model is that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses, the first of which is due to the left ventricular ejection from the heart while the remaining component pressure pulses are reflections and re-reflections that originate from only two reflection sites within the central arteries. The hypothesis examined here is that the PDA parameter T13, the timing delay between the first and third component pulses, correlates with pulse pressure. Furthermore the comparison of experimental and model predictions provides insight into the pressure/velocity responses of the different arterial segments that the iliac reflection pulse (P3) traverses.
Blood Pressure Variability: Prognostic Value and Therapeutic Implications
Abstract
Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs.
Continuous Non-invasive finger cuff CareTaker® comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery
Abstract
Background
Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060–2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTaker® (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis.
Methods
A convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created.
Continuous Noninvasive Blood Pressure Monitoring of Beat-By-Beat Blood Pressure and Heart Rate Using Caretaker Compared With Invasive Arterial Catheter in the Intensive Care Unit
Abstract
Objective: To examine the accuracy of noninvasively-derived peripheral arterial blood pressure (BP) by the Caretaker device (CT) against invasively measured arterial BP and the fidelity of heart rate variability by CT compared with electrocardiogram (ECG)-derived data.
Design: Prospective cohort study.
Participants: Adult surgical and trauma patients admitted to the intensive care unit.
Setting: Academic tertiary care medical center.
Interventions: In a prospective manner, beat-by-beat BP by CT was recorded simultaneously with invasive arterial BP measured in patients in the intensive care unit. Invasive arterial BPs were compared with those obtained by the CT system. All comparisons among the CT data, arterial catheter data, and ECG data were postprocessed.
Measurements and main results: From 37 enrolled patients, 34 were included with satisfactory data that overlapped between arterial catheter and CT. A total of 87,757 comparative data points were obtained for the 40-minute time window comparisons of the 34 patients, spanning approximately 22.5 hours in total. Systolic BP and diastolic BP correlations (Pearson coefficient), as well as the mean difference (standard deviation), were 0.92 and -0.36 (7.57) mmHg and 0.83 and -2.11 (6.00) mmHg, respectively. The overall interbeat correlation was 0.99, with the mean difference between interbeats obtained with the arterial BP and the CT of -0.056 ms (6.0).
Conclusions: This study validated the noninvasive tracking of BP using the CT device, and the pulse decomposition analysis approach is possible within the guidelines of the standard.
Validation of the Next-Generation Caretaker Continuous Physiological Monitor Using Invasive Intra-Arterial Pressures in Abdominal Surgery Patients
Abstract
Introduction
The reliable detection and, ultimately, prediction of hypotensive events in post-operative settings remains an unsolved problem, as patients are currently only monitored intermittently because of the lack of validated, non-invasive/non-intrusive and continuous physiological monitoring technologies.
With this goal in mind, the aim of this study was to validate a next-generation platform version of the currently FDA-cleared non-invasive Caretaker (CT) physiological monitor in the hemodynamically challenging environment of abdominal surgeries in comparison with blood pressures obtained from arterial catheters, evaluated against ANSI/AAMI/ISO 81060–2:2019 standards as well as against current non-invasive standard of care measurements provided by clinical-grade automatic oscillometric cuffs.
Methods
Comparison data from 41 major abdominal surgery patients at Cooper Hospital (Camden NJ) were analyzed in this IRB approved study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral middle finger. Systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared using Pearson correlation coefficients and Bland-Altman analysis. In addition, a trend analysis using 4Q plots was performed. Both the CT’s continuous BP tracking and the CT’s self-calibration capability were analyzed.
Results
The continuous data comparisons were performed with and without taking the CT recalibrations into account. With the recalibrations the mean differences and standard deviations (STDs) for systole and diastole were, respectively, -1.14 mmHg (13.82 mmHg) and -2.49 mmHg (9.42 mmHg), while the correlations were 0.80 and 0.78. Mean differences and STDs for an initial calibration and no subsequent recalibrations were, respectively for systole and diastole, -0.42 mmHg (16.73 mmHg) and -2.57 mmHg (10.36 mmHg), while the correlations were 0.64 and 0.67. For the CT’s self-calibrations alone, correlations for systole and diastole were, respectively, 0.83 and 0.75, while corresponding mean differences (STD) were -3.19 mmHg (10.86 mmHg) and -2.41 mmHg (8.18 mmHg). For 41% of total surgery time, both systole and diastole were within 8 mmHg of the arterial catheter Gold Standard. The concordances for systolic and diastolic blood pressure changes on a 30-second time scale were 0.87 and 0.86. The same comparison analysis for the automatic cuff and the arterial catheter data yielded: correlations for systole and diastole: 0.69 and 0.61, mean differences and STDs: 2.48 mmHg (15.82 mmHg) and 0.65 mmHg (10.68 mmHg).
Tracking of the beat-to-beat blood pressure changes by the Caretaker physiological monitor against invasive central aortic measurement
Objective: There is an unmet need for noninvasive continuous blood pressure (BP) monitoring technologies in various clinical settings. Continuous and noninvasive central aortic BP monitoring is technically not feasible currently, but if realized, would provide more accurate and real-time global hemodynamic information than any form of peripheral arterial BP monitoring in an acute care setting. As part of our efforts to develop such, herein we examined the tracking correlation between noninvasively-derived peripheral arterial BP by Caretaker device against invasively measured central aortic BP.
Methods: Beat-to-beat BP by Caretaker was recorded simultaneously with central aortic BP measured in patients undergoing cardiac catheterization. Pearson's correlation was also derived for SBP and DBP. A trend comparison analysis of the beat-to-beat BP change was performed using a four-quadrant plot analysis with the exclusion zones of 0.5 mmHg/s to determine concordance, (i.e. the direction of beat-to-beat changes in SBP and DBP).
Results: A total of 47 patients were included in the study. A total of 31 369 beats representing an average of 17.3 min of recording were used for analysis. The trend analysis yielded concordances of 84.4 and 83.5% for SBP and DBP, respectively. Respective correlations (Pearson's r) for SBP and DBP trends were 0.87 and 0.86 (P < 0.01). Tracking of beat-to-beat BP by Caretaker showed excellent concordance and correlation in the direction and the degree of BP change with central aortic BP, respectively.
Ambulatory monitoring of central arterial pressure, wave reflections, and arterial stiffness in patients at cardiovascular risk
This paper reviews current 24 h ambulatory noninvasive technologies for pulse wave analysis (PWA) providing central arterial pressure, pulse wave velocity, and augmentation index and the scientific evidence supporting their use in the clinical management of patients with arterial hypertension or at risk for cardiovascular complications.
The most outstanding value of these techniques lies in the fact that they are user-friendly, mostly operator independent, and enable the evaluation of vascular function during daily-life conditions, allowing to obtain repeated measurements in different out-of-office circumstances, less artificial than those of the laboratory or doctor’s office.
Studies performed so far suggest that 24 h PWA may represent a potentially promising tool for evaluating vascular function, structure, and damage in daily-life conditions and promoting early screening in subjects at risk. The current evidence in favor of such an approach in the clinical practice is still limited and does not recommend its routine use. In particular, at the moment, there is a shortage of long-term prognostic studies able to support the predictive value of 24 h PWA. Finally, the accuracy of the measures is strongly dependent on the type of technology and device employed with lack of interoperability among the devices that deeply affects comparability of results among studies using different technologies. It is thus mandatory in the near future to promote proper validation studies, for instance using the ARTERY protocol, and to plan well-designed long-term longitudinal studies that may prove the accuracy and high predictive value of PWA in ambulatory conditions.
Evaluation of pulse wave velocity for predicting major adverse cardiovascular events in post-infarcted patients; comparison of oscillometric and MRI methods
Increased aortic pulse wave velocity (PWV) has been proved as a strong predictor of major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI). Due to the various technical approaches the level of high PWV values show significant differences. We evaluated the cut-off PWV values for MACE prediction using cardiac magnetic resonance imaging (CMR) and oscillometric methods for validating the prognostic value of high PWV in post-infarcted patients. Phase contrast imaging (PCI) and oscillometric based Arteriograph (AG) were compared in this 6 years follow-up study, including 75 consecutive patients of whom 49 suffered previous ST-elevation myocardial infarction (STEMI). Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. An acceptable agreement and significant correlation (rho: 0.332, p
<
0.01) was found between AG and CMR derived PWV values. The absolute values, however, were significantly higher for AG (median (IQR): 10.4 (9.2–11.9) vs 6.44 (5.64–7.5) m/s; p
<
0.001). Totally 51 MACE events occurred during the 6 years follow-up period in post-infarcted patients. Kaplan-Meier analysis in both methods showed significantly lower event-free survival in case of high PWV (CMR:
>
6.47 m/s, AG:
>
9.625 m/s, p
<
0.001, respectively). Multivariate Cox regression revealed PWV as a predictor of MACE (PWV CMR hazard ratio (HR): 1.31 (CI: 1.1–1.7), PWV AG HR: 1.24 (CI: 1.0–1.5), p
<
0.05, respectively). Increased PWV derived by AG and CMR methods are feasible for MACE prediction in post-infarcted patients. However, adjusted cut-off values of PWV are recommended for different techniques to improve individual risk stratification.
Updated and revised normal values of aortic pulse wave velocity in children and adolescents aged 3–18 years
Measurement of aortic pulse wave velocity (PWVao) is recommended for stratifying individual cardiovascular (CV) risk in adults. Diseases in children and adolescents might influence aortic stiffness. It is necessary to exclude overweight (OW), obese (O) subjects, and individuals with increased systolic (SBP) and/or diastolic blood pressure (DBP) from the population, when creating normal values of PWVao in children and adolescents. Body mass index (BMI), SBP/DBP cut-off values have remarkably changed in this population during the last decade. Aims of our study were to expand our previously published PWVao database and to revise it by using the recently determined normal values. PWVao was measured by an occlusive-oscillometric device (Arteriograph, TensioMed Ltd, Budapest, Hungary) in a healthy population aged 3–18 years. 7940 (4374 boys) participants were recruited, 1912 OW/O subjects and 1368 individuals with high SBP/DBP were excluded. Finally, n = 4690 (2599 boys) participants were enrolled. Mean PWVao values increased from 5.4 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in boys and from 5.5 ± 0.6 to 6.4 ± 0.5 m/s (p < 0.05) in girls. Mean PWVao values were significantly lower in our new study, in boys in age groups of 9–16, in girls in age groups of 11–17. This is the largest and widest age-ranged database of PWVao published to date. Due to the change of BMI and SBP/DBP reference values during the last decade, the “old” database of PWVao needed to be revised. As a result of this, normal values of PWVao decreased significantly in both sex
Hyperuricemia Prediction Using Photoplethysmogram and Arteriograph
Hyperuricemia Prediction Using Photoplethysmogram and Arteriograph
January 2022Computers, Materials and Continua 71(1):287-304
DOI:10.32604/cmc.2022.021987
Authors:
H.A. Hamid
Nazrul Anuar Nayan
Universiti Kebangsaan Malaysia
Mohd Zubir Suboh
Universiti Kebangsaan Malaysia
Hyperuricemia is an alarming issue that contributes to cardiovascular disease.
Uric acid (UA) level was proven to be related to pulse wave velocity,
a marker of arterial stiffness. A hyperuricemia prediction method utilizing
photoplethysmogram (PPG) and arteriograph by using machine learning (ML) is proposed.
From the literature search, there is no available papers found
that relates PPG with UA level even though PPG is highly associated with vessel condition.
The five phases in this research are data collection, signal preprocessing
including denoising and signal quality indexes, features extraction
for PPG and SDPPG waveform, statistical analysis for feature selection and
classification of UA levels usingML. Adding PPG to the current arteriograph
able to reduce cost and increase the prediction performance.
PPG and arteriograph data were measured from 113 subjects, and
226 sets of data were collected from the left and right hands of the subjects.
The performance of four types of ML, namely, artificial neural network (ANN),
linear discriminant analysis (LDA), k-nearest neighbor (kNN), and
support vector machine (SVM) in predicting hyperuricemia was compared.
From the total of 98 features extracted, 16 features of which showed
statistical significance for hyper and normouricemia.
ANN gives the best performance compared to the other three ML techniques
with 91.67%, 95.45%, and 94.12% for sensitivity, specificity, and accuracy,
respectively. Features from PPG and arteriograph able to be used to predict hyperuricemia
accurately and noninvasively. This study is the first to find the relationship
of PPG with hyperuricemia. It shows a significant relation between PPG signals and
arteriograph data toward the UA level. The proposed method of UA prediction shows
its potential for noninvasive preliminary assessment.
Evaluation of pulse wave velocity for predicting major adverse cardiovascular events in post-infarcted patients; comparison of oscillometric and MRI methods
Evaluation of pulse wave velocity for predicting major adverse cardiovascular
events in post-infarcted patients; comparison of oscillometric and MRI methods
Zsofia Meiszterics1, Tamas Simor1, Rob J. van der Geest2, Nelli Farkas3, Balazs Gaszner1,*
Show Less
1 Heart Institute, Medical School, University of Pecs, 7624 Pecs, Hungary
2 Radiology Department, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
3 Institute of Bioanalysis, Medical School, University of Pecs, 7624 Pecs, Hungary
*Correspondence: gaszner.balazs@pte.hu (Balazs Gaszner)
Academic Editor: Hack-Lyoung Kim
Rev. Cardiovasc. Med. 2021, 22(4), 1701–1710; https://doi.org/10.31083/j.rcm2204178
Submitted: 3 September 2021 | Revised: 29 October 2021 | Accepted: 11 November 2021
| Published: 22 December 2021
(This article belongs to the Special Issue Arterial Stiffness in Cardiovascular Disease)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license
(https://creativecommons.org/licenses/by/4.0/).
Download PDF Brower Figures Cite
Abstract
Increased aortic pulse wave velocity (PWV) has been proved as a strong predictor
of major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI).
Due to the various technical approaches the level of high PWV values
show significant differences. We evaluated the cut-off PWV values
for MACE prediction using cardiac magnetic resonance imaging (CMR) and
oscillometric methods for validating the prognostic value of high PWV
in post-infarcted patients. Phase contrast imaging (PCI) and oscillometric based
Arteriograph (AG) were compared in this 6 years follow-up study,
including 75 consecutive patients of whom 49 suffered previous ST-elevation
myocardial infarction (STEMI). Patients received follow-up
for MACE comprising all-cause death, non-fatal MI, ischemic stroke,
hospitalization for heart failure and coronary revascularization.
An acceptable agreement and significant correlation (rho: 0.332, p
<
0.01) was found between AG and CMR derived PWV values.
The absolute values, however, were significantly higher for AG (median (IQR)
: 10.4 (9.2–11.9) vs 6.44 (5.64–7.5) m/s; p
<
0.001). Totally 51 MACE events occurred during the 6 years follow-up period
in post-infarcted patients. Kaplan-Meier analysis in both methods showed significantly
lower event-free survival in case of high PWV (CMR:
Aortic Pulse Wave Velocity Measured by Occlusive, Suprasystolic, Oscillometric Method (Arteriograph) Independently Predicts all Cause Mortality
Artery Research
Volume 25, Issue Supplement 1, December 2019, Pages S32 - S32
4.3 Aortic Pulse Wave Velocity Measured by Occlusive, Suprasystolic,
Oscillometric Method (Arteriograph) Independently Predicts all Cause Mortality
Authors
Miklos Illyes*
Heart Institute, Faculty of Medicine, University of Pécs, Pécs Hungary
Available Online 15 February 2020.
DOI
10.2991/artres.k.191224.024How to use a DOI?
Abstract
Introduction: It has been long debated whether Arteriograph predicts cardiovascular events
and/or all cause mortality, despite that its prognostic value has been proven
in systolic heart failure and in myocardial infarction already. However,
no data were available about the prognostic value of this method in general population.
Materials and Methods: Altogether 4146 subjects in the age range of 35–75 years
(mean age 53.2 ± 9.2 years, male/female 2042/2104, SBP/DBP 136.5/82.1 ± 20.1/11.3 mmHg,
treated hypertension 47.6%, treated diabetes 8.5%, total se-cholesterol 5.2 mmol/l)
were measured in multiple centers in Hungary. Subjects visited
the outpatient centers on their own initiative. Information on registered hospitalization events,
mortality and medical treatment was provided by the Hungarian National Health Insurance Fund (HNHIF).
For privacy protection reasons the data were managed and analyzed by the HNHIF.
The PWVao measurements were performed by an invasively validated occlusive, suprasystolic,
oscillometric method (Arteriograph).
Results: The mean follow-up was 5.5 years. 116 all-cause mortality events were observed.
By univariate analysis 1 m/s increase in PWVao resulted HR 1.71 (1.47–1.98; 95% CI).
In multivariate Cox analysis Aortic PWV independently predicted (p = 0.002)
the all-cause mortality in the final model of multivariate analysis (1.34 [1.12–1.62])
adjusted for age, gender, mean arterial pressure, pulse pressure, ejection duration
and antiplatelet drug treatment. Body mass index, smoking, heart rate, blood pressure,
augmentation index, diabetes, and cardiovascular drug therapy were all accounted for.
Conclusion: The PWVao, measured by an easy-of-use, user independent, oscillometric method
in a large population, proved to be a strong, independent predictor of all-cause mortality.
Ambulatory arterial stiffness in chronic kidney disease: a methodological review
nature hypertension research review article
Ambulatory arterial stiffness in chronic kidney disease: a methodological review
Download PDF
Published: 03 December 2015
Ambulatory arterial stiffness in chronic kidney disease: a methodological review
Andrea László, György Reusz & János Nemcsik
Hypertension Research volume 39, pages192–198 (2016)Cite this article
803 Accesses 24 Citations 7 Altmetric Metricsdetails
Abstract
Cardiovascular mortality is the leading cause of death in chronic kidney disease
(CKD) and end-stage renal disease (ESRD). This can be explained in part
by an increased and progressive calcification of the medial layer of
the large arteries leading to arterial stiffening. The prognostic value
of measurements of arterial stiffness, especially pulse wave velocity (PWV),
in the general population and in CKD and ESRD patients is high,
and is above that of traditional risk factors with respect to cardiovascular outcome.
In recent years, as an alternative to office measurements,
methods for monitoring ambulatory arterial stiffness have been developed.
The ambulatory arterial stiffness index (AASI) allows derivation of
a parameter from ambulatory blood pressure measurements; however,
doubts have emerged about the usefulness of this parameter.
Recently, new oscillometric methodologies using simple brachial cuffs,
such as Mobil-O-Graph, Vasotens or Arteriograph 24, have been introduced.
They measure parameters of 24-h arterial stiffness including PWV,
augmentation index and central blood pressure.
This enables study of the 24-h variability of these parameters,
which will hopefully lead to better cardiovascular risk stratification and
improved cardiovascular outcomes of patients.
Our review summarizes the present data and future directions of AASI and
the methods for monitoring oscillometric 24-h stiffness
in different patient populations and especially in CKD.
Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes
Arterial Stiffness Predicts Mortality in Individuals With Type 1 Diabetes
Tynjälä, Anniina
2020-09
Tynjälä , A , Forsblom , C , Harjutsalo , V , Groop , P-H & Gordin , D 2020 , ' Arterial
Stiffness Predicts Mortality in Individuals With Type 1 Diabetes ' , Diabetes Care , vol. 43 ,
no. 9 , pp. 2266-2271 . https://doi.org/10.2337/dc20-0078
http://hdl.handle.net/10138/320487
https://doi.org/10.2337/dc20-0078
acceptedVersion
Downloaded from Helda, University of Helsinki institutional repository.
This is an electronic reprint of the original article.
This reprint may differ from the original in pagination and typographic detai
Invasive validation of arteriograph estimates of central blood pressure in patients with type 2 diabetes
Invasive validation of arteriograph estimates of central blood pressure in patients with type 2 diabetes
Niklas Blach Rossen 1, Esben Laugesen, Christian Daugaard Peters, Eva Ebbehøj, Søren Tang Knudsen,
Per Løgstrup Poulsen, Hans Erik Bøtker, Klavs Würgler Hansen
Affiliations expand
PMID: 23996499 DOI: 10.1093/ajh/hpt162
Abstract
Background: Central blood pressure (BP) has attracted increasing interest because of
a potential superiority over brachial BP in predicting cardiovascular morbidity and mortality.
Several devices estimating central BP noninvasively are now available.
The aim of our study was to determine the validity of the Arteriograph,
a brachial cuff-based, oscillometric device, in patients with type 2 diabetes.
Methods: We measured central BP invasively and compared it
with the Arteriograph-estimated values in 22 type 2 diabetic patients referred
to elective coronary angiography.
Results: The difference (invasively measured BP minus
Arteriograph-estimated BP) in central systolic BP (SBP)
was 4.4±8.7 mm Hg (P = 0.03). The limits of agreement were ±17.1 mm Hg.
Conclusions: Compared with invasively measured central SBP,
we found a systematic underestimation by the Arteriograph.
However, the limits of agreement were similar to the previous Arteriograph validation study
and to the invasive validation studies of other brachial cuff-based,
oscillometric devices. A limitation in our study was the large number of patients
(n = 14 of 36) in which the Arteriograph was unable to analyze the pressure curves.
In a research setting, the Arteriograph seems applicable in patients with type 2 diabetes.
Arteriograph
The Arteriograph applies a brachial cuff-based, oscillometric method for the estimation of aortic pulse wave velocity,
aortic augmentation index, and central (aortic) BPs. In a 2-minute sequential procedure,
the Arteriograph initially measures brachial BP. Immediately after, the BP cuff is first inflated to diastolic
and then suprasystolic BP
(brachial SBP + 35mm Hg), creating a stop-flow condition in the brachial artery.
In this suprasystolic phase (duration of 8 seconds), the conduit arteries (subclavian, axillary,
and brachial arteries) transfer changes in central pressure, and a high-fidelity sensor records the oscillations
from the brachial artery. The Arteriograph software determines the parameters by analysis of the pressure curves obtained
during the suprasystolic phase. Aortic augmentation index is calculated from the brachial augmentation index
and a previously published regression equation, obtained from the validation study.12 Central SBP is calculated
from a proprietary algorithm. DBP is assumed to be equal centrally and peripherally, and brachial MAP
is calculated as DBP + 1/3(SBP − DBP).
The Arteriograph used in our project was the Medexpert Arteriograph Bluetooth (TL2) with software version 3.0.0.0
(updated 11 September 2012). The Arteriograph software suggests cuff size based on arm circumference.
Recommended bladder dimensions are 6×18cm, 8×26cm, and 8×34cm for arm circumference range of
18–25cm, 26–33cm, and 34–43cm, respectively.
2023年12月28日木曜日
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