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.