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Fukuie M, Yamabe T, Kimura R, Zhu DC, Ohyama-Byun K, Maeda S, Sugawara J, Tarumi T. Ascending aortic impedance in young endurance athletes: a time-resolved phase-contrast MRI study. J Appl Physiol (1985) 2024; 136:555-566. [PMID: 38234292 DOI: 10.1152/japplphysiol.00184.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
Ventricular-vascular coupling in endurance athletes remains incompletely understood. The purpose of this study was to determine the ascending aortic impedance in endurance athletes and explore its associations with traditional cardiovascular measurements. In 15 young male endurance runners and 19 young healthy men, time-resolved (CINE) two-dimensional (2-D) phase-contrast MRI quantified the ascending aortic flow while the pressure waveform was simultaneously collected via a generalized transfer function. The aortic impedance modulus and phase were calculated in the frequency domain while characteristic impedance (ZcF) was calculated by averaging moduli between the 4th and 8th heart rate (HR) harmonics. Stroke volume (SV), left ventricular (LV) morphometry, double product, aortic compliance, and total peripheral resistance (TPR) were also measured. Endurance athletes had higher SV, slower HR, greater LV end-diastolic volume and mass, and lower double product than sedentary participants (all P < 0.05). ZcF was significantly lower in athletes than in sedentary participants (73.3 ± 19.2 vs. 93.4 ± 19.0 dyn·s/cm5, P = 0.005). Furthermore, ZcF was negatively correlated with SV (r = -0.691) and aortic compliance (r = -0.601) but was positively correlated with double product (r = 0.445) and TPR (r = 0.458; all P < 0.05). Multivariate analysis revealed that ZcF was the strongest predictor of SV followed by TPR and HR (adjusted R2 = 0.788, P < 0.001). Therefore, our findings collectively suggest that LV afterload quantified by aortic ZcF is significantly lower in endurance athletes than in sedentary adults. The lower pulsatile LV afterload may contribute to greater SV in endurance athletes.NEW & NOTEWORTHY This is the first study to investigate aortic impedance with the noninvasive, simultaneous recordings of aortic pressure using SphygmoCor XCEL and flow using phase-contrast MRI. We found that the characteristic impedance (Zc) is significantly lower in endurance athletes than sedentary adults, is the strongest predictor of stroke volume (SV), and is inversely associated with aortic compliance. These findings suggest that aortic impedance is a key determinant of the ventricular-vascular coupling adapted to long-term training in endurance athletes.
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Affiliation(s)
- Marina Fukuie
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Yamabe
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ryota Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, United States
| | - Keigo Ohyama-Byun
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Seiji Maeda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
- Sports Physiology, School of Sport Sciences, The University of Waseda, Saitama, Japan
| | - Jun Sugawara
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takashi Tarumi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
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Gbaoui L, Hoeschen C, Kaniusas E, Khatib S, Gretschel S, Wellnhofer E. Estimation of central blood pressure waveform from femoral blood pressure waveform by blind sources separation. Front Cardiovasc Med 2023; 10:1280899. [PMID: 38045918 PMCID: PMC10690369 DOI: 10.3389/fcvm.2023.1280899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Background Central blood pressure (cBP) is a better indicator of cardiovascular morbidity and mortality than peripheral BP (pBP). However, direct cBP measurement requires invasive techniques and indirect cBP measurement is based on rigid and empirical transfer functions applied to pBP. Thus, development of a personalized and well-validated method for non-invasive derivation of cBP from pBP is necessary to facilitate the clinical routine. The purpose of the present study was to develop a novel blind source separation tool to separate a single recording of pBP into their pressure waveforms composing its dynamics, to identify the compounds that lead to pressure waveform distortion at the periphery, and to estimate the cBP. The approach is patient-specific and extracts the underlying blind pressure waveforms in pBP without additional brachial cuff calibration or any a priori assumption on the arterial model. Methods The intra-arterial femoral BPfe and intra-aortic pressure BPao were anonymized digital recordings from previous routine cardiac catheterizations of eight patients at the German Heart Centre Berlin. The underlying pressure waveforms in BPfe were extracted by the single-channel independent component analysis (SCICA). The accuracy of the SCICA model to estimate the whole cBP waveform was evaluated by the mean absolute error (MAE), the root mean square error (RMSE), the relative RMSE (RRMSE), and the intraclass correlation coefficient (ICC). The agreement between the intra-aortic and estimated parameters including systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and pulse pressure (PP) was evaluated by the regression and Bland-Altman analyses. Results The SCICA tool estimated the cBP waveform non-invasively from the intra-arterial BPfe with an MAE of 0.159 ± 1.629, an RMSE of 5.153 ± 0.957 mmHg, an RRMSE of 5.424 ± 1.304%, and an ICC of 0.94, as well as two waveforms contributing to morphological distortion at the femoral artery. The regression analysis showed a strong linear trend between the estimated and intra-aortic SBP, DBP, MAP, and PP with high coefficient of determination R2 of 0.98, 0.99, 0.99, and 0.97 respectively. The Bland-Altman plots demonstrated good agreement between estimated and intra-aortic parameters with a mean error and a standard deviation of difference of -0.54 ± 2.42 mmHg [95% confidence interval (CI): -5.28 to 4.20] for SBP, -1.97 ± 1.62 mmHg (95% CI: -5.14 to 1.20) for DBP, -1.49 ± 1.40 mmHg (95% CI: -4.25 to 1.26) for MAP, and 1.43 ± 2.79 mmHg (95% CI: -4.03 to 6.90) for PP. Conclusions The SCICA approach is a powerful tool that identifies sources contributing to morphological distortion at peripheral arteries and estimates cBP.
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Affiliation(s)
- Laila Gbaoui
- Chair of Medical System Technology, Institute for Medical Instrumentation, Otto von Guericke University, Magdeburg, Germany
| | - Christoph Hoeschen
- Chair of Medical System Technology, Institute for Medical Instrumentation, Otto von Guericke University, Magdeburg, Germany
| | - Eugenijus Kaniusas
- Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
| | - Saher Khatib
- Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital of Ruppin-Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Fontane, Neuruppin, Germany
| | - Stephan Gretschel
- Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital of Ruppin-Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Fontane, Neuruppin, Germany
| | - Ernst Wellnhofer
- Institute of Computer-Assisted Cardiovascular Medicine, Charité, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Sanjana F, Delgorio PL, DeConne TM, Hiscox LV, Pohlig RT, Johnson CL, Martens CR. Vascular determinants of hippocampal viscoelastic properties in healthy adults across the lifespan. J Cereb Blood Flow Metab 2023; 43:1931-1941. [PMID: 37395479 PMCID: PMC10676145 DOI: 10.1177/0271678x231186571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
Arterial stiffness and cerebrovascular pulsatility are non-traditional risk factors of Alzheimer's disease. However, there is a gap in understanding the earliest mechanisms that link these vascular determinants to brain aging. Changes to mechanical tissue properties of the hippocampus (HC), a brain structure essential for memory encoding, may reflect the impact of vascular dysfunction on brain aging. We tested the hypothesis that arterial stiffness and cerebrovascular pulsatility are related to HC tissue properties in healthy adults across the lifespan. Twenty-five adults underwent measurements of brachial blood pressure (BP), large elastic artery stiffness, middle cerebral artery pulsatility index (MCAv PI), and magnetic resonance elastography (MRE), a sensitive measure of HC viscoelasticity. Individuals with higher carotid pulse pressure (PP) exhibited lower HC stiffness (β = -0.39, r = -0.41, p = 0.05), independent of age and sex. Collectively, carotid PP and MCAv PI significantly explained a large portion of the total variance in HC stiffness (adjusted R2 = 0.41, p = 0.005) in the absence of associations with HC volumes. These cross-sectional findings suggest that the earliest reductions in HC tissue properties are associated with alterations in vascular function.
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Affiliation(s)
- Faria Sanjana
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Peyton L Delgorio
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Theodore M DeConne
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Lucy V Hiscox
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE, USA
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
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Zócalo Y, Bia D, Sánchez R, Lev G, Mendiz O, Ramirez A, Cabrera-Fischer EI. Central-to-peripheral blood pressure amplification: role of the recording site, technology, analysis approach, and calibration scheme in invasive and non-invasive data agreement. Front Cardiovasc Med 2023; 10:1256221. [PMID: 37886732 PMCID: PMC10598655 DOI: 10.3389/fcvm.2023.1256221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Background Systolic blood pressure amplification (SBPA) and pulse pressure amplification (PPA) can independently predict cardiovascular damage and mortality. A wide range of methods are used for the non-invasive estimation of SBPA and PPA. The most accurate non-invasive method for obtaining SBPA and/or PPA remains unknown. Aim This study aims to evaluate the agreement between the SBPA and PPA values that are invasively and non-invasively obtained using different (1) measurement sites (radial, brachial, carotid), (2) measuring techniques (tonometry, oscillometry/plethysmography, ultrasound), (3) pulse waveform analysis approaches, and (4) calibration methods [systo-diastolic vs. approaches using brachial diastolic and mean blood pressure (BP)], with the latter calculated using different equations or measured by oscillometry. Methods Invasive aortic and brachial pressure (catheterism) and non-invasive aortic and peripheral (brachial, radial) BP were simultaneously obtained from 34 subjects using different methodologies, analysis methods, measuring sites, and calibration methods. SBPA and PPA were quantified. Concordance correlation and the Bland-Altman analysis were performed. Results (1) In general, SBPA and PPA levels obtained with non-invasive approaches were not associated with those recorded invasively. (2) The different non-invasive approaches led to (extremely) dissimilar results. In general, non-invasive measurements underestimated SBPA and PPA; the higher the invasive SBPA (or PPA), the greater the underestimation. (3) None of the calibration schemes, which considered non-invasive brachial BP to estimate SBPA or PPA, were better than the others. (4) SBPA and PPA levels obtained from radial artery waveform analysis (tonometry) (5) and common carotid artery ultrasound recordings and brachial artery waveform analysis, respectively, minimized the mean errors. Conclusions Overall, the findings showed that (i) SBPA and PPA indices are not "synonymous" and (ii) non-invasive approaches would fail to accurately determine invasive SBPA or PPA levels, regardless of the recording site, analysis, and calibration methods. Non-invasive measurements generally underestimated SBPA and PPA, and the higher the invasive SBPA or PPA, the higher the underestimation. There was not a calibration scheme better than the others. Consequently, our study emphasizes the strong need to be critical of measurement techniques, to have methodological transparency, and to have expert consensus for non-invasive assessment of SBPA and PPA.
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Affiliation(s)
- Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ramiro Sánchez
- Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Gustavo Lev
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Oscar Mendiz
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Agustín Ramirez
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Favaloro University—CONICET, Buenos Aires, Argentina
| | - Edmundo I. Cabrera-Fischer
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Favaloro University—CONICET, Buenos Aires, Argentina
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Chemla D, Agnoletti D, Jozwiak M, Zhang Y, Protogerou AD, Millasseau S, Blacher J. Non-Invasive Estimation of Central Systolic Blood Pressure by Radial Tonometry: A Simplified Approach. J Pers Med 2023; 13:1244. [PMID: 37623496 PMCID: PMC10455683 DOI: 10.3390/jpm13081244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKROUND Central systolic blood pressure (cSBP) provides valuable clinical and physiological information. A recent invasive study showed that cSBP can be reliably estimated from mean (MBP) and diastolic (DBP) blood pressure. In this non-invasive study, we compared cSBP calculated using a Direct Central Blood Pressure estimation (DCBP = MBP2/DBP) with cSBP estimated by radial tonometry. METHODS Consecutive patients referred for cardiovascular assessment and prevention were prospectively included. Using applanation tonometry with SphygmoCor device, cSBP was estimated using an inbuilt generalized transfer function derived from radial pressure waveform, which was calibrated to oscillometric brachial SBP and DBP. The time-averaged MBP was calculated from the radial pulse waveform. The minimum acceptable error (DCBP-cSBP) was set at ≤5 (mean) and ≤8 mmHg (SD). RESULTS We included 160 patients (58 years, 54%men). The cSBP was 123.1 ± 18.3 mmHg (range 86-181 mmHg). The (DCBP-cSBP) error was -1.4 ± 4.9 mmHg. There was a linear relationship between cSBP and DCBP (R2 = 0.93). Forty-seven patients (29%) had cSBP values ≥ 130 mmHg, and a DCBP value > 126 mmHg exhibited a sensitivity of 91.5% and specificity of 94.7% in discriminating this threshold (Youden index = 0.86; AUC = 0.965). CONCLUSIONS Using the DCBP formula, radial tonometry allows for the robust estimation of cSBP without the need for a generalized transfer function. This finding may have implications for risk stratification.
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Affiliation(s)
- Denis Chemla
- INSERM UMRS 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France;
| | - Davide Agnoletti
- Hypertension and Cardiovascular Risk Research Center, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Cardiovascular Internal Medicine, Heart Chest and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation CHU de Nice, 06200 Nice, France;
- UR2CA, Unité de Recherche Clinique Côte d’Azur, Université Côte d’Azur, 06200 Nice, France
| | - Yi Zhang
- Research Center for Epidemiology and Biostatistics, Sorbonne Paris Cité (CRESS), Université Paris Cité, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, 1, Place du Parvis Notre Dame, 75004 Paris, France; (Y.Z.); (J.B.)
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Middle Yanchang Road 301, Shanghai 200072, China
| | - Athanase D. Protogerou
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Department of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece;
| | | | - Jacques Blacher
- Research Center for Epidemiology and Biostatistics, Sorbonne Paris Cité (CRESS), Université Paris Cité, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, 1, Place du Parvis Notre Dame, 75004 Paris, France; (Y.Z.); (J.B.)
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Abdel-Galeel A, Fawzy NN, Ali WA, Fouad DA. Comparison between central and automated peripheral blood pressure measurement for early detection of kidney dysfunction in hypertensive patients. BMC Cardiovasc Disord 2023; 23:255. [PMID: 37198541 DOI: 10.1186/s12872-023-03292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a close relationship between blood pressure levels and the risk of cardiovascular events, strokes, and kidney disease. For many years, the gold standard instrument for blood pressure measurement was a mercury sphygmomanometer and a stethoscope, but this century-old technique of Riva-Rocci/Korotkov is being progressively removed from clinical practice. Central blood pressure is considered better than peripheral blood pressure in predicting cardiovascular events, as it assesses wave reflections and viscoelastic properties of the arterial wall which make systolic and pulse pressures vary from central to peripheral arteries, but mean blood pressure is constant in the conduit arteries. METHODS The study included 201 patients with primary hypertension (108 patients with chronic kidney disease and 93 patients without kidney disease). All patients underwent blood pressure measurement by OMRON M2 and Mobil-O-Graph devices, kidney function assessment and abdominal ultrasonography. RESULTS Patients with chronic kidney disease were significantly older (60.02 ± 9.1 vs. 55.33 ± 8.5; P < 0.001), with longer duration of hypertension (7.56 ± 5.9 vs. 6.05 ± 5.8; P = 0.020) in comparison to those without chronic kidney disease. Automated peripheral measurement of systolic blood pressure, diastolic blood pressure and pulse pressure were significantly higher in comparison to central blood pressure. Patients with chronic kidney disease had significantly higher augmentation index (24.06 ± 12.6 vs. 19.02 ± 10.8; P < 0.001) and pulsed wave velocity (8.66 ± 1.5 vs. 8.69 ± 6.8; P = 0.004) in comparison to those without chronic kidney disease. Augmentation index had positive correlation with pulse wave velocity (r = 0.183, P = 0.005). There was negative correlation between both pulse wave velocity and augmentation index and estimated glomerular filtration rate (r = -0.318, P < 0.001), and (r = -0.236, P < 0.001), respectively. Hence, arterial stiffness parameters are good positive test for prediction of chronic kidney disease. CONCLUSION There is a strong agreement between non-invasive centrally and automated peripherally measured blood pressure in diagnosis of hypertension. But non-invasive central measurements are preferred over automated measurements for early prediction and detection of renal impairment.
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Affiliation(s)
- Ahmed Abdel-Galeel
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt.
| | - Nader N Fawzy
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | - Wageeh A Ali
- Radiodiagnosis Department, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Doaa A Fouad
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
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Carlini NA, Romanowski S, Rabalais EN, Kistler BM, Campbell MS, Krishnakumar IM, Harber MP, Fleenor BS. Coconut sugar derived from coconut inflorescence sap lowers systolic blood pressure and arterial stiffness in middle-aged and older adults: a pilot study. J Appl Physiol (1985) 2023; 134:508-514. [PMID: 36656985 DOI: 10.1152/japplphysiol.00394.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Nutraceutical-based interventions hold promise to reduce blood pressure (BP) and arterial stiffness, which are two cardiovascular disease (CVD) risk factors. However, the effects of coconut sap powder (CSP), an Asian sweetener and novel nutraceutical, on BP and arterial stiffness in middle-aged and older adults (MA/O, ≥45 yr) has yet to be established. We hypothesized CSP will decrease BP and arterial stiffness in MA/O adults. In a double-blind, randomized, placebo-controlled study design, 19 (age 55.3 ± 2.1 yr) MA/O adults completed measures of brachial and carotid BP, and arterial stiffness [carotid-femoral pulse wave velocity (cfPWV), common carotid artery (CCA) β-stiffness, compliance, distensibility, and Young's and Peterson's Elastic moduli] before and after 8 wk of CSP (1.5 g/day) or placebo (1.5 g/day). A two-way repeated-measures analysis of variance was used to compare group mean differences. Compared with placebo, CSP lowered brachial systolic BP (SBP) (CSP pre: 117.4 ± 2.9 vs. post: 109.0 ± 2.4 mmHg, P < 0.05), but not carotid SBP (P = 0.12). CSP also lowered Young's (CSP pre: 5,514.4 ± 1,115.4 vs. post: 3,690.6 ± 430.9 kPa) and Peterson's elastic moduli (CSP pre: 22.2 ± 4.4 vs. post: 19.2 ± 4.5 kPa) (P < 0.05, both). A trend for CSP to lower CCA β-stiffness (P = 0.06) and increase CCA compliance (P = 0.07) was also observed. Arterial stiffness assessed by cfPWV did not change (P > 0.05). No inflammatory or antioxidant biomarkers were affected by CSP. In summary, 8 wk of CSP lowers brachial SBP and CCA mechanical stiffness indicating a potential cardioprotective effect in MA/O adults.NEW & NOTEWORTHY Blood pressure (BP) and arterial stiffness are important predictors of cardiovascular health with aging. Nutraceuticals are an easy-to-implement lifestyle strategy demonstrating promise to effectively lower BP and arterial stiffness with aging and ultimately cardiovascular disease risk. We demonstrate that coconut sap powder (CSP), a traditional Asian sweetener, lowers brachial systolic BP and carotid artery mechanical stiffness in middle-aged and older (MA/O) adults. These findings provide initial evidence for the CSP-related cardioprotective effects in MA/O adults.
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Affiliation(s)
- Nicholas A Carlini
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Spencer Romanowski
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Emily N Rabalais
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, United States
| | - Marilyn S Campbell
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, United States
| | | | - Matthew P Harber
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Bradley S Fleenor
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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Bia D, Zócalo Y, Sánchez R, Lev G, Mendiz O, Pessana F, Ramirez A, Cabrera-Fischer EI. Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods. Front Physiol 2023; 14:1113972. [PMID: 36726850 PMCID: PMC9885133 DOI: 10.3389/fphys.2023.1113972] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established. Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% ("033"), 41.2% ("0412") or 33% corrected for heart rate ("033HR"). Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes. Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The "033HR" and "0412" calibration schemes ensured the lowest mean error, and the "033" method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods. Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay,*Correspondence: Daniel Bia, ; Yanina Zócalo,
| | - Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay,*Correspondence: Daniel Bia, ; Yanina Zócalo,
| | - Ramiro Sánchez
- Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Gustavo Lev
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Oscar Mendiz
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires, Argentina
| | - Franco Pessana
- Department of Information Technology, Engineering and Exact Sciences Faculty, Favaloro University, Buenos Aires, Argentina
| | - Agustín Ramirez
- IMETTYB Favaloro University—CONICET, Buenos Aires, Argentina
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Desbiens LC, Goulamhoussen N, Fortier C, Bernier-Jean A, Agharazii M, Goupil R. Enhancing central blood pressure accuracy through statistical modeling: A proof-of-concept study. Front Cardiovasc Med 2022; 9:1048507. [PMID: 36505368 PMCID: PMC9728538 DOI: 10.3389/fcvm.2022.1048507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Non-invasive estimation of central blood pressure (BP) may have better prognostic value than brachial BP. The accuracy of central BP is limited in certain populations, such as in females and the elderly. This study aims to examine whether statistical modeling of central BP for clinical and hemodynamic parameters results in enhanced accuracy. Methods This study is a cross-sectional analysis of 500 patients who underwent cardiac catheterization. Non-invasive brachial cuff and central BP were measured simultaneously to invasive aortic systolic BP (AoSBP). Central BP was calibrated for brachial systolic (SBP) and diastolic BP (Type I calibration; C1SBP) or brachial mean and diastolic BP (Type II calibration; C2SBP). Differences between central SBP and the corresponding AoSBP were assessed with linear regression models using clinical and hemodynamic parameters. These parameters were then added to C1SBP and C2SBP in adjusted models to predict AoSBP. Accuracy and precision were computed in the overall population and per age or sex strata. Results C1SBP underestimated AoSBP by 11.2 mmHg (±13.5) and C2SBP overestimated it by 6.2 mmHg (±14.8). Estimated SBP amplification and heart rate were the greatest predictors of C1- and C2-AoSBP accuracies, respectively. Statistical modeling improved both accuracy (0.0 mmHg) and precision (±11.4) but more importantly, eliminated the differences of accuracy seen in different sex and age groups. Conclusion Statistical modeling greatly enhances the accuracy of central BP measurements and abolishes sex- and age-based differences. Such factors could easily be implemented in central BP devices to improve their accuracy.
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Affiliation(s)
| | | | - Catherine Fortier
- Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, QC, Canada
| | - Amélie Bernier-Jean
- Department of Medicine, Université de Montréal, Montréal, QC, Canada,Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Mohsen Agharazii
- Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec City, QC, Canada
| | - Rémi Goupil
- Department of Medicine, Université de Montréal, Montréal, QC, Canada,Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada,*Correspondence: Rémi Goupil,
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10
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Factors That May Impact the Noninvasive Measurement of Central Blood Pressure Compared to Invasive Measurement: The MATCHY Study. J Pers Med 2022; 12:jpm12091482. [PMID: 36143267 PMCID: PMC9505856 DOI: 10.3390/jpm12091482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Calibration affects central blood pressure (BP) estimation accuracy. Factors influencing the accuracy of noninvasive central BP measurement, type of calibration method implemented (systolic/diastolic BP or mean/diastolic BP), and type of BP measurement device used (devices using the transfer function method, directly measurement from the carotid artery, and the transfer function-like method), were investigated. Fifty participants (aged 62.4 ± 8.9 years) without overt heart diseases were recruited. Invasive aortic and radial BP was measured. Simultaneously, noninvasive central BP was measured using three types of devices. The mean invasive aortic BP was 127 ± 19/95 ± 14 mmHg. Noninvasive central BP tended to be slightly lower than invasive BP, though without statistical significance. The type of calibration method did not significantly influence the noninvasive cSBP measurements (p ≥ 0.24). Results from cuff-based devices were significantly lower than invasive measurements (p = 0.04). Multiple regression analyses showed that gender was significantly correlated with the accuracy of noninvasive cSBP measurement. In conclusion, noninvasive cSBP measurements are comparable to invasive measurements but might underestimate true cSBP. The type of device may affect the accuracy of measurement. Either of the two calibration methods is acceptable.
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11
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V RK, Manoj R, S I, P M N, Joseph J. Comparison of Approximated and Actual Bramwell-Hill Equation Implementation for Local Pulse Wave Velocity: Ex-vivo Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3989-3992. [PMID: 36086029 DOI: 10.1109/embc48229.2022.9871209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bramwell-Hill (BH) equation is widely adopted for the evaluation of local pulse wave velocity (PWV), primarily for its theoretical association with the vessel's distensibility. Its implementation, however, requires arterial pressure and diameter waveforms simultaneously from a single site. Owing to the challenges associated with such a noninvasive recording, an approximated BH equation is adopted without requiring the entire pressure waveform but only the diastolic and systolic values. The approximated BH method yields a single value of local PWV as opposed to the actual method that provides instantaneous PWV within a cardiac cycle. This study aims to provide the currently lacking insights into how the approximate versus actual BH implementations compare. The study also addresses the pivotal question of which instantaneous value within the cardiac cycle corresponds to the approximated BH. An ex-vivo study was conducted for this purpose, emulating different flow conditions (changing mean and pulse pressures) to vary the local PWV within the range of 4.4 to 8.9 m/s. The results revealed the expected (pressure-dependent) incremental nature of local PWV due to hyper-elastic behavior of the artery, with systolic BH-PWV > diastolic BH-PWV by 13.6%. The approximate BH-PWV was similar to actual BH-PWV obtained from mean pressure level. It further underestimated the systolic, and overestimated the diastolic PWVs by 8.5% and 6.6%, respectively. Clinical Relevance - When estimated BH-PWV estimates are compared to normal values for patient classification or utilized as a reference standard in validation studies these findings become extremely important.
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12
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Baek S, Lee Y, Baek J, Kwon J, Kim S, Lee S, Strunk KP, Stehlin S, Melzer C, Park SM, Ko H, Jung S. Spatiotemporal Measurement of Arterial Pulse Waves Enabled by Wearable Active-Matrix Pressure Sensor Arrays. ACS NANO 2022; 16:368-377. [PMID: 34910466 DOI: 10.1021/acsnano.1c06695] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Wearable pressure sensors have demonstrated great potential in detecting pulse pressure waves on the skin for the noninvasive and continuous diagnosis of cardiac conditions. However, difficulties lie in positioning conventional single-point sensors on an invisible arterial line, thereby preventing the detection of adequate signal amplitude for accurate pulse wave analysis. Herein, we introduce the spatiotemporal measurements of arterial pulse waves using wearable active-matrix pressure sensors to obtain optimal pulse waveforms. We fabricate thin-film transistor (TFT) arrays with high yield and uniformity using inkjet printing where array sizes can be customizable and integrate them with highly sensitive piezoresistive sheets. We maximize the pressure sensitivity (16.8 kPa-1) and achieve low power consumption (101 nW) simultaneously by strategically modulating the TFT operation voltage. The sensor array creates a spatiotemporal pulse wave map on the wrist. The map presents the positional dependence of pulse amplitudes, which allows the positioning of the arterial line to accurately extract the augmentation index, a parameter for assessing arterial stiffness. The device overcomes the positional inaccuracy of conventional single-point sensors, and therefore, it can be used for medical applications such as arterial catheter injection or the diagnosis of cardiovascular disease in daily life.
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Affiliation(s)
- Sanghoon Baek
- Department of Convergence IT Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-Gu, Pohang 37673, Republic of Korea
| | - Youngoh Lee
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology, Ulsan Metropolitan City 44919, Republic of Korea
| | - JinHyeok Baek
- Department of Convergence IT Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-Gu, Pohang 37673, Republic of Korea
| | - Jimin Kwon
- Department of Electrical Engineering, Stanford University, Stanford, California 94305, United States
| | - Seongju Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-Gu, Pohang 37673, Republic of Korea
| | - Seungjae Lee
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology, Ulsan Metropolitan City 44919, Republic of Korea
| | | | | | - Christian Melzer
- InnovationLab GmbH, Speyerer Straße 4, 69115 Heidelberg, Germany
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-Gu, Pohang 37673, Republic of Korea
| | - Hyunhyub Ko
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology, Ulsan Metropolitan City 44919, Republic of Korea
| | - Sungjune Jung
- Department of Convergence IT Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-Gu, Pohang 37673, Republic of Korea
- Department of Materials Science and Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-Gu, Pohang 37673, Republic of Korea
- Yonsei Institute of Convergence Technology, Yonsei University, Incheon 21983, Republic of Korea
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13
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Raj KV, Nabeel PM, Chandran D, Sivaprakasam M, Joseph J. High-frame-rate A-mode ultrasound for calibration-free cuffless carotid pressure: feasibility study using lower body negative pressure intervention. Blood Press 2022; 31:19-30. [PMID: 35014940 DOI: 10.1080/08037051.2021.2022453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Existing technologies to measure central blood pressure (CBP) intrinsically depend on peripheral pressure or calibration models derived from it. Pharmacological or physiological interventions yielding different central and peripheral responses compromise the accuracy of such methods. We present a high-frame-rate ultrasound technology for cuffless and calibration-free evaluation of BP from the carotid artery. The system uses a pair of single-element ultrasound transducers to capture the arterial diameter and local pulse wave velocity (PWV) for the evaluation of beat-by-beat BP employing a novel biomechanical model. MATERIALS AND METHODS System's functionality assessment was conducted on eight male subjects (26 ± 4 years, normotensive and no history of cardiovascular risks) by perturbing pressure via short-term moderate lower body negative pressure (LBNP) intervention (-40 mmHg for 1 min). The ability of the system to capture dynamic responses of carotid pressure to LBNP was investigated and compared against the responses of peripheral pressure measured using a continuous BP monitor. RESULTS While the carotid pressure manifested trends similar to finger measurements during LBNP, the system also captured the differential carotid-to-peripheral pressure response, which corroborates the literature. The carotid diastolic and mean pressures agreed with the finger pressures (limits-of-agreement within ±7 mmHg) and exhibited acceptable uncertainty (mean absolute errors were 2.4 ± 3.5 and 2.6 ± 4.0 mmHg, respectively). Concurrent to the literature, the carotid systolic and pulse pressures (PPs) were significantly lower than those of the finger pressures by 11.1 ± 9.4 and 11.3 ± 8.2 mmHg, respectively (p < .0001). CONCLUSIONS The study demonstrated the method's potential for providing cuffless and calibration-free pressure measurements while reliably capturing the physiological aspects, such as PP amplification and dynamic pressure responses to intervention.
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Affiliation(s)
- Kiran V Raj
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India
| | - P M Nabeel
- Healthcare Technology Innovation Centre, IIT Madras, Chennai, India
| | - Dinu Chandran
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India.,Healthcare Technology Innovation Centre, IIT Madras, Chennai, India
| | - Jayaraj Joseph
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India
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14
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Chemla D, Millasseau S, Hamzaoui O, Teboul JL, Monnet X, Michard F, Jozwiak M. New Method to Estimate Central Systolic Blood Pressure From Peripheral Pressure: A Proof of Concept and Validation Study. Front Cardiovasc Med 2021; 8:772613. [PMID: 34977186 PMCID: PMC8714848 DOI: 10.3389/fcvm.2021.772613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The non-invasive estimation of central systolic blood pressure (cSBP) is increasingly performed using new devices based on various pulse acquisition techniques and mathematical analyses. These devices are most often calibrated assuming that mean (MBP) and diastolic (DBP) BP are essentially unchanged when pressure wave travels from aorta to peripheral artery, an assumption which is evidence-based. We tested a new empirical formula for the direct central blood pressure estimation of cSBP using MBP and DBP only (DCBP = MBP2/DBP). Methods and Results: First, we performed a post-hoc analysis of our prospective invasive high-fidelity aortic pressure database (n = 139, age 49 ± 12 years, 78% men). The cSBP was 146.0 ± 31.1 mmHg. The error between aortic DCBP and cSBP was −0.9 ± 7.4 mmHg, and there was no bias across the cSBP range (82.5–204.0 mmHg). Second, we analyzed 64 patients from two studies of the literature in whom invasive high-fidelity pressures were simultaneously obtained in the aorta and brachial artery. The weighed mean error between brachial DCBP and cSBP was 1.1 mmHg. Finally, 30 intensive care unit patients equipped with fluid-filled catheter in the radial artery were prospectively studied. The cSBP (115.7 ± 18.2 mmHg) was estimated by carotid tonometry. The error between radial DCBP and cSBP was −0.4 ± 5.8 mmHg, and there was no bias across the range. Conclusion: Our study shows that cSBP could be reliably estimated from MBP and DBP only, provided BP measurement errors are minimized. DCBP may have implications for assessing cardiovascular risk associated with cSBP on large BP databases, a point that deserves further studies.
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Affiliation(s)
- Denis Chemla
- Service d'explorations fonctionnelles multidisciplinaires bi-site Antoine Béclère - Kremlin Bicêtre, GHU Paris Sud, AP-HP, Le Kremlin-Bicêtre, France
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- *Correspondence: Denis Chemla
| | | | - Olfa Hamzaoui
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Jean-Louis Teboul
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Mathieu Jozwiak
- Equipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur UCA, Nice and Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire l'Archet, Nice, France
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15
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Nachman D, Gilan A, Goldstein N, Constantini K, Littman R, Eisenkraft A, Grossman E, Gepner Y. Twenty-Four-Hour Ambulatory Blood Pressure Measurement Using a Novel Noninvasive, Cuffless, Wireless Device. Am J Hypertens 2021; 34:1171-1180. [PMID: 34143867 DOI: 10.1093/ajh/hpab095] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/25/2020] [Accepted: 06/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for diagnosis and treatment of hypertension. Technical limitations, low compliance, and complex procedures limit their use. The aim of the present study was to test the accuracy of a new photoplethysmography-based, wearable device (Wrist-monitor) as compared with the standard cuff-based ABPM device. METHODS Twenty-four-hour (24H) ABPM was performed in parallel for both devices on volunteers aged 18-65 years, while documenting their daily activities. Level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between devices. Receiver operating characteristic (ROC) curve analysis was used to classify hypertension based on the average Wrist-monitor measurements as compared with a cuff-based ABPM device. RESULTS The study included 28 subjects (18 men) mean age 41.5 ± 16.2 years. Bland-Altman analysis resulted in 24H bias of -1.1 mm Hg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was -1.9 mm Hg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mm Hg for DBP and SBP, respectively). ROC curve analysis yielded a mean area under the curve (AUC) of 1 for SBP and 24H blood pressure measurements. AUCs of 0.994 and 0.955 were found for the daytime DBP and night DBP, respectively. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared with the cuff-based device (P < 0.001). CONCLUSIONS The cuffless device provides comparable measurements to those obtained with the currently used cuff-based ABPM device, with significantly less inconvenience to the subject. CLINICAL TRIALS REGISTRATION Trial Number NCT03810586.
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Affiliation(s)
- Dean Nachman
- Department of Military Medicine, Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel.,Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Gilan
- Department of Military Medicine, Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
| | - Nir Goldstein
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel
| | - Keren Constantini
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel
| | - Romi Littman
- Clinical Department, Biobeat Technologies Ltd, Petah Tikva, Israel
| | - Arik Eisenkraft
- Department of Military Medicine, Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel.,Clinical Department, Biobeat Technologies Ltd, Petah Tikva, Israel
| | - Ehud Grossman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel.,Internal Medicine Wing, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel
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16
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Cheng HM. Meet the Section Editor. Curr Hypertens Rev 2021. [DOI: 10.2174/157340211702211025095357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hao-Min Cheng
- Taiwan Development Institute Veterans General Hospital-Taipei Taipei, Taiwan
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17
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Fukuda Y, Kataoka Y, Kodama H, Yasuno Y, Tomoike H. Tonometric Condition of Cellular Polypropylene Film Sensors in Measuring Arterial Pressure Waveform. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7445-7449. [PMID: 34892817 DOI: 10.1109/embc46164.2021.9629747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Tonometric continuous measurement of arterial pressure becomes feasible using a cellular polypropylene (Cellular PP) film sensor. A pulsatile arterial vascular phantom model was used to find the range of optimal tonometric conditions and the responsiveness to dynamic pressure changes. The optimal tonometric condition was assessed by the correlation coefficient between the hydraulic pressure and the Cellular PP output using two different types of tubes (the latex tube and the hydrogel tube) to simulate arteries. With a setting of the normal blood pressure range, the output of Cellular PP correlated strongly with the level of hydraulic pressure, 0.998 and 0.989 in the latex tube and the hydrogel tube, respectively. For maintaining the optimal tonometric condition, the depressed depths of the latex and the hydrogel tube were less than 1.2 and 0.6 mm, respectively. The phantom model also demonstrated that the Cellular PP sensor followed changes in a hydraulic pressure dynamically under the optimal tonometric conditions. The present results demonstrated the Cellular PP film sensor is applicable to the arterial tonometry in measuring the instantaneous blood pressure while the sensor is adjusted to maintain the minimal flatness of the underlying arterial wall.Clinical Relevance- To understand the physiological characteristics of blood pressure and arterial system, the instantaneous measurement of blood pressure is necessary. The present study suggests that Cellular PP films are applicable to peripheral arteries tonometrically to obtain simultaneously the respective blood pressure waveforms.
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18
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Fanelli E, Abate Daga F, Pappaccogli M, Eula E, Astarita A, Mingrone G, Fasano C, Magnino C, Schiavone D, Rabbone I, Gollin M, Rabbia F, Veglio F. A structured physical activity program in an adolescent population with overweight and obesity: a prospective interventional study. Appl Physiol Nutr Metab 2021; 47:253-260. [PMID: 34706211 DOI: 10.1139/apnm-2021-0092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity is a significant health problem, with increasing involvement of young population worldwide. The aim of this study was to evaluate the effects of two different types of physical exercise (resistance vs combined aerobic-resistance) on cardiovascular and anthropometric profile of a sample of sedentary adolescents with overweight and obesity. METHODS After undergoing clinical, cardiovascular and anthropometric-metabolic evaluation (T0), subjects with overweight and obesity were randomized to a 6-months resistance or combined aerobic-resistance training program. Clinical, cardiovascular and anthropometric-metabolic evaluations were repeated after 6 months of training (T1) and after 3 months of detraining (T2). RESULTS Thirty adolescents with overweight/obesity were enrolled; 20 subjects completed training program. A significant improvement in body composition was detected after 6 months, with a reduction of BMI (32.1 [30.5-34.4] vs 31.1 [29.6-33.4] kg/m2, p=0.02) and adipose tissue (45.5 [41.1-49.7] vs 41.6 [37.0-49.2] Kg, p<0.01). A reduction in Diastolic blood pressure (75.5 ± 8.9 vs 68.2 ± 6.4 mmHg, p=0.02) and Pulse Wave Velocity (5.7 [5.1-5.9] vs 5.2 [4.7-5.7] m/s, p=0.04) was also observed. Persistence of the effect on the most important parameters was observed also after detraining period. CONCLUSIONS Regular physical exercise induces positive metabolic and cardiovascular effects, with persistence also after brief discontinuation. Novelty bullets. Physical exercise induces positive effect on cardiovascular risk profile. Positive effects persist also after brief discontinuation. Physical exercise reduces early signs of autonomic disfunction.
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Affiliation(s)
- Elvira Fanelli
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy, 10124;
| | - Federico Abate Daga
- Università degli Studi di Torino, 9314, Dipartimento di Scienze delle attività motorie e sportive, Torino, Italy;
| | - Marco Pappaccogli
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Elisabetta Eula
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Anna Astarita
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Giulia Mingrone
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Chiara Fasano
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Corrado Magnino
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Domenica Schiavone
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Ivana Rabbone
- Università degli Studi di Torino, 9314, Dipartimento di Pediatria, Torino, Italy.,Università degli Studi del Piemonte Orientale Amedeo Avogadro Facoltà di Medicina e Chirurgia, 60252, Divisione di Pediatria, Novara, Piemonte, Italy;
| | - Massimiliano Gollin
- Università degli Studi di Torino, 9314, Dipartimento di Scienze delle Attività motorie e sportive, Torino, Italy;
| | - Franco Rabbia
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Franco Veglio
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
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19
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Ambulatory monitoring of central arterial pressure, wave reflections, and arterial stiffness in patients at cardiovascular risk. J Hum Hypertens 2021; 36:352-363. [PMID: 34518619 DOI: 10.1038/s41371-021-00606-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/09/2022]
Abstract
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.
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20
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Trinkmann F, Benck U, Halder J, Semmelweis A, Saur J, Borggrefe M, Akin I, Kaden JJ. Automated Noninvasive Central Blood Pressure Measurements by Oscillometric Radial Pulse Wave Analysis: Results of the MEASURE-cBP Validation Studies. Am J Hypertens 2021; 34:383-393. [PMID: 33140085 DOI: 10.1093/ajh/hpaa174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Central blood pressure becomes increasingly accepted as an important diagnostic and therapeutic parameter. Accuracy of widespread applanation tonometry can be affected by calibration and operator training. To overcome this, we aimed to evaluate novel VascAssist 2 using automated oscillometric radial pulse wave analysis and a refined multi-compartment model of the arterial tree. METHODS Two hundred and twenty-five patients were prospectively enrolled. Invasive aortic root measurements served as reference in MEASURE-cBP 1 (n = 106) whereas applanation tonometry (SphygmoCor) was used in MEASURE-cBP 2 (n = 119). RESULTS In MEASURE-cBP 1, we found a mean overestimation for systolic values of 4 ± 12 mmHg (3 ± 10%) and 6 ± 10 mmHg (9 ± 14%) for diastolic values. Diabetes mellitus and low blood pressure were associated with larger variation. In MEASURE-cBP 2, mean overestimation of systolic values was 4 ± 4 mmHg (4 ± 4%) and 1 ± 4 mmHg (1 ± 7%) of diastolic values. Arrhythmia was significantly more frequent in invalid measurements (61 vs. 18%, P < 0.0001) which were most often due to a low quality index of SphygmoCor. CONCLUSIONS Central blood pressure estimates using VascAssist 2 can be considered at least as accurate as available techniques, even including diabetic patients. In direct comparison, automated measurement considerably facilitates application not requiring operator training and can be reliably applied even in patients with arrhythmias.
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Affiliation(s)
- Frederik Trinkmann
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Urs Benck
- 5th Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julian Halder
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexandra Semmelweis
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joachim Saur
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- ECAS (European Center for AngioScience) and DZHK (German Center for Cardiovascular Research), partner site Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- ECAS (European Center for AngioScience) and DZHK (German Center for Cardiovascular Research), partner site Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jens J Kaden
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Tomiyama H. Carotid Artery: A Window for the Assessment of Multiple Cardiovascular Risks. JMA J 2021; 4:174-175. [PMID: 33997454 PMCID: PMC8118967 DOI: 10.31662/jmaj.2021-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022] Open
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Esmaelpoor J, Moradi MH, Kadkhodamohammadi A. Cuffless blood pressure estimation methods: physiological model parameters versus machine-learned features. Physiol Meas 2021; 42. [PMID: 33647892 DOI: 10.1088/1361-6579/abeae8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/01/2021] [Indexed: 11/11/2022]
Abstract
Objective.For the first time in the literature, this paper investigates some crucial aspects of blood pressure (BP) monitoring using photoplethysmogram (PPG) and electrocardiogram (ECG). In general, the proposed approaches utilize two types of features: parameters extracted from physiological models or machine-learned features. To provide an overview of the different feature extraction methods, we assess the performance of these features and their combinations. We also explore the importance of the ECG waveform. Although ECG contains critical information, most models merely use it as a time reference. To take this one step further, we investigate the effect of its waveform on the performance.Approach.We extracted 27 commonly used physiological parameters in the literature. In addition, convolutional neural networks (CNNs) were deployed to define deep-learned representations. We applied the CNNs to extract two different feature sets from the PPG segments alone and alongside corresponding ECG segments. Then, the extracted feature vectors and their combinations were fed into various regression models to evaluate our hypotheses.Main results.We performed our evaluations using data collected from 200 subjects. The results were analyzed by the mean difference t-test and graphical methods. Our results confirm that the ECG waveform contains important information and helps us to improve accuracy. The comparison of the physiological parameters and machine-learned features also reveals the superiority of machine-learned representations. Moreover, our results highlight that the combination of these feature sets does not provide any additional information.Significance.We conclude that CNN feature extractors provide us with concise and precise representations of ECG and PPG for BP monitoring.
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23
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Accuracy of fully automated oscillometric central aortic blood pressure measurement techniques. J Hypertens 2021; 38:235-242. [PMID: 31503132 DOI: 10.1097/hjh.0000000000002237] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central aortic blood pressure (cBP) is a valuable predictor of cardiovascular risk. The lack of fully automated measurement devices impeded an implementation in daily clinical practice so far. The present study compares two novel automated oscillometric devices with invasively measured cBP. METHODS From March 2017 to March 2018, we enrolled consecutive patients undergoing elective coronary angiography to this cross-sectional study. Noninvasive assessment of cBP was performed by the SphygmoCor XCEL device and the Mobil-O-Graph NG device simultaneously to invasive measurement. RESULTS Our study included 502 patients (228 women, 274 men) with a mean age of 67.9 ± 11.6 years. The noninvasive measurement of cBP was successful in 498 patients (99%) with SphygmoCor XCEL device and in 441 patients (88%) with Mobil-O-Graph NG device (P = 0.451). Measurements of both devices revealed a high correlation to invasively measured systolic (SphygmoCor R 0.864, P < 0.001; Mobil-O-Graph R 0.763, P < 0.001) and diastolic (SphygmoCor R 0.772, P < 0.001; Mobil-O-Graph R 0.618, P < 0.001) cBP. Both devices slightly underestimated systolic and overestimated diastolic central blood pressure: biases were -5.0 ± 7.7/0.5 ± 6.2 mmHg with SphygmoCor XCEL and -6.0 ± 10.4/3.6 ± 8.3 mmHg with Mobil-O-Graph NG device. Correlations (R) were higher and biases were lower with the SphygmoCor device (P < 0.001 each). CONCLUSION The present study is the largest validation study of noninvasive cBP measurement techniques so far and shows that two current automated oscillometric monitors are able to assess cBP with acceptable accuracy. Automated oscillometric devices may facilitate the implementation of cBP in daily clinical practice.
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Cai TY, Haghighi MM, Roberts PA, Mervis J, Qasem A, Butlin M, Celermajer DS, Avolio A, Skilton MR, Ayer JG. Assessment of Central Arterial Hemodynamics in Children: Comparison of Noninvasive and Invasive Measurements. Am J Hypertens 2021; 34:163-171. [PMID: 32902618 DOI: 10.1093/ajh/hpaa148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/23/2020] [Accepted: 09/04/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In adults, central systolic blood pressure (cSBP) and augmentation index (cAIx) are independently associated with cardiovascular events and mortality. There is increasing interest in central hemodynamic indices in children. We aimed to assess the accuracy of current techniques against invasive intra-aortic measurements in children. METHODS Intra-aortic pressure waveforms were recorded with simultaneous brachial, radial, and carotid waveforms in 29 children (6.7 ± 3.9 years old) undergoing cardiac catheterization. Adult and age-appropriate transfer functions (TFs) (brachial adult: b-aTF; radial adult: r-aTF; radial for 8-year-old children: TF8; and radial for 14-year-old children: TF14) were used to synthesize central aortic waveforms from peripheral waveforms calibrated either to invasively or noninvasively recorded BP. Central hemodynamic indices were measured by pulse wave analysis. RESULTS cSBP measured from invasively calibrated r-aTF (β = 0.84; intraclass correlation coefficient = 0.91; mean error ± SDD = -1.0 ± 5.0 mm Hg), TF8 (β = 0.78; intraclass correlation coefficient = 0.84; mean error ± SDD = 4.4 ± 5.6 mm Hg), and TF14 (β = 0.82; intraclass correlation coefficient = 0.90; mean error ± SDD = 2.0 ± 4.7 mm Hg)-synthesized central waveforms correlated with and accurately estimated intra-aortic cSBP measurements, while noninvasively calibrated waveforms did not. cAIx derived from TF-synthesized central waveforms did not correlate with intra-aortic cAIx values, and degree of error was TF-dependent. CONCLUSIONS The currently available r-aTF accurately estimates cSBP with invasive pulse pressure calibration, while. Age-appropriate TFs do not appear to provide additional benefit. Accuracy of cAIx estimation appears to be TF dependent.
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Affiliation(s)
- Tommy Y Cai
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Marjan M Haghighi
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- The Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, Australia
| | - Philip A Roberts
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- The Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, Australia
| | - Jonathan Mervis
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- The Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, Australia
| | - Ahmad Qasem
- Australian School of Advanced Medicine, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Mark Butlin
- Australian School of Advanced Medicine, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - David S Celermajer
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alberto Avolio
- Australian School of Advanced Medicine, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Michael R Skilton
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Julian G Ayer
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- The Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, Australia
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Gallo C, Olbers J, Ridolfi L, Scarsoglio S, Witt N. Testing a Patient-Specific In-Silico Model to Noninvasively Estimate Central Blood Pressure. Cardiovasc Eng Technol 2021; 12:144-157. [PMID: 33438147 DOI: 10.1007/s13239-020-00512-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To show some preliminary results about the possibility to exploit a cardiovascular mathematical model-made patient-specific by noninvasive data routinely measured during ordinary clinical examinations-in order to obtain sufficiently accurate central blood pressure (BP) estimates. METHODS A closed-loop multiscale (0D and 1D) model of the cardiovascular system is made patient-specific by using as model inputs the individual mean heart rate and left-ventricular contraction time, weight, height, age, sex and mean/pulse brachial BPs. The resulting framework is used to determine central systolic, diastolic, mean and pulse pressures, which are compared with the beat-averaged invasive pressures of 12 patients aged 72 ± 6.61 years. RESULTS Errors in central systolic, diastolic, mean and pulse pressures by the model are 4.26 ± 2.81, 5.86 ± 4.38, 4.98 ± 3.95 and 3.51±2.38 mmHg, respectively. CONCLUSION The proposed modeling approach shows a good patient-specific response and appears to be potentially useful in clinical practice. However, this approach needs to be evaluated in a larger cohort of patients and could possibly be improved through more accurate oscillometric BP measurement methods.
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Affiliation(s)
- Caterina Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
| | - Joakim Olbers
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Nils Witt
- Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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26
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Influence of noninvasive central blood pressure devices for afterload monitoring with aortic velocity-pressure Loop in anesthetized patients. Blood Press Monit 2020; 25:184-194. [PMID: 32433117 DOI: 10.1097/mbp.0000000000000445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Global afterload angle (GALA) is a parameter derived from velocity-pressure loop (VP Loop), for continuous assessment of cardiac afterload in the operating room. It has been validated with invasive measure of central pressure. The aim of this study was to evaluate the feasibility of noninvasive VP Loop obtained with central pressure measured with two different noninvasive tonometers. METHODS A prospective, observational, monocentric study was conducted in 51 patients under general anesthesia. Invasive central pressure (cPINV) was measured with a fulfilled intravascular catheter, and noninvasive central pressure signals were obtained with two applanation tonometry devices: radial artery tonometry (cPSHYG: Sphygmocor tonometer) and carotid tonometry (cPCOMP: Complior tonometer). Three VP Loops were built: VP LoopINV, VP LoopSPHYG and VP LoopCOMP. Patients were separated according to cardiovascular risk factors. RESULTS In the 51 patients under general anesthesia, cPSHYG was adequately obtained in 48 patients (89%) but, compared to cPINV, SBP was underestimated (-4 ± 6 mmHg, P < 0.0001), augmentation index (AIXSPHYG) and a GALASPHYG were overestimated (+13 ± 19%, P = 0.0077 and +4 ± 8°, P = 0.0024, respectively) with large limit of agreement (LOA) (-21 to 47% and -13 to 21° for AIXSPHYG and GALASPHYG, respectively). With the Complior, the failure rate of measurement for cPCOMP was 41%. SBP was similar (3 ± 17 mmHg, P = 0.32), AIXCOMP was underestimated (-11 ± 19%, P = 0.0046) and GALACOMP was similar but with large LOA (-50 to 26% and -20 to 18° for AIXCOMP and GALACOMP, respectively). CONCLUSION In anesthetized patient, the reliability of noninvasive central pressure monitoring by tonometry seems too limited to monitor cardiac afterload with VP Loop.
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27
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Schultz MG, Picone DS, Armstrong MK, Black JA, Dwyer N, Roberts-Thomson P, Sharman JE. Validation Study to Determine the Accuracy of Central Blood Pressure Measurement Using the Sphygmocor Xcel Cuff Device. Hypertension 2020; 76:244-250. [PMID: 32475318 DOI: 10.1161/hypertensionaha.120.14916] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Numerous devices purport to measure central (aortic) blood pressure (BP) as distinct from conventional brachial BP. This validation study aimed to determine the accuracy of the Sphygmocor Xcel cuff device (AtCor Medical, CardieX, Sydney, Australia) for measuring central BP. 296 patients (mean age 61±12 years) undergoing coronary angiography had simultaneous measurement of invasive central BP and noninvasive cuff-derived central BP using the Xcel cuff device (total n=558 individual comparisons). A subsample (n=151) also had invasive brachial BP measured. Methods were undertaken according to the Artery Society recommendations, and several calibration techniques to derive central systolic BP (SBP) were examined. Minimum acceptable error was ≤5±≤8 mm Hg. Central SBP was significantly underestimated, and with wide variability, when using the default calibration of brachial-cuff SBP and diastolic BP (DBP; mean difference±SD, -7.7±11.0 mm Hg). Similar variability was observed using other calibration methods (cuff 33% form-factor mean arterial pressure and DBP, -4.4±11.5 mm Hg; cuff 40% form-factor mean arterial pressure and DBP, 4.7±11.9 mm Hg; cuff oscillometric mean arterial pressure and DBP, -18.2±12.1 mm Hg). Only calibration with invasive central integrated mean arterial pressure and DBP was within minimal acceptable error (3.3±7.5 mm Hg). The difference between brachial-cuff SBP and invasive central SBP was 3.3±10.7 mm Hg. A subsample analysis to determine the accuracy of central-to-brachial SBP amplification showed this to be overestimated by the Xcel cuff device (mean difference 4.3±9.1 mm Hg, P=0.02). Irrespective of cuff calibration technique, the Sphygmocor Xcel cuff device does not meet the Artery Society accuracy criteria for noninvasive measurement of central BP.
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Affiliation(s)
- Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.G.S., D.S.P., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.G.S., D.S.P., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Matthew K Armstrong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.G.S., D.S.P., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - J Andrew Black
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.G.S., D.S.P., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.)
| | - Nathan Dwyer
- Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.)
| | - Philip Roberts-Thomson
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.G.S., D.S.P., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.)
| | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.G.S., D.S.P., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
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Blind, Cuff-less, Calibration-Free and Continuous Blood Pressure Estimation using Optimized Inductive Group Method of Data Handling. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101682] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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29
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Cheng HM, Chuang SY, Wang TD, Kario K, Buranakitjaroen P, Chia YC, Divinagracia R, Hoshide S, Minh HV, Nailes J, Park S, Shin J, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Sukonthasarn A, Tay JC, Teo BW, Turana Y, Verma N, Zhang Y, Wang JG, Chen CH. Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice? J Clin Hypertens (Greenwich) 2019; 22:391-406. [PMID: 31841279 DOI: 10.1111/jch.13758] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 12/31/2022]
Abstract
Since noninvasive central blood pressure (BP) measuring devices are readily available, central BP has gained growing attention regarding its clinical application in the management of hypertension. The disagreement between central and peripheral BP has long been recognized. Some previous studies showed that noninvasive central BP may be better than the conventional brachial BP in association with target organ damages and long-term cardiovascular outcomes. Recent studies further suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control. Despite the use of central BP being promising, more randomized controlled studies comparing central BP-guided therapeutic strategies with conventional care for cardiovascular events reduction are required because noninvasive central and brachial BP measures are conveniently available. In this brief review, the rationale supporting the utility of central BP in clinical practice and relating challenges are summarized.
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Affiliation(s)
- Hao-Min Cheng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - Tzung-Dau Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Huynh Van Minh
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Jennifer Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Sungha Park
- Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea
| | - Jinho Shin
- Faculty of Cardiology Service, Hanyang University Medical Center, Seoul, Korea
| | | | - Jorge Sison
- Section of Cardiology, Department of Medicine, Medical Center Manila, Manila, Philippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia-National Cardiovascular Center, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- MIOT International Hospital, Chennai, India.,College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Apichard Sukonthasarn
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Wee Teo
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yuda Turana
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Narsingh Verma
- Indian Society of Hypertension, King George's Medical University, Lucknow, India
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chen-Huan Chen
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Scolletta S, Herpain A, Romano SM, Taccone FS, Donadello K, Lubicz B, Franchi F, Kaefer KM, Polati E, Vincent JL, De Backer D. Estimation of central arterial pressure from the radial artery in patients undergoing invasive neuroradiological procedures. BMC Anesthesiol 2019; 19:173. [PMID: 31484508 PMCID: PMC6727486 DOI: 10.1186/s12871-019-0844-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/26/2019] [Indexed: 01/29/2023] Open
Abstract
Backgrounds Central arterial pressure can be derived from analysis of the peripheral artery waveform. The aim of this study was to compare central arterial pressures measured from an intra-aortic catheter with peripheral radial arterial pressures and with central arterial pressures estimated from the peripheral pressure wave using a pressure recording analytical method (PRAM). Methods We studied 21 patients undergoing digital subtraction cerebral angiography under local or general anesthesia and equipped with a radial arterial catheter. A second catheter was placed in the ascending aorta for central pressure wave acquisition. Central (AO) and peripheral (RA) arterial waveforms were recorded simultaneously by PRAM for 90–180 s. During an off-line analysis, AO pressures were reconstructed (AOrec) from the RA trace using a mathematical model obtained by multi-linear regression analysis. The AOrec values obtained by PRAM were compared with the true central pressure value obtained from the catheter placed in the ascending aorta. Results Systolic, diastolic and mean pressures ranged from 79 to 180 mmHg, 47 to 102 mmHg, and 58 to 128 mmHg, respectively, for AO, and 83 to 174 mmHg, 47 to 107 mmHg, and 60 to 129 mmHg, respectively, for RA. The correlation coefficients between AO and RA were 0.86 (p < 0.01), 0.83 (p < 0.01) and 0.86 (p < 0.01) for systolic, diastolic and mean pressures, respectively, and the mean differences − 0.3 mmHg, 2.4 mmHg and 1.5 mmHg. The correlation coefficients between AO and AOrec were 0.92 (p < 0.001), 0.87 (p < 0.001) and 0.92 (p < 0.001), for systolic, diastolic and mean pressures, respectively, and the mean differences 0.01 mmHg, 1.8 mmHg and 1.2 mmHg. Conclusions PRAM can provide reliable estimates of central arterial pressure. Electronic supplementary material The online version of this article (10.1186/s12871-019-0844-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabino Scolletta
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. .,Department of Medicine, Surgery and Neurosciences, Anesthesia and Intensive Care Unit, University Hospital of Siena, Siena, Italy.
| | - Antoine Herpain
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Salvatore Mario Romano
- Department of Heart and Vessels, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Katia Donadello
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, AOUI, University Hospital Integrated Trust of Verona, Verona, Italy
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Federico Franchi
- Department of Medicine, Surgery and Neurosciences, Anesthesia and Intensive Care Unit, University Hospital of Siena, Siena, Italy
| | - Keitiane Michele Kaefer
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Enrico Polati
- Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, AOUI, University Hospital Integrated Trust of Verona, Verona, Italy
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel De Backer
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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Noninvasive validation of central and peripheral augmentation index estimated by a novel wrist-worn tonometer. J Hypertens 2019; 36:2204-2214. [PMID: 29846328 DOI: 10.1097/hjh.0000000000001806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The validation of new blood pressure devices with easier use and more rapid data collection may facilitate the incorporation of these measures into clinical practice. We analyze the reliability and validity of Pulse Wave Analysis as reported by a novel wrist-worn device, easy and quick to use, comparing central and peripheral augmentation index (AIx) with the same measures from the SphygmoCor. Additionally, we analyzed clinical relevance through the association of the Pulse Wave Analysis, as reported by a novel wrist-worn device, with other cardiovascular parameters. METHODS Cross-sectional study including 254 participants. Mean age was 51.9 ± 13.4 years and 53% were women. MEASUREMENTS peripheral AIx (PAIx) and central AIx (CAIx) by the wrist-worn device and SphygmoCor (MM3); carotid-femoral (cf) pulse wave velocity (PWV) by SphygmoCor (MM3); cardioankle-vascular index (CAVI), ankle-brachial index (ABI) and brachial-ankle (ba) PWV by the Vasera device and carotid-intima media thickness (IMT) by ultrasonography. RESULTS Intra-observer intra-class correlation coefficient (ICC) for PAIx was 0.886 (95% CI 0.803-0.934) and for CAIx 0.943 (95% CI 0.901-0.968) with Bland Altman limits of agreement -0.75 (-23.8 to 21.8) and 0.08 (-15.7 to 15.9), respectively. Inter-observer ICC for PAIx was 0.952 (95% CI 0.915-0.972) and CAIx 0.893 (95% CI 0.811-0.939) with limits of agreement -0.45 (-13.7 to 12.8) and 0.43 (-17.7 to 18.5), respectively. Comparing the wrist-worn device with SphygmoCor, the ICC was 0.849 (95% CI 0.798-0.887) for PAIx, and 0.783 (95% CI 0.711-0.838) for CAIx. In Bland-Altman, limits of agreement for PAIx 1.03 (-20.67 to 22.73), and for CAIx -2.14 (-24.79 to 20.50). PAIx and CAIx, from the wrist-worn device, correlated with age, CAVI, ABI, baPWV, cfPWV, IMT, glomerular filtration and cardiovascular risk. CONCLUSION AIx measurements by wrist-worn device shows a good intra-observer and inter-observer reliability, inter-device noninvasive reliability and validity when compared with SphygmoCor, and clinical relevance by association with measures of vascular structure and function, end-organ damage and cardiovascular risk. TRIAL REGISTRATION Clinicaltrials.gov NCT02623894; https://clinicaltrials.gov/ct2/show/NCT02623894.
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Pour-Ghaz I, Manolukas T, Foray N, Raja J, Rawal A, Ibebuogu UN, Khouzam RN. Accuracy of non-invasive and minimally invasive hemodynamic monitoring: where do we stand? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:421. [PMID: 31660320 DOI: 10.21037/atm.2019.07.06] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One of the most important variables in assessing hemodynamic status in the intensive care unit (ICU) is the cardiac function and blood pressure. Invasive methods such as pulmonary artery catheter and arterial line allow monitoring of blood pressure and cardiac function accurately and reliably. However, their use is not without drawbacks, especially when the invasive nature of these procedures and complications associated with them are considered. There are several newer methods of noninvasive and minimally invasive hemodynamic monitoring available. In this manuscript, we will review these different methods of minimally invasive and non-invasive hemodynamic monitoring and will discuss their advantages, drawbacks and limitations.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Theodore Manolukas
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathalie Foray
- Department of Medicine - Critical Care, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aranyak Rawal
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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Noninvasive Determination of Blood Pressure by Heart Sound Analysis Compared With Intra-Arterial Monitoring in Critically Ill Children-A Pilot Study of a Novel Approach. Pediatr Crit Care Med 2019; 20:809-816. [PMID: 31107377 DOI: 10.1097/pcc.0000000000001997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a novel device to predict systolic and diastolic blood pressure based on measured heart sound signals and evaluate its accuracy in comparison to intra-arterial blood pressure readings. STUDY DESIGN Prospective, observational pilot study. SETTING PICU. PATIENTS Critically ill children (0-18 yr) undergoing continuous blood pressure monitoring via radial artery intra-arterial catheters were enrolled in the study after informed consent. The study included medical, cardiac, and surgical PICU patients. INTERVENTIONS Along with intra-arterial blood pressure, patient's heart sounds were recorded simultaneously by a highly sensitive sensor taped to the chest. Additional hardware included a data acquisition unit and laptop computer. Subsequently, advanced signal processing technologies were used to minimize random interfering signals and extract and separate S1 and S2 signals. A computerized model was then developed using artificial neural network systems to estimate blood pressure from the extracted heart sound analysis. MEASUREMENTS AND MAIN OUTCOMES We found a statistically significant correlation for systolic (r = 0.964; R = 0.928) and diastolic (r = 0.935; R = 0.868) blood pressure readings (n = 491) estimated by the novel heart-sound signal-based method and those recorded by intra-arterial catheters. The mean difference of the individually paired determinations of the blood pressure between the heart-sound-based method and intra-arterial catheters was 0.6 ± 7 mm Hg for systolic blood pressure and -0.06 ± 5 mm Hg for diastolic blood pressure, which was within the recommended range of 5 ± 8 mm Hg for any new blood pressure devices. CONCLUSIONS Our findings provide proof of concept that the heart-sound signal-based method can provide accurate, noninvasive blood pressure monitoring.
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Kim J, Chou E, Le J, Wong S, Chu M, Khine M. Soft Wearable Pressure Sensors for Beat-to-Beat Blood Pressure Monitoring. Adv Healthc Mater 2019; 8:e1900109. [PMID: 31033256 DOI: 10.1002/adhm.201900109] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/01/2019] [Indexed: 01/01/2023]
Abstract
Wrinkled gold thin films on elastomeric substrates are used as robust parallel plate electrodes for soft capacitive pressure sensors. The wrinkled structures create a robust integration with the polymer, allowing repeated normal force to deform the thin film without failure. By incorporating microridged structures that support the counter electrodes to create air cavities within the elastomeric dielectric layer, pressure sensitivity is further increased to 0.148 kPa-1 over a wide dynamic range of up to 10 kPa. The wide dynamic range and pressure sensitivity of the pressure sensor allow for consistent measurements of the pressure exerted by the radial artery located on the wrist. The soft capacitive pressure sensor displays comparable results when tested against an FDA approved device (Clearsight, Edwards Lifesciences, Irvine, CA) measuring beat-to-beat blood pressure. These soft pressure sensors using wrinkled thin films, therefore, illustrate considerable potential to continuously monitor beat-to-beat blood pressure.
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Affiliation(s)
- Joshua Kim
- Department of Materials Science and EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - En‐Fan Chou
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Jamie Le
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Sabrina Wong
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Michael Chu
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
| | - Michelle Khine
- Department of Materials Science and EngineeringUniversity of California Irvine Irvine CA 92697 USA
- Department of Biomedical EngineeringUniversity of California Irvine Irvine CA 92697 USA
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Relation of blood pressure and organ damage: comparison between feasible, noninvasive central hemodynamic measures and conventional brachial measures. J Hypertens 2019; 36:1276-1283. [PMID: 29465711 DOI: 10.1097/hjh.0000000000001688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The present cross-sectional study investigated whether central SBP and pulse pressure (PP) measured noninvasively with a novel cuff-based stand-alone monitor are more strongly associated with hypertensive end-organ damage than corresponding brachial measures. METHODS We investigated the cross-sectional association of central versus brachial SBP and PP with echocardiographic left ventricular mass index (LVMI), LV hypertrophy (LVH), carotid intima-media thickness (IMT), and increased IMT (IMT ≥ 75th percentile) among 246 participants drawn from the general population (mean age 57.2 years, 55.3% women). RESULTS All blood pressure (BP) measures were positively correlated with LVMI and IMT (P < 0.001 for all). Brachial and central SBP correlated equally strongly with LVMI (r = 0.42 versus 0.40, P for difference 0.19) and IMT (r = 0.32 versus 0.33, P = 0.60). However, brachial PP correlated more strongly than central PP with LVMI (r = 0.34 versus 0.27, P = 0.03) and IMT (r = 0.40 versus 0.35, P = 0.04). In multivariable-adjusted logistic models, all four BP measures were significantly associated with LVH and increased IMT (P ≤ 0.03 for all). However, the diagnostic accuracy of logistic regression models that included brachial or central hemodynamic parameters was similar for LVH [area under curve (AUC) for SBP: 0.74 versus 0.76, P = 0.16; AUC for PP: 0.75 versus 0.73, P = 0.35] and IMT (AUC for SBP: 0.61 versus 0.61, P = 0.67; AUC for PP: 0.63 versus 0.61, P = 0.29). CONCLUSION Our findings suggest that central SBP and PP measured with a stand-alone noninvasive BP monitor do not improve diagnostic accuracy for end-organ damage over corresponding brachial measures.
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Sharifi I, Goudarzi S, Khodabakhshi MB. A novel dynamical approach in continuous cuffless blood pressure estimation based on ECG and PPG signals. Artif Intell Med 2019; 97:143-151. [DOI: 10.1016/j.artmed.2018.12.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/01/2022]
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Cheng HM, Chuang SY, Sung SH, Wu CC, Wang JJ, Hsu PF, Chao CL, Hwang JJ, Wang TD, Chen CH. 2019 Consensus of the Taiwan Hypertension Society and Taiwan Society of Cardiology on the Clinical Application of Central Blood Pressure in the Management of Hypertension. ACTA CARDIOLOGICA SINICA 2019; 35:234-243. [PMID: 31249456 PMCID: PMC6533580 DOI: 10.6515/acs.201905_35(3).20190415b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/15/2019] [Indexed: 12/17/2022]
Abstract
The Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS) have appointed a joint consensus group for the 2019 Consensus of the TSOC and THS on the Clinical Application of Central blood pressure (BP) in the Management of Hypertension with the aim of formulating a management consensus on the clinical application of central BP in the management of hypertension. This consensus document focuses on the clinical application of central BP in the care of patients with hypertension. The major determinants of central BP are increased arterial stiffness and wave reflection, which are also the dominant hemodynamic manifestations of vascular aging. Central BP can be measured noninvasively using various techniques, including with convenient cuff-based oscillometric central BP monitors. Noninvasive central BP is better than conventional brachial BP to assess target organ damage and long-term cardiovascular outcomes. Based on the analysis of long-term events, a central BP threshold of 130/90 mmHg for defining hypertension has been proposed. Recent studies have suggested that a central BP strategy to confirm a diagnosis of hypertension may be more cost-effective than conventional strategies, and that guiding hypertension management with central BP may result in the use of fewer medications to achieve BP control. Although noninvasive measurements of brachial BP are inaccurate and central BP has been shown to carry superior prognostic value beyond brachial BP, the use of central BP should be justified in studies comparing central BP-guided therapeutic strategies with conventional care for cardiovascular events.
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Affiliation(s)
- Hao-Min Cheng
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli
| | - Shih-Hsien Sung
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
| | - Chih-Cheng Wu
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch
- College of Medicine and Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu
| | - Jiun-Jr Wang
- School of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City
| | - Pai-Feng Hsu
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei
| | - Chia-Lun Chao
- Cardinal Tien Hospital An Kang District, New Taipei City
| | - Juey-Jen Hwang
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei
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Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med 2019; 8:jcm8010069. [PMID: 30634565 PMCID: PMC6352261 DOI: 10.3390/jcm8010069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in context of a “cardiopulmonary continuum” rather than being simply attributed to shared risk factors such as cigarette smoking. Overlapping symptoms such as dyspnea or chest pain lead to a worse prognosis due to missed concomitant diagnoses. Moreover, medication is often withheld as a result of unfounded concerns about side effects. Despite the frequent coincidence, current guidelines are still mostly restricted to the management of the individual disease. Future diagnostic and therapeutic strategies should therefore be guided by an integrative perspective as well as a refined phenotyping of disease entities.
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Kotovskaya YV, Rogoza AN, Orlova YA, Posokhov IN. Ambulatory pulse wave monitoring: current and future. Opinion paper of Russian Experts. ACTA ACUST UNITED AC 2018. [DOI: 10.15829/1728-8800-2018-6-95-109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. There are appropriate recommendations on their clinical use in clinical practice guidelines of various scientific societies. Operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions. The acceptable accuracy and reproducibility of ambulatory PWA makes it be a promising tool for evaluating vascular biomarkers in daily-life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, there is no sufficient evidence to support the routine clinical use of PWA in ambulatory conditions at the moment. In particular, long-term outcome studies are needed to show the predictive value of ambulatory PWV, CAP and AIx values.
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Affiliation(s)
- Yu. V. Kotovskaya
- Russian Gerontology Clinical Research Center of the Ministry of Health
| | - A. N. Rogoza
- Scientific Medical Research Center of Cardiology of the Ministry of Health
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Multiscale mathematical modeling vs. the generalized transfer function approach for aortic pressure estimation: a comparison with invasive data. Hypertens Res 2018; 42:690-698. [PMID: 30531842 DOI: 10.1038/s41440-018-0159-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 01/11/2023]
Abstract
We aimed to evaluate the performance of a mathematical model and currently available non-invasive techniques (generalized transfer function (GTF) method and brachial pressure) in the estimation of aortic pressure. We also aimed to investigate error dependence on brachial pressure errors, aorta-to-brachial pressure changes and demographic/clinical conditions. Sixty-two patients referred for invasive hemodynamic evaluation were consecutively recruited. Simultaneously, the registration of the aortic pressure using a fluid-filled catheter, brachial pressure and radial tonometric waveform was recorded. Accordingly, the GTF device and mathematical model were set. Radial invasive pressure was recorded soon after aortic measurement. The average invasive aortic pressure was 141.3 ± 20.2/76 ± 12.2 mm Hg. The simultaneous brachial pressure was 144 ± 17.8/81.5 ± 11.7 mm Hg. The GTF-based and model-based aortic pressure estimates were 133.1 ± 17.3/82.4 ± 12 and 137 ± 21.6/72.2 ± 16.7 mm Hg, respectively. The Bland-Altman plots showed a marked tendency to pressure overestimation for increasing absolute values, with the exclusion of mathematical model diastolic estimations. The systolic pressure was increased from the aortic to radial locations (7.5 ± 19 mm Hg), while the diastolic pressure was decreased (3.8 ± 9.8 mm Hg). The brachial pressure underestimated the systolic and overestimated diastolic intra-arterial radial pressure. GTF errors were independently correlated with the variability in pulse pressure amplification and with the brachial error. Errors of the mathematical model were related to only demographic and clinical conditions. Neither a multiscale mathematical model nor a generalized transfer function device substantially outperformed the oscillometric brachial pressure in the estimation of aortic pressure. Mathematical modeling should be improved by including further patient-specific conditions, while the variability in pulse pressure amplification may hamper the performance of the GTF method in patients at the risk of coronary artery disease.
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Soleimani E, Mokhtari-Dizaji M, Fatouraee N, Saberi H. Estimation of Biomechanical Properties of Normal and Atherosclerotic Common Carotid Arteries. Cardiovasc Eng Technol 2018; 10:112-123. [DOI: 10.1007/s13239-018-00389-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
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Method of deflection corrected tonometry with phantom vessel experiments. Comput Biol Med 2018; 104:329-334. [PMID: 30463806 DOI: 10.1016/j.compbiomed.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Continuous Non-Invasive measurement of arterial Blood Pressure [CNIBP] is possible via the method of arterial tonometry and the arterial volume clamp methods. Arterial tonometry successfully measures continuous arterial pressure but requires large vessel deformation and a highly miniaturized pressure sensor to obtain a direct calibration of pressure. A properly designed tonometer is capable of achieving pressure accuracy of less than 5% error at the radial artery. The volume clamp method achieves comparable errors but is generally restricted to the very peripheral arteries. Since the brachial or radial arteries are preferable sites to record blood pressure, tonometry is generally preferred. However, due to its strict operating requirements, tonometry requires a highly skilled operator. The greatest source of measurement error results from slight deviation from the artery wall applanation position. In this study, a method for correcting tonometry deflection error is introduced and evaluated using preliminary experiments. METHODS-MODELING In prior analysis it has been shown that arterial wall flattening causes contact stress to become uniform and equal to the arterial pressure. In this article, we derive the contact stress for deflections other than the ideal applanation position and to allow variable vessel deflection. This analysis permits the contact stress to be corrected for tonometer positions that are not exact so that pressure accuracy is maintained in spite of less than ideal positioning. This will alleviate the necessity for highly skilled users and allow rapid determination of the pulse pressure. METHODS-EXPERIMENTAL Experiments were performed to evaluate applied model corrections for tonometer accuracy versus vessel deflection. Two experiments were performed to evaluate tonometer accuracy when deflection is varied. The first experiment used no deflection correction and the second experiment applied model derived deflection correction. A force sensor was used to deflect a phantom latex vessel of known internal pressure. The corrected contact pressure was then compared with known pressures to evaluate the pressure accuracy. RESULTS-MODELING: a geometric model was derived for vessel contact area versus deflection. This resulted in a formula that provides contact area continuously for any amount of deflection. Once the contact area is known the average tonometer contact pressure was obtained that corresponds with the vessel internal pressure. RESULTS - EXPERIMENTAL A latex tubing phantom vessel was pressurized to a known amount and was deflected in increments over its full diameter while measuring contact force at each position. The model-derived formula was then used to calculate pressure at each position. The calculated pressure was then compared with known internal pressure to evaluate pressure accuracy for all the phantom pressure and deflection points. CONCLUSIONS A modeling method for tonometer deflection correction was derived and evaluated using a phantom vessel. Average error was significantly reduced over the non-corrected data. The variability of error was also reduced for all data points collected. The experiments reveal that blood pressure measurement error can be reduced to levels obtained in near ideal tonometry conditions without the need for precise position control. The relaxed user precision is anticipated to simplify the use and design requirements for arterial tonometry in practice.
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Rosenbaek JB, Pedersen EB, Bech JN. The effect of sodium nitrite infusion on renal function, brachial and central blood pressure during enzyme inhibition by allopurinol, enalapril or acetazolamide in healthy subjects: a randomized, double-blinded, placebo-controlled, crossover study. BMC Nephrol 2018; 19:244. [PMID: 30241504 PMCID: PMC6150994 DOI: 10.1186/s12882-018-1035-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background Sodium nitrite (NaNO2) causes vasodilation, presumably by enzymatic conversion to nitric oxide (NO). Several enzymes with nitrite reducing capabilities have been discovered in vitro, but their relative importance in vivo has not been investigated. We aimed to examine the effects of NaNO2 on blood pressure, fractional sodium excretion (FENa), free water clearance (CH2O) and GFR, after pre-inhibition of xanthine oxidase, carbonic anhydrase, and angiotensin-converting enzyme. The latter as an approach to upregulate endothelial NO synthase activity. Methods In a double-blinded, placebo-controlled, crossover study, 16 healthy subjects were treated, in a randomized order, with placebo, allopurinol 150 mg twice daily (TD), enalapril 5 mg TD, or acetazolamide 250 mg TD. After 4 days of treatment and standardized diet, the subjects were examined at our lab. During intravenous infusion of 240 μg NaNO2/kg/hour for 2 h, we measured changes in brachial and central blood pressure (BP), plasma cyclic guanosine monophosphate (P-cGMP), plasma and urine osmolality, GFR by 51Cr-EDTA clearance, FENa and urinary excretion rate of cGMP (U-cGMP) and nitrite and nitrate (U-NOx). Subjects were supine and orally water-loaded throughout the examination day. Results Irrespective of pretreatment, we observed an increase in FENa, heart rate, U-NOx, and a decrease in CH2O and brachial systolic BP during NaNO2 infusion. P-cGMP and U-cGMP did not change during infusion. We observed a consistent trend towards a reduction in central systolic BP, which was only significant after allopurinol. Conclusion This study showed a robust BP lowering, natriuretic and anti-aquaretic effect of intravenous NaNO2 regardless of preceding enzyme inhibition. None of the three enzyme inhibitors used convincingly modified the pharmacological effects of NaNO2. The steady cGMP indicates little or no conversion of nitrite to NO. Thus the effect of NaNO2 may not be mediated by NO generation. Trial registration EU Clinical Trials Register, 2013-003404-39. Registered December 3 2013.
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Affiliation(s)
- Jeppe B Rosenbaek
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Laegaardvej 12J, DK-7500, Holstebro, Denmark.
| | - Erling B Pedersen
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Laegaardvej 12J, DK-7500, Holstebro, Denmark
| | - Jesper N Bech
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Laegaardvej 12J, DK-7500, Holstebro, Denmark
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Eley VA, Christensen R, Kumar S, Callaway LK. A review of blood pressure measurement in obese pregnant women. Int J Obstet Anesth 2018; 35:64-74. [PMID: 29954650 DOI: 10.1016/j.ijoa.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/27/2018] [Accepted: 04/15/2018] [Indexed: 10/17/2022]
Abstract
Blood pressure monitoring is a critical component of antenatal, peripartum and postnatal care. The accurate detection and treatment of abnormal blood pressure during pregnancy is essential for the optimisation of maternal and neonatal outcomes. Increasing maternal obesity in western populations is well documented. The presence of a large arm circumference in obese pregnant women may lead to difficult and inaccurate blood pressure measurements. Difficulties measuring blood pressure in non-pregnant obese patients are well described. In the literature, the problem is uncommonly mentioned in relation to pregnant patients. This topic review will discuss the importance and challenges of blood pressure measurement in pregnancy. The currently available equipment for blood pressure monitoring in pregnancy will be identified and the process of validating devices described. The limitations of the current validation protocols in pregnancy will be highlighted. It is concluded that a pregnancy-specific validation protocol is required: this would facilitate the introduction of new technology for use in high-risk pregnant women. More accurate blood pressure measurement has the potential to improve the diagnosis and management of abnormal blood pressure in pregnancy and influence maternal and neonatal outcomes.
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Affiliation(s)
- V A Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St Herston, 2006 Queensland, Australia; The University of Queensland, Faculty of Medicine, Herston Road, Herston 4006, Queensland, Australia.
| | - R Christensen
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St Herston, 2006 Queensland, Australia; The University of Queensland, Faculty of Medicine, Herston Road, Herston 4006, Queensland, Australia
| | - S Kumar
- The University of Queensland, Faculty of Medicine, Herston Road, Herston 4006, Queensland, Australia; Mater Research Institute and Department of Maternal Fetal Medicine, The Mater Mothers' Hospital, Raymond Terrace, South Brisbane, 4101 Queensland, Australia
| | - L K Callaway
- The University of Queensland, Faculty of Medicine, Herston Road, Herston 4006, Queensland, Australia; Department of Obstetrics and Gynaecology/Obstetric Medicine, The Royal Brisbane and Women's Hospital, Butterfield St Herston, 2006 Queensland, Australia
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Central Blood Pressure Monitoring via a Standard Automatic Arm Cuff. Sci Rep 2017; 7:14441. [PMID: 29089581 PMCID: PMC5663968 DOI: 10.1038/s41598-017-14844-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 11/08/2022] Open
Abstract
Current oscillometric devices for monitoring central blood pressure (BP) maintain the cuff pressure at a constant level to acquire a pulse volume plethysmography (PVP) waveform and calibrate it to brachial BP levels estimated with population average methods. A physiologic method was developed to further advance central BP measurement. A patient-specific method was applied to estimate brachial BP levels from a cuff pressure waveform obtained during conventional deflation via a nonlinear arterial compliance model. A physiologically-inspired method was then employed to extract the PVP waveform from the same waveform via ensemble averaging and calibrate it to the brachial BP levels. A method based on a wave reflection model was thereafter employed to define a variable transfer function, which was applied to the calibrated waveform to derive central BP. This method was evaluated against invasive central BP measurements from patients. The method yielded central systolic, diastolic, and pulse pressure bias and precision errors of -0.6 to 2.6 and 6.8 to 9.0 mmHg. The conventional oscillometric method produced similar bias errors but precision errors of 8.2 to 12.5 mmHg (p ≤ 0.01). The new method can derive central BP more reliably than some current non-invasive devices and in the same way as traditional cuff BP.
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Weber T, Wassertheurer S, Schmidt-Trucksäss A, Rodilla E, Ablasser C, Jankowski P, Lorenza Muiesan M, Giannattasio C, Mang C, Wilkinson I, Kellermair J, Hametner B, Pascual JM, Zweiker R, Czarnecka D, Paini A, Salvetti M, Maloberti A, McEniery C. Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study. Hypertension 2017; 70:1157-1164. [PMID: 29061725 DOI: 10.1161/hypertensionaha.117.09917] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/12/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
We investigated the relationship between left ventricular mass and brachial office as well as brachial and central ambulatory systolic blood pressure in 7 European centers. Central systolic pressure was measured with a validated oscillometric device, using a transfer function, and mean/diastolic pressure calibration. M-mode images were obtained by echocardiography, and left ventricular mass was determined by one single reader blinded to blood pressure. We studied 289 participants (137 women) free from antihypertensive drugs (mean age: 50.8 years). Mean office blood pressure was 145/88 mm Hg and mean brachial and central ambulatory systolic pressures were 127 and 128 mm Hg, respectively. Mean left ventricular mass was 93.3 kg/m2, and 25.6% had left ventricular hypertrophy. The correlation coefficient between left ventricular mass and brachial office, brachial ambulatory, and central ambulatory systolic pressure was 0.29, 0.41, and 0.47, respectively (P=0.003 for comparison between brachial office and central ambulatory systolic pressure and 0.32 for comparison between brachial and central ambulatory systolic pressure). The results were consistent for men and women, and young and old participants. The areas under the curve for prediction of left ventricular hypertrophy were 0.618, 0.635, and 0.666 for brachial office, brachial, and central ambulatory systolic pressure, respectively (P=0.03 for comparison between brachial and central ambulatory systolic pressure). In younger participants, central ambulatory systolic pressure was superior to both other measurements. Central ambulatory systolic pressure, measured with an oscillometric cuff, shows a strong trend toward a closer association with left ventricular mass and hypertrophy than brachial office/ambulatory systolic pressure. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01278732.
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Affiliation(s)
- Thomas Weber
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.).
| | - Siegfried Wassertheurer
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Arno Schmidt-Trucksäss
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Enrique Rodilla
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Cornelia Ablasser
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Piotr Jankowski
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Maria Lorenza Muiesan
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Cristina Giannattasio
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Claudia Mang
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Ian Wilkinson
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Jörg Kellermair
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Bernhard Hametner
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Jose Maria Pascual
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Robert Zweiker
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Danuta Czarnecka
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Anna Paini
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Massimo Salvetti
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Alessandro Maloberti
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
| | - Carmel McEniery
- From the Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.); Center for Health & Bioresources, Department of Health and Environment, Austrian Institute of Technology, Vienna (S.W., B.H.); Division Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland (A.S.-T.); Department of Medicina Interna, Hospital de Sagunto, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., J.M.P.); Cardiology Department, Medical University Graz, Austria (C.A., R.Z.); 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland (P.J., D.C.); Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., A.P., M.S.); Cardiology IV, 'A. De Gasperis' Department, ASTT Ospedale Niguarda Ca' Granda, School of Medicine and Surgery, Milano-Bicocca University, Italy (C.G., A.M.); Department of Obstetrics and Gynecology, Bethesda Spital, Basel, Switzerland (C.M.); Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (I.W., C.M.); and Cardiology Department, Kepler University Clinic, Linz, Austria (J.K.)
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Schumacher G, Kaden JJ, Trinkmann F. Multiple coupled resonances in the human vascular tree: refining the Westerhof model of the arterial system. J Appl Physiol (1985) 2017; 124:131-139. [PMID: 29025900 DOI: 10.1152/japplphysiol.00405.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The human arterial vascular tree can be described by multicompartment models using electrical components. First introduced in the 1960s by Noordergraaf and Westerhof, these hardware-based approaches required several simplifications. We were able to remove the restrictions using modern software simulation tools and improve overall model quality considerably. Whereas the original Westerhof model consisted of 121 Windkessel elements, the refined model has 711 elements and gives realistic pulse waveforms of the aorta and brachial and radial arteries with realistic blood pressures. Moreover, novel insights concerning the formation of the physiological aortic-to-radial transfer function were gained. Its being potentially due to the coupling of many small resonant elements gives new impetus to the discussion of arterial pressure wave reflection. The individualized transfer function derived from our improved model incorporates distinct patient characteristics and can potentially be used for estimation of central blood pressure values. NEW & NOTEWORTHY We were able to find an individualized transfer function giving realistic pulse waveforms and blood pressures using a multicompartment model of the arterial system. Based on the hardware-built Westerhof approach, several simplifications initially introduced in the 1960s could be reversed using software simulation. Overall model quality was improved considerably, and multiple coupled resonances were identified as potential explanation for the formation of the aortic-to-radial transfer function, giving new impetus to the discussion of arterial pressure wave reflection.
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Affiliation(s)
| | - Jens J Kaden
- 1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
| | - Frederik Trinkmann
- 1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
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Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability. J Hypertens 2017; 34:1665-77. [PMID: 27214089 DOI: 10.1097/hjh.0000000000000969] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).
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Sharman JE, Avolio AP, Baulmann J, Benetos A, Blacher J, Blizzard CL, Boutouyrie P, Chen CH, Chowienczyk P, Cockcroft JR, Cruickshank JK, Ferreira I, Ghiadoni L, Hughes A, Jankowski P, Laurent S, McDonnell BJ, McEniery C, Millasseau SC, Papaioannou TG, Parati G, Park JB, Protogerou AD, Roman MJ, Schillaci G, Segers P, Stergiou GS, Tomiyama H, Townsend RR, Van Bortel LM, Wang J, Wassertheurer S, Weber T, Wilkinson IB, Vlachopoulos C. Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization. Eur Heart J 2017; 38:2805-2812. [PMID: 28158489 PMCID: PMC5837446 DOI: 10.1093/eurheartj/ehw632] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alberto P. Avolio
- Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Macquarie University, Sydney, Australia
| | - Johannes Baulmann
- Clinic of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Athanase Benetos
- Département de Médecine Gériatrique, CHRU de Nancy and INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Jacques Blacher
- Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - C. Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Pierre Boutouyrie
- Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
| | - Chen-Huan Chen
- Faculty of Medicine, Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, London, UK
| | - John R. Cockcroft
- Department of Biomedical Sciences, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - J. Kennedy Cruickshank
- Cardiovascular Medicine Group, Division of Diabetes and Nutritional Sciences, King’s College, London, UK
| | - Isabel Ferreira
- School of Public Health, The University of Queensland, Herston, Brisbane, Australia
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alun Hughes
- Institute of Cardiovascular Science, University College London, London, UK
| | - Piotr Jankowski
- First Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stephane Laurent
- Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
| | - Barry J. McDonnell
- Department of Biomedical Sciences, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Carmel McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Theodoros G. Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gianfranco Parati
- Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
| | - Athanase D. Protogerou
- Department of Pathophysiology, Cardiovascular Prevention and Research Unit, ‘Laiko’ Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mary J. Roman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Giuseppe Schillaci
- Dipartimento di Medicina, Università di Perugia, Unità di Medicina Interna, Ospedale ‘S. Maria’, Terni, Italy
| | | | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Raymond R. Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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50
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Central blood pressure in children and adolescents: non-invasive development and testing of novel transfer functions. J Hum Hypertens 2017; 31:831-837. [DOI: 10.1038/jhh.2017.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/07/2017] [Accepted: 07/10/2017] [Indexed: 01/25/2023]
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