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Yang Z, Zhao Y, Lan Y, Xiang M, Wu G, Zang J, Zhang Z, Xue C, Gao L. Screen-Printable Iontronic Pressure Sensor with Thermal Expansion Microspheres for Pulse Monitoring. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 39039805 DOI: 10.1021/acsami.4c05688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Constructing microstructures to improve the sensitivity of flexible pressure sensors is an effective approach. However, the preparation of microstructures usually involves inverted molds or subtractive manufacturing methods, which are difficult in large-scale (e.g., in screen printing) preparation. To solve this problem, we introduced thermally expandable microspheres for screen printing to fabricate flexible sensors. Thermally expandable microspheres can be constructed into microstructures by simple heating after printing, which simplifies the microstructure fabrication step. In addition, the added microspheres can also be used as ionic liquid reservoir materials to further increase the capacitance change and improve the sensitivity. The prepared sensors exhibited superior performance, including ultrahigh sensitivity (Smax = 49999.5 kPa-1) and wide detection range (0-350 kPa). Even after 30,000 cycles at a high pressure of 300 kPa and a low pressure of 30 kPa, the sensor showed minimal signal degradation, demonstrating long-term cycling stability. In order to verify the practical potential of the sensors, we performed human radial artery beat detection experiments using these sensors. The variations in the intensity of the 3D radial artery pulse wave can be observed very clearly, which is important for human health monitoring. The above demonstrates that our strategy can provide an effective approach for the large-scale preparation of high-performance flexible pressure sensors.
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Affiliation(s)
- Zekun Yang
- Key Laboratory of Instrumentation Science and Dynamic Measurement Ministry of Education, North University of China, Taiyuan 030051, China
| | - Yunlong Zhao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, and Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
- Shenzhen Research institute of Xiamen University, Xiamen University, Shenzhen 518000, China
| | - Yihui Lan
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, and Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
- Shenzhen Research institute of Xiamen University, Xiamen University, Shenzhen 518000, China
| | - Menghui Xiang
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, and Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
- Shenzhen Research institute of Xiamen University, Xiamen University, Shenzhen 518000, China
| | - Guirong Wu
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, and Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
- Shenzhen Research institute of Xiamen University, Xiamen University, Shenzhen 518000, China
| | - Junbin Zang
- Key Laboratory of Instrumentation Science and Dynamic Measurement Ministry of Education, North University of China, Taiyuan 030051, China
| | - Zhidong Zhang
- Key Laboratory of Instrumentation Science and Dynamic Measurement Ministry of Education, North University of China, Taiyuan 030051, China
| | - Chenyang Xue
- Key Laboratory of Instrumentation Science and Dynamic Measurement Ministry of Education, North University of China, Taiyuan 030051, China
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, and Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
| | - Libo Gao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, and Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
- Shenzhen Research institute of Xiamen University, Xiamen University, Shenzhen 518000, China
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Xing C, Xie X, Wu Y, Xu L, Guan X, Li F, Zhan X, Yang H, Li J, Zhou Q, Mu Y, Zhou Q, Ding Y, Wang Y, Wang X, Zheng Y, Sun X, Li H, Zhang C, Zhao C, Qiu S, Yan G, Yang H, Mao Y, Zhan W, Ma C, Gu Y, Chen W, Xie M, Jiang T, Yuan L. Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal: A nationwide, multicenter study. Chin Med J (Engl) 2024:00029330-990000000-01129. [PMID: 38958034 DOI: 10.1097/cm9.0000000000003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants. METHODS A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson's correlation, multiple linear regression, and analyses of covariance. RESULTS All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. CONCLUSIONS The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.
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Affiliation(s)
- Changyang Xing
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi 710038, China
| | - Xiujing Xie
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Yu Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Lei Xu
- Department of Ultrasound, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi 710021, China
| | - Xiangping Guan
- Ultrasound Medical Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068, China
| | - Fan Li
- Department of Ultrasound, Hospital of Northwestern Polytechnical University, Xi'an, Shaanxi 710072, China
| | - Xiaojun Zhan
- Department of Ultrasound, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, Shaanxi 710002, China
| | - Hengli Yang
- Department of Ultrasound Diagnosis, The Second Affiliated Hospital, Xi'an Medical College, Xi'an, Shaanxi 710038, China
| | - Jinsong Li
- Department of Ultrasound, Xi'an Gem Flower ChangQing Hospital, Xi'an, Shaanxi 710201, China
| | - Qi Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, China, Xi'an, Shaanxi 710004, China
| | - Yuming Mu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Qing Zhou
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Yunchuan Ding
- Department of Ultrasound, Yan'an Hospital, The Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650051, China
| | - Yingli Wang
- Department of Ultrasound, Yan'an University Xianyang Hospital, Xianyang, Shaanxi 712000, China
| | - Xiangzhu Wang
- Department of Function Examination, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China
| | - Yu Zheng
- Department of Ultrasound, Xi'an Central Hospital, Xi'an, Shaanxi 710004, China
| | - Xiaofeng Sun
- Cadre's Wards Ultrasound Department, Diagnostic Ultrasound Center, First Hospital of Jilin University, Changchun, Jilin 130000, China
| | - Hua Li
- Department of Echocardiography, Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi, Xinjiang 830002, China
| | - Chaoxue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Cheng Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Shaodong Qiu
- Department of Ultrasound, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
| | - Guozhen Yan
- Department of Ultrasound, The First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia 014000, China
| | - Hong Yang
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Yinjuan Mao
- Department of Ultrasound, The Fourth People's Hospital, Xi'an, Shaanxi 710043, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Ying Gu
- Department of Ultrasound Center, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Wu Chen
- Department of Ultrasound Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Lijun Yuan
- Department of Ultrasound Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi 710038, China
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Bia D, Salazar F, Cinca L, Gutierrez M, Facta Á, Diaz A, Zócalo Y. Impact of a cuff-based device calibration method on the agreement between invasive and noninvasive aortic and brachial pressure. Clin Physiol Funct Imaging 2024; 44:228-239. [PMID: 38014525 DOI: 10.1111/cpf.12869] [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: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Brachial cuff-based methods are increasingly used to estimate aortic systolic blood pressure (aoSBP). However, there are several unresolved issues. AIMS to determine to what extent the scheme used to calibrate brachial records (1) can affect noninvasive obtained aoSBP levels, and consequently, the level of agreement with the aoSBP recorded invasively, and (2) how different ways of calibrating ultimately impact the relationship between aoSBP and cardiac properties. METHODS brachial and aortic blood pressure (BP) was simultaneously obtained by invasive (catheterisation) and noninvasive (brachial oscillometric-device) methods (89 subjects). aoSBP was noninvasive obtained using three calibration schemes: 'SD': diastolic and systolic brachial BP, 'C': diastolic and calculated brachial mean BP (bMBP), 'Osc': diastolic and oscillometry-derived bMBP. Agreement between invasive and noninvasive aoSBP, and associations between BP and echocardiographic-derived parameters were analysed. CONCLUSIONS 'C' and 'SD' schemes generated aoSBP levels lower than those recorded invasively (mean errors: 6.9 and 10.1 mmHg); the opposite was found when considering 'Osc'(mean error: -11.4 mmHg). As individuals had higher invasive aoSBP, the three calibration schemes increasingly underestimated aoSBP levels; and viceversa. The 'range' of invasive aoSBP in which the calibration schemes reach the lowest error level (-5-5 mmHg) is different: 'C': 103-131 mmHg; 'Osc': 159-201 mmHg; 'SD':101-124 mmHg. The calibration methods allowed reaching levels of association between aoSBP and cardiac characteristics, somewhat lower, but very similar to those obtained when considering invasive aoSBP. There is no evidence of a clear superiority of one calibration method over another when considering the association between aoSBP and cardiac characteristics.
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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
| | - Federico Salazar
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Luis Cinca
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Marcos Gutierrez
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Álvaro Facta
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Alejandro Diaz
- Instituto de Investigación en Ciencias de la Salud, UNICEN-CCT CONICET, Tandil, Provincia de Buenos Aires, Argentina
| | - Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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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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Bia D, Salazar F, Cinca L, Gutierrez M, Facta A, Zócalo Y, Diaz A. Direct estimation of central aortic pressure from measured or quantified mean and diastolic brachial blood pressure: agreement with invasive records. Front Cardiovasc Med 2023; 10:1207069. [PMID: 37560119 PMCID: PMC10409477 DOI: 10.3389/fcvm.2023.1207069] [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: 04/17/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
Background Recently it has been proposed a new approach to estimate aortic systolic blood pressure (aoSBP) without the need for specific devices, operator-dependent techniques and/or complex wave propagation models/algorithms. The approach proposes aoSBP can be quantified from brachial diastolic and mean blood pressure (bDBP, bMBP) as: aoSBP = bMBP2/bDBP. It remains to be assessed to what extent the method and/or equation used to obtain the bMBP levels considered in aoSBP calculation may affect the estimated aoSBP, and consequently the agreement with aoSBP invasively recorded. Methods Brachial and aortic pressure were simultaneously obtained invasively (catheterization) and non-invasively (brachial oscillometry) in 89 subjects. aoSBP was quantified in seven different ways, using measured (oscillometry-derived) and calculated (six equations) mean blood pressure (MBP) levels. The agreement between invasive and estimated aoSBP was analyzed (Concordance correlation coefficient; Bland-Altman Test). Conclusions The ability of the equation "aoSBP = MBP2/DBP" to (accurately) estimate (error <5 mmHg) invasive aoSBP depends on the method and equation considered to determine bMBP, and on the aoSBP levels (proportional error). Oscillometric bMBP and/or approaches that consider adjustments for heart rate or a form factor ∼40% (instead of the usual 33%) would be the best way to obtain the bMBP levels to be used to calculate aoSBP.
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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
| | - Federico Salazar
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Luis Cinca
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Marcos Gutierrez
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Alvaro Facta
- Sección Hipertensión Arterial, Departamento de Cardiología, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Yanina Zócalo
- Departamento de Fisiología, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Diaz
- Instituto de Investigación en Ciencias de la Salud, UNICEN-CCT CONICET, Tandil, Argentina
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Bia D, Zócalo Y, Sánchez R, Torrado JF, Lev G, Mendiz O, Pessana F, Ramírez A, Cabrera-Fischer EI. Brachial Blood Pressure Invasively and Non-Invasively Obtained Using Oscillometry and Applanation Tonometry: Impact of Mean Blood Pressure Equations and Calibration Schemes on Agreement Levels. J Cardiovasc Dev Dis 2023; 10:jcdd10020045. [PMID: 36826541 PMCID: PMC9959257 DOI: 10.3390/jcdd10020045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023] Open
Abstract
The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.
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Affiliation(s)
- Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay
- Correspondence: or (D.B.); (Y.Z.)
| | - Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay
- Correspondence: or (D.B.); (Y.Z.)
| | - Ramiro Sánchez
- Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina
| | - Juan F. Torrado
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay
| | - Gustavo Lev
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina
| | - Oscar Mendiz
- Department of Interventional Cardiology, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina
| | - Franco Pessana
- Department of Information Technology, Engineering and Exact Sciences Faculty, Favaloro University, Buenos Aires 1746, Argentina
| | - Agustín Ramírez
- IMETTYB, Favaloro University—CONICET, Buenos Aires 1746, Argentina
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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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8
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Sun H, Yao Y, Liu W, Zhou S, Du S, Tan J, Yu Y, Xu L, Avolio A. Wave reflection quantification analysis and personalized flow wave estimation based on the central aortic pressure waveform. Front Physiol 2023; 14:1097879. [PMID: 36909238 PMCID: PMC9996124 DOI: 10.3389/fphys.2023.1097879] [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: 11/14/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Pulse wave reflections reflect cardiac afterload and perfusion, which yield valid indicators for monitoring cardiovascular status. Accurate quantification of pressure wave reflections requires the measurement of aortic flow wave. However, direct flow measurement involves extra equipment and well-trained operator. In this study, the personalized aortic flow waveform was estimated from the individual central aortic pressure waveform (CAPW) based on pressure-flow relations. The separated forward and backward pressure waves were used to calculate wave reflection indices such as reflection index (RI) and reflection magnitude (RM), as well as the central aortic pulse transit time (PTT). The effectiveness and feasibility of the method were validated by a set of clinical data (13 participants) and the Nektar1D Pulse Wave Database (4,374 subjects). The performance of the proposed personalized flow waveform method was compared with the traditional triangular flow waveform method and the recently proposed lognormal flow waveform method by statistical analyses. Results show that the root mean square error calculated by the personalized flow waveform approach is smaller than that of the typical triangular and lognormal flow methods, and the correlation coefficient with the measured flow waveform is higher. The estimated personalized flow waveform based on the characteristics of the CAPW can estimate wave reflection indices more accurately than the other two methods. The proposed personalized flow waveform method can be potentially used as a convenient alternative for the measurement of aortic flow waveform.
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Affiliation(s)
- Hongming Sun
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China
| | - Yang Yao
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Wenyan Liu
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China
| | - Shuran Zhou
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China
| | - Shuo Du
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China
| | - Junyi Tan
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China
| | - Yin Yu
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China
| | - Lisheng Xu
- College of Medicine and Biological and Information Engineering, Northeastern University, Shenyang, China.,Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, China.,Neusoft Research of Intelligent Healthcare Technology, Co. Ltd, Shenyang, China
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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9
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Pereira MM, Torrado J, Bock J, Sosa C, Diaz A, Bia D, Zócalo Y. Wave separation analysis-derived indexes obtained from radial and carotid tonometry in healthy pregnancy and pregnancy-associated hypertension: Comparison with pulse wave analysis-derived indexes. Front Cardiovasc Med 2022; 9:997452. [PMID: 36386340 PMCID: PMC9664074 DOI: 10.3389/fcvm.2022.997452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increased wave reflections assessed by pulse wave analysis (PWA) was proposed as one of the potential culprits of hypertension seen in women with pregnancy-associated hypertension (PAH). However, this statement has never been confirmed with "Wave Separation Analysis" (WSA), a more sophisticated mathematical approach that analyzes the amplitude and interaction between forward and backward aortic pressure waveform components. OBJECTIVE To characterize potential changes in pressure wave components of PAH compared to healthy non-pregnant (NP) women and women with normal pregnancies (HP) by using WSA and compared these findings with PWA-derived indexes; secondarily, to evaluate differences in WSA-derived indexes between subgroups of PAH (i.e., preeclampsia [PE] and gestational hypertension [GH]). METHODS Using radial and carotid applanation tonometry, we quantified in HP (n = 10), PAH (n = 16), and NP (n = 401): (i) PWA-derived indexes; (ii) WSA-derived indexes: forward (Pf) and backward (Pb) waveform components, backward component arrival time (PbAT), reflection magnitude (RM = Pb/Pf) and index [RIx = Pb/(Pf + Pb)]. RESULTS While PAH was associated with a higher Pf compared to HP and NP, Pb and PbAT were similar between the groups. Both GH and PE showed a higher Pf compared to HP, but only PE had a trend of presenting with higher Pb and lower PbAT compared to the other groups. Finally, PAH showed a trend of having lower RM and RIx compared to NP and HP, with no differences between GH and PE. CONCLUSION PAH was associated with higher Pf, but not higher Pb, compared to NP and HP, although PE also demonstrated a trend of higher Pb.
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Affiliation(s)
- María M. Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joshua Bock
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology “C”, Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Alejandro Diaz
- Consejo Nacional de Investigaciones Científicas y Técnicas, Tandil, Argentina
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay,*Correspondence: Yanina Zócalo,
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10
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Gómez-García M, Torrado J, Pereira M, Bia D, Zócalo Y. Fat-Free Mass Index, Visceral Fat Level, and Muscle Mass Percentage Better Explain Deviations From the Expected Value of Aortic Pressure and Structural and Functional Arterial Properties Than Body Fat Indexes. Front Nutr 2022; 9:856198. [PMID: 35571946 PMCID: PMC9099434 DOI: 10.3389/fnut.2022.856198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Bioelectrical impedance analysis (BIA)-derived indexes [e.g., fat (FMI) and fat-free mass indexes (FFMI), visceral fat level (VFL)] are used to characterize obesity as a cardiovascular risk factor (CRF). The BIA-derived index that better predicts arterial variability is still discussed.
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Affiliation(s)
- Mariana Gómez-García
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - María Pereira
- Department of Obstetrics and Gynecology, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, New York, NY, United States
| | - Daniel Bia
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Yanina Zócalo
- CUiiDARTE-Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
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11
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Gómez-García M, Torrado J, Bia D, Zócalo Y. Influence of Epoch Length and Recording Site on the Relationship Between Tri-Axial Accelerometry-Derived Physical Activity Levels and Structural, Functional, and Hemodynamic Properties of Central and Peripheral Arteries. Front Sports Act Living 2022; 4:799659. [PMID: 35280222 PMCID: PMC8909126 DOI: 10.3389/fspor.2022.799659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
BackgroundIt remains to be established to what extent physical activity (PA) levels among individuals are independently associated with deviations from the “optimal” state of the arterial system. Accelerometers have been proposed as means to obtain reliable, objective, and more comprehensive data of PA. Decisions at the time of data collection/processing could influence the association between accelerometry-derived indices and arterial properties.Objectives(i) To identify to what extent the strength of association between arterial properties and accelerometer-derived indices depend on the recording site and/or the epoch length; (ii) to determine whether some arterial characteristics (hemodynamic vs. structural vs. functional) or regions (elastic vs. transitional vs. muscular arteries; central vs. peripheral) have higher levels of association with accelerometry-derived indices.MethodsPhysical activity (PA), cardiovascular risk factors (CRFs), and cardiovascular properties were evaluated in 60 volunteers (general population; age: 23–62 years; women: 43%). PA was measured daily for 7 days (free-living situation; triaxial-accelerometers ActiGraph-GT3X+; hip and wrist; “Worn-to-wrist” option) and raw data was converted at epoch lengths of 1, 5, 10, 30, and 60-s. PA-related energy expenditure, daily time in moderate-to-vigorous PA, steps/minute, and counts-per-minute for vector magnitude were calculated. The cardiovascular evaluation included hemodynamic (central and peripheral pressure), structural (diameters and intima-media thickness), and functional (local and regional stiffness) parameters of carotids, femoral, and brachial arteries, and carotid-femoral and carotid-radial pathways. Arterial z-scores were obtained using age-related equations derived from healthy participants not exposed to CRFs (n = 1,688; age: 2–84 years; female: 51.2%) to evaluate at which degree each parameter deviates from the “optimal” value.MethodsIn general, hip recordings outperformed those obtained on the wrist regarding the strength of association with arterial parameters. Accelerometer-derived indices and their association with arterial properties vary depending on the recording site and epoch length. PA indices are stronger associated with functional (local) than structural variables and with central than peripheral arteries.ConclusionsRegardless of the PA index, there were independent associations with central artery characteristics, which reinforces that these territories would be the most related to PA levels. Differences in data acquisition and processing could lead to differences in conclusions when addressing the association between accelerometer-derived indices and the cardiovascular system.
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Affiliation(s)
- Mariana Gómez-García
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Yanina Zócalo
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
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12
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Zócalo Y, Gómez-García M, Torrado J, Bia D. Aging-Related Moderation of the Link Between Compliance With International Physical Activity Recommendations and the Hemodynamic, Structural, and Functional Arterial Status of 3,619 Subjects Aged 3–90 Years. Front Sports Act Living 2022; 4:800249. [PMID: 35265833 PMCID: PMC8899126 DOI: 10.3389/fspor.2022.800249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Compliance with physical activity recommendations (CPARs) is associated with better health indicators. However, there are only few studies to date that have comprehensively analyzed the association between CPARs and cardiovascular status “as a whole” (e.g., analyzing hemodynamic, structural, and functional properties, and different arterial territories). The relationship between CPARs and cardiovascular properties could be strongly influenced by the growth and aging process. Aim The goal of the study is to investigate the association between CPAR and cardiovascular properties by placing special emphasis on: (i) identifying if there is an independent association, (ii) if the association is “moderated” by age, and (iii) to what extent the association depends on the arterial parameter (hemodynamic vs. structural vs. functional) and/or the arterial segment (e.g., central vs. peripheral; elastic vs. transitional vs. muscular arteries). Methods A total of 3,619 subjects (3–90 years of age) were studied. Extensive cardiovascular evaluations were performed. Cardiovascular risk factors (CRFs) and physical activity (PA) levels were determined. The subjects were categorized as compliant (n = 1, 969) or non-compliant (n = 1,650) with World Health Organization-related PA recommendations. Correlation and multiple regression models (including CPAR*Age interaction) were obtained, and Johnson-Neyman technique was used to produce regions of significance. Results The independent association between CPARs and cardiovascular characteristics were strongly moderated by age. The moderation was observed on a wide range of age but particularly notorious on the extremes of life. Certain arterial characteristics demonstrated opposite effects in relation to CPAR status depending on the range of age considered. The association between CPAR and cardiovascular characteristics was independent of CRFs and moderated by age. In subjects younger than 45–55 years, CPAR status was associated with lower central and peripheral blood pressure (i.e., the younger the subject, the higher the reduction). During adult life, as age increases in the subjects, CPARs was associated with a beneficial hemodynamic profile, which is not related with variations in pressure but strongly related with lower levels of waveform-derived indexes and ventricular afterload determinants. Conclusions The independent associations between CPARs and arterial properties were strongly moderated by age. Data provided by blood pressure levels and waveform-derived indexes would be enough to evaluate the independent association between CPARs and the vascular system in the general population.
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Affiliation(s)
- Yanina Zócalo
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
| | - Mariana Gómez-García
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Daniel Bia
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Universidad de la República, Montevideo, Uruguay
- CUiiDARTE - Movimiento, Actividad, Salud (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica, Universidad de la República, Montevideo, Uruguay
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