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Arteriographを評価している最近の文献例

Central blood pressure: current evidence and clinical importance
Carmel M. McEniery1*, John R. Cockcroft2, Mary J. Roman3,
Stanley S. Franklin4, and Ian B.Wilkinson1
1Clinical Pharmacology Unit, University of Cambridge, Addenbrookes Hospital, Box 110, Cambridge CB22QQ, UK; 2Department of Cardiology,Wales Heart Research Institute, Cardiff
CF14 4XN, UK; 3Division of Cardiology,Weill Cornell Medical College, New York, NY 10021, USA; and 4University of California, UCI School of Medicine, Irvine, CA 92697-4101, USA

Received 29 April 2013; revised 27 November 2013; accepted 17 December 2013; online publish-ahead-of-print 23 January 2014

and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications
for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively
targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.
Central pressure Blood pressure Anti-hypertensive treatment Cardiovascular risk

Introduction

The brachial cuff sphygmomanometer was introduced into medicalpractice well over 100 years ago, enabling the routine, non-invasive,
measurement of arterial blood pressure. Life insurance companieswere among the first to capitalize on the information provided by
cuff sphygmomanometry, by observing that blood pressure inlargely asymptomatic individuals relates to future cardiovascular
riskobservations that are nowsupported by a wealth of epidemiologicaldata.1 The most recent Global Burden of Disease report2
identified hypertension as the leading cause of death and disabilityworldwide. Moreover, data from over 50 years of randomized controlled
trials clearly demonstrate that lowering brachial pressure,in hypertensive individuals, substantially reduces cardiovascular
events.1,3 For these reasons, measurement of brachial blood pressurehas become embedded in routine clinical assessment throughout
the
developed world, and is one of the most widely accepted surrogatemeasures for regulatory bodies.
The major driving force for the continued use of brachial bloodpressure has been its ease of measurement, and the wide variety of
devices available for clinical use. However, we have known for overhalf a century that brachial pressure is a poor surrogate for aortic
pressure, which is invariably lower than corresponding brachialvalues. Recent evidence suggests that central pressure is also more
strongly related to future cardiovascular events4 7 than brachialpressure, and responds differently to certain drugs.8,9 Appreciating
this provides an ideal framework for understanding the much publicizedinferiority of atenolol and some other beta-blockers,10 compared
with other drug classes, in the management of essentialhypertension. Although central pressure can now be assessed noninvasively
with the same ease as brachial pressure, clinicians are unlikelyto discard the brachial cuff sphygmomanometer without
robust evidence that cardiovascular risk stratification, and monitoringresponse to therapy, are better when based on central rather
than peripheral pressure. Central pressure assessment and accuracywill also have to be standardized, as it has been for brachial pressure
assessment with oscillometric devices. This review will discuss ourcurrent understanding about central pressure and the evidence
required to bring blood pressure measurement, and cardiovascularrisk assessment into the modern era.

Physiological concepts

Arterial pressure varies continuously over the cardiac cycle, but inclinical practice only systolic and diastolic pressures are routinely
reported. These are invariably measured in the brachial arteryusing cuff sphygmomanometrya practice that has changed little
over the last century. However, the shape of the pressure waveform* Corresponding author. Tel: +44 1223 336806, Fax: +44 1223 216893, Email: cmm41@cam.ac.uk
Published on behalf of the European Society of Cardiology. All rights reserved. &The Author 2014. For permissions please email: journals.permissions@oup.com
European Heart Journal (2014) 35, 17191725 doi:10.1093/eurheartj/eht565
Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk.
However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding
 
brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better
 related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial
 and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications
 for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively 
targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.As discussed earlier,
a full synthesis of the available evidence concerning

central pressure and the risk of future cardiovascular events is now required. However, it will also be necessary to determine
the
 clinical relevance of differences between brachial and central pressure
for the individual patient, especially given
the relatively high correlation
 between the two. Emerging data support the prognostic superiority of both 24-h ambulatory blood pressure monitoring
(ABPM)79 81 andhomemonitoring81 in comparison with office measurements. Interestingly, a recent study82 demonstrated that
24-h
 ambulatory cuff pressures were comparable with office central pressure
measurements in the prediction of risk, although the significance of this study awaits confirmation.83 As yet, there are no data comparing
 the predictive value ofhomemonitoring vs. central pressure in the
prediction of risk. Ultimately, it will be necessary to evaluate
the prognostic
 value of 24-h ambulatory central pressure.With the recent development of ambulatory central pressure systems,84,85 this is now
possible and it may be reasonable to hypothesize that 24-h central, rather than brachial ABPM would be superior in terms of risk prediction.

Arteriographを開発したTensiomed社が推薦した文献は以下の通り
Arterial stiffness The term "arterial stiffness" once referred only to the loss of compliance in the large arteries, now it is a comprehensive term encompassing the characteristics of the entire arterial system, including the biochemical-structural-mechanical changes in the small and large arteries, as well as the comparative pressures. Cardiovascular disease is the No. 1 cause of death worldwide. Heart attack, heart failure and stroke are the top three within the category. A sudden jump in blood pressure is the most frequent cause of stroke, while myocardial infarctions (heart attacks) are most often caused by a partial or full coronary occlusion, a rupture of vulnerable plaque built up during severe coronary atherosclerosis. In nearly every case, some stage of the process of sclerosis is present. In order to prevent severe vascular crises, it is essential to identify individuals who are at risk but have not yet developed symptoms. Identification of at-risk individuals, examination of the patient for the signs of preclinical atherosclerosis, as well as the identification and treatment of the classical risk factors are included in the European Guidelines for the management of arterial hypertension since 2007. "Sudden heart attack," in the literal sense of the word, does not exist. The arterial system prepares for a plaque rupture over the course of years, or even decades, like a ticking time bomb. Most severe events can, therefore, be prevented with early detection of atherosclerosis (with the help of functional and structural tests) and preventive treatment begun in a timely manner. European Guidelines list the types of target organ damage that can occur even in asymptomatic patients. The screening is recommended and mandatory in every hypertension patient. The Guidelines emphasize the screening for asymptomatic atherosclerosis in as large a pool of individuals as possible, as well as the importance of such testing for high risk of cardiovascular disease because together with the traditional risk factors, it has a greater degree of predictive value. It is a simple, proven fact today that arterial stiffness is a truly important and independent indicator of cardiovascular risk. The functional and structural changes in the large arteries are partly age-related, but there are several conditions that show a link with accelerated arterial stiffening, such as hypertension, atherosclerosis, end-stage renal disease, as well as the traditional risk factors (diabetes, dyslipidemia, smoking etc.). That is why arterial stiffness has become a main topic of clinical research in recent years, indicated by the huge increase in publications on the subject. Why you should buy an Arteriograph Arteriograph- Comprehensive cardiovascular risk assessment in only 3 minutes! - A medical breakthrough in early diagnostics of atherosclerosis! A big problem today is that many individuals with high risk of cardiovascular diseases otherwise have normal values; normal blood pressure, blood lipids and resting-EKG. The catastrophe strikes without any prior warning. The Arteriograph is an evidence based, fast, easy, noninvasive and user independent way of assessing cardiovascular risk. For the first time one have a good chance of finding high risk patient before it is too late. 1. Screening of early atherosclerosis among "healthy" individuals. Only the Arteriograph is useful for this. The Arteriograph gives an overall picture of the risk of assessing cardiovascular disease. 2. Evaluating the effects of treatments (drugs, nutritional supplements and lifestyle changes etc) on the vascular functions among patients with established atherosclerosis (CAD, POST MI, STROKE, PAD) 3. Is it not enough to check the blood lipids and blood pressure to prevent atherosclerosis and thereby strokes? No, 40-60% of patients with stroke or heart attacks do not have any know abnormal values such as high amount of blood lipids or high blood pressure (Johns Hopkins White Papers, Coronary Heart Disease - 1998, etc). They also have normal blood glucose values, resting-EKG, are non-smokers and have a healthy diet. Up until now it has been impossible to find there individuals. 4. Todays metods of assessing cardiovascular risk (SCORE, Framingham) all have limits. They do not take into account important factors such as lack of physical activity, overweight, psychological factors or previous cardiovascular circumstances. (Simon, A. and Levenson, J.: May subclinical arterial disease helps to better detect and treat high-risk asymptomatic individuals? J Hypertension 2005, 23: 1939-1945) 5. In most cases, lowering the blood pressure is not enough to avoid early death. Individuals who can lower both their arterial stiffness and blood pressure have a much greater chance of a longer life.Circulation 2001;103:987 6. The Arteriograph is mobile and easy to use. The screening is fast, comfortable, harmless and user independent. It takes only a few minutes and can be described as a computerized blood pressure measurement. 7. Today´s other available methods are hard to use, expensive, and requires an adequate educated staff. In the future, the Arteriograph may replace the regular blood pressure measurement as it is just as easy but gives much more information. The Arteriograph is intended for DAILY USE at your clinic to measure AIx, PWV and Central blood pressure etc. Arteriograph- Comprehensive cardiovascular risk assessment in only 3 minutes! - A medical breakthrough in early diagnostics of atherosclerosis! A big problem today is that many individuals with high risk of cardiovascular diseases otherwise have normal values; normal blood pressure, blood lipids and resting-EKG. The catastrophe strikes without any prior warning. The Arteriograph is an evidence based, fast, easy, noninvasive and user independent way of assessing cardiovascular risk. For the first time one have a good chance of finding high risk patients before it is too late .The Arteriograph is also used to evaluate the effect of different medications. Free demonstration of the Arteriograph on Wednesdays at 5-7 pm at S?derkliniken, G?tgatan 82. Please call in advance to let us know that you will be there.
American Journal of Hypertension ajh.oxfordjournals.org Am J Hypertens (2005) 18 (S4): 15A. doi: 10.1016/j.amjhyper.2005.03.035 P-17: A new and fast screening method for measuring complex hemodynamical parameters and arterial stiffness non-invasively with a simple arm cuff Miklos Illyes1 + Author Affiliations 1TensioMed Ltd., TensioMed Ltd, Budapest, Hungary Abstract Aims: In a project of the National Research Program of Hungary, we studied if oscillometric signals received during an oscillometric BP measurement contain any information about arterial hemodynamics Materials, Methods: We have developed a research tool by which not only SBP, DBP, HR data, but the complete oscillometric signals were stored and transmitted telemedically to our computer center from the home of 650 patients who performed BP measurements at least 4 times a day, for at least 1 month. Through this a large database was collected, containing more than 1700000 oscillometric pulse curves and the relevant clinical data of patients. For data mining we used Kohonen's self-organising map method. Non-invasively recorded oscillometric curves from the upper arm cuff were validated by the simultaneously recorded intraarterial pressure curve of brachial artery. Results: Our researches showed that oscillometric pulse curve of the brachial artery is identical to the intraarterial pressure curve if the cuff was inflated to suprasystolic pressure, preferably 35 mmHg above the SBP. Thus the early and the late systolic pressure peak, the closing incisure of the aortic valve can be recognizable, and several hemodinamical parameters could be calculated. By using the mentioned results of basic researches, a new instrument, the TensioClinic Arteriograph was developed, by which the following parameters could be measured within 2 minutes, by using a simple upper arm cuff: SBP, DBP, HR, MAP, PP, augmentation index (AIx), normalized augmentation index to 80/min heart rate (AIx80), return time of the pulse wave of the aorta (RT), pulse wave velocity (PWV) of the aorta, length of the cardiac cycle, area of systolic (SAI) and diastolic (DAI) part of pulse curve. Validation studies of the new method to control the accuracy of measured AIx and PWV showed high correlations (R = 0,76 and R = 0,8) with values measured with other non-invasive methods (Sphygmocor and Complior) respectively. Conclusions: Due to the swiftness, simplicity and good reproducibility of this method and apparatus, the non-invasive assessment of the most important hemodynamical parameters and arterial stiffness had become available for population screening, opening a new window in the detection of the early phase of the athero- and arteriosclerosis, and thus it can play an important role in the reduction of the CV morbidity and mortality. Hungary's "tensio arteriograph" - a simple way of examining our veins 27-01-2006 11:38 | S?ndor Laczk? " Send by email " Print Cardio-vascular disease is the leading cause of death in Hungary and much of the rest of the world. Problems are often detected too late because many people do not suffer obvious symptoms. Even suspect cases can be difficult to confirm. But that may soon be history thanks to a new device invented by Hungarian doctor Miklos Illyes. The "tensio arteriograph" is the first and so far only device that provides us with a fast and easy way of obtaining cardiac data that in the past could only be obtained through complicated and sometimes painful screenings. "The medical profession was lacking a proper method to determine these data, called 'arterial stiffness parameters', namely, the augmentation index and the pulse rate velocity of the human aorta. So, this method before was determined by very specific procedures, very difficult methods, which needed a lot of time and a lot of expert knowledge of how to perform the examination." Tensio arteriograph Says, doctor Miklos Illyes, the inventor of the tensio arteriograph. So how does it work? It's much simpler than one might expect. The arteriograph detects the condition of our veins in a procedure that's just as easy as taking our blood pressure. "We discovered a new method how to assess the so-called arterial stiffness non-invasively with a very fast method, which needs only two minutes to determine the arterial age of the patient. This novelty consists of the fact that we use a simple cough to determine important central human dynamical parameters. This makes it possible for us to use this method for everyday practice and to screen the patient for arteriosclerosis. We do feel that in a few years, this kind of method will be used generally not only to check blood pressure but to have much more information about arterial stiffness beyond blood pressure measurement." Dr. Laszlo Tisler of the St. Imre Hospital in Budapest was one of the first physicians to use it: "My experience over all is very positive. It uses a very new way of assessing the compliance of large blood vessels. This information is substantial because it is associated with the survival of our patients - in particular, with patients of higher cardiovascular risk. The information this device provides is extremely helpful in those with high risk, and this may add new information, information on compliance of the vessel, or stiffness of the vessel, may provide information on those who have no other risk factors and this may be a very early sign of cardiovascular risk."
Pulse Wave Analysis The pulse wave reflects the condition of the entire arterial system, from the large arteries all the way to the small arteries. Pulse wave analysis is a technique recognized long ago, since doctors in China measured it as part of traditional medicine, using the three fingers on the pulse method, and a long road of experience brought it into scientific knowledge. The first graphic procedures for registration of pulse waves were first demonstrated in Paris (Marey) and then London (Mahomed) in the last century, then for a smaller audience of interested parties. 100 years ago, Mahomed used the sphygmomanometer to show asymptomatic high blood pressure and to test for chronic nephritis. In the 20th century with the high-tech explosion, technologies offering fundamental and detailed information about the condition of the entire arterial system were developed, whose use and analysis is very simple. Thus the non-invasive pulse wave test is now conducted with other methods. High-fidelity sensors, tonometers and piezo-techniques make it possible to observe and record the pulse wave shape more and more accurately. The recognition of changes in pressure makes it easier to understand hemodynamics and the process of arterial aging. The pulse wave, depending on the method, can be felt and registered in areas where arterial pulsation is easily accessible. Measurement can be carried out most easily similarly to blood pressure measurement with tonometry and piezo-electric technologies on the carotid, radial and femoral arteries, and the newest, oscillometric methods on the upper arm. The direct wave traveling toward the heart, the reflective wave and the systolic and diastolic periods can be determined from the pulse wave contour, and from this we can draw conclusions regarding the interaction of the heart and the arterial system, which until now could only be recognized using invasive arterial catheterization. Today, with the help of pulse wave analysis, we can better familiarize ourselves with the physiological and pathological behavior of the arterial wall, and determine a more exact diagnosis and therapy. Pulse wave amplification The shape of a blood pressure wave (BP) constantly distorts as it travels from the central elastic arteries toward the muscular conduit arteries. This is a physiological phenomenon, that the blood pressure, as a periodically oscillating wave, travels and reflects in occasionally differently structured portions of the viscoelastic arterial system. In healthy individuals, the pulse wave amplitude (pulse pressure (PP)) increases from the aorta/carotid section to the brachial/radial section without added energy, such that the arterial central pressure and the diastolic pressure remains almost unchanged. This phenomenon is called pulse wave amplification, the change in the maximum systolic blood pressure level in the arterial system, its increase from the aorta toward the periphery. More and more clinical research focuses on the prognostic value of the peripheral and central systolic blood pressure levels. Pulse wave amplification can be described in several different ways, the most well known being the ratio or difference between the distal and the proximal maximums. From a physiological standpoint, in addition to a given brachial (peripheral) pulse pressure the most favorable effect on the heart and arterial system is an even lower central pressure value, since the heart must thus work against a lower pulsatile pressure (and the larger the difference in the absolute value of the periphery and central pressures, the more favorable the amplification). Pulse wave amplification, according to statistics, decreases with age. In high blood pressure research and in heart and arterial system risk assessment the role of central blood pressure has come to the forefront, and today it is clear that it is a better marker than peripheral (upper arm) blood pressure for the condition of target organ damage and for cardiovascular risk and therapy. The conventional, traditional method based on high blood pressure in quite a number of cases overestimates or underestimates cardiovascular risk. Furthermore it has become clear that the different pharmaceutical groups do not affect pulse pressure amplification in the same way; for example, vasodilator agents increase compared with the beta blockers. In contrast to brachial blood pressure, pulse wave amplification in and of itself predicts CV mortality, and shows a strong correlation with pulse pressure measured in the carotid as well - we can read this in a study of late-stage renal disease patients. Another publication provides evidence that in untreated patients suffering from essential high blood pressure they observed that following therapy a decrease in left ventricular mass index directly correlated to an increase in pulse wave amplification, and not to a decrease in brachial blood pressure. Benetos et al first carried out testing at the population level, in which they proved that PP amplification in and of itself correlates to cardiovascular mortality, independent of other risk factors. Renal Denervation Improves Blood Pressure And Arterial Stiffness Published: August 27, 2012. By European Society of Cardiology http://www.escardio.org Munich, Germany - August 27 2012: Renal denervation improves blood pressure and arterial stiffness in patients with therapy resistant hypertension, according to research presented at ESC Congress 2012 by Mr Klaas Franzen from the University Hospital of Schleswig-Holstein. The findings suggest that renal denervation regenerates blood vessels and could reduce cardiovascular events. Related Content " Go to European Society of Cardiology's website " Show More News from European Society of Cardiology Malignant arterial hypertension was historically treated with surgical thoracolumbar splanchnicectomy, a type of sympathectomy treatment that was introduced in 1938. "A significant reduction in blood pressure response was observed in at least half of the patients who underwent splanchnicectomy," said Mr Franzen. "But the treatment led to severe adverse events such as orthostatic hypotension, anhidrosis and intestinal disturbances. After the discovery of effective antihypertensive drugs, splanchnicectomy became neglected and disregarded over time." In 2009 the concept of sympathectomy was reintroduced with intravasal catheter-based percutaneous renal sympathetic denervation (RDN) used in patients suffering from resistant arterial hypertension. Recent publications have shown that RDN significantly lowers systolic and diastolic peripheral brachial blood pressure by 32/12 mmHg after 6 months. Mr Franzen said: "RDN with radiofrequency energy has several important advantages over surgical splanchnicectomy: it is a minimally invasive procedure without significant systematic side effects, it is well tolerated, and recovery times are short." Arterial hypertension can irrevocably harm blood vessels in the short and long term, subsequently leading to increased aortic/arterial stiffness and arteriosclerosis. "Since central aortic pressures and arterial stiffness are much better predictors for future cardiovascular events than peripheral pressures we focused the present study on the effects of RDN on central hemodynamics and arterial stiffness," said Mr Franzen. The researchers studied 21 patients with therapy resistant hypertension (61.9% men; mean age 64 years; 5.0±1.3 antihypertensive drugs) and 6 controls (83.3% men; mean age 57 years; 4.3±2.3 antihypertensive drugs). The inclusion criteria were: (i) use of >3 antihypertensive drugs, (ii) peripheral blood pressure at baseline ?150 mmHg, and (iii) exclusion of secondary hypertension and anatomical abnormalities of the renal arteries. RDN was performed with an RDN radiofrequency ablation catheter system (1). Central hemodynamics and arterial stiffness, i.e. pulse wave velocity (PWV), were recorded with an Arteriograph device (2). Measurements were performed at baseline, and 3 and 6 months after the intervention. RDN led to an improvement in all parameters compared to baseline. Peripheral systolic blood pressure improved by 7.6% (145 mmHg versus 156 mmHg, p<0.05) after 3 months and by 5.4% (148 mmHg versus 156 mmHg, p<0.05) after 6 months. Central systolic blood pressure improved by 9.5% (147 mmHg versus 161 mmHg, p<0.01) after 3 months and by 6.6% (151 mmHg versus 161 mmHg, p<0.05) after 6 months. Most importantly, PWV improved significantly, both at 3 months (9.4±1.2 m/s versus 10.9±1.8 m/s, p<0.01) and 6 months (9.7±1.8 m/s versus 10.9±1.8 m/s, p<0.01). Univariate analysis of variance (f-test) showed that the improvement of PWV was, at least in part, blood pressure independent. In controls no significant changes in blood pressure values or PWV were observed. "Besides peripheral blood pressures, RDN improved central blood pressures and arterial stiffness, i.e. PWV," said Mr Franzen. "According to age adjusted reference values, the improvement of approximately 1m/s PWV observed in our study could be interpreted as a blood vessel rejuvenation of almost 10 years. This suggests that RDN might be a fountain of youth for blood vessels in patients with therapy resistant hypertension." He added: "Further studies are needed to determine whether the benefits of RDN translate into a reduced risk of cardiovascular events."
Hypertension Research (2011) 34, 202-208; doi:10.1038/hr.2010.196; published online 21 October 2010 Can arterial stiffness parameters be measured in the sitting position? Jens N?rnberger1, Rene Michalski2, Tobias R T?rk2, Anabelle Opazo Saez1, Oliver Witzke2 and Andreas Kribben2 1. 1Department of Nephrology and Dialysis, HELIOS Kliniken Schwerin, Wismarsche Stra?e, Schwerin, Germany 2. 2Department of Nephrology, University Hospital Essen, University Essen-Duisburg, Hufelandstra?e, Essen, Germany Correspondence: Dr J N?rnberger, Department of Nephrology, HELIOS Kliniken Schwerin, Wismarsche Stra?e 393-397, Schwerin 19049, Germany. E-mail: jens.nuernberger@uni-due.de Received 2 May 2010; Revised 25 July 2010; Accepted 31 July 2010; Published online 21 October 2010. Top of page Abstract Despite the introduction of arterial stiffness measurements in the European recommendation, pulse wave velocity (PWV) and augmentation index (AI) are still not used routinely in clinical practice. It would be of advantage if such measurements were done in the sitting position as is done for blood pressure. The aim of this study was to evaluate whether there is a difference in stiffness parameters in sitting vs. supine position. Arterial stiffness was measured in 24 healthy volunteers and 20 patients with cardiovascular disease using three different devices: SphygmoCor (Atcor Medical, Sydney, Australia), Arteriograph (TensioMed, Budapest, Hungary) and Vascular Explorer (Enverdis, Jena, Germany). Three measurements were performed in supine position followed by three measurements in sitting position. Methods were compared using correlation and Bland-Altman analysis. There was a significant correlation between PWV in supine and sitting position (Arteriograph: P<0.0001, r=0.93; Vascular Explorer; P<0.0001, r=0.87). There were significant correlations between AI sitting and AI supine using Arteriograph (P<0.0001, r=0.97), Vascular Explorer (P<0.0001, r=0.98) and SphygmoCor (P<0.0001, r=0.96). When analyzed by Bland-Altman, PWV and AI measurements in supine vs. sitting showed good agreement. There was no significant difference in PWV obtained with the three different devices (Arteriograph 7.5±1.6?m?s?1, Vascular Explorer 7.3±0.9?m?s?1, SphygmoCor 7.0±1.8?m?s?1). AI was significantly higher using the Arteriograph (17.6±15.0%) than Vascular Explorer and SphygmoCor (10.2±15.1% and 10.3±18.1%, respectively). The close agreement between sitting and supine measurements suggests that both PWV and AI can be reliably measured in the sitting position. Keywords: arterial stiffness; augmentation index; PWV; pluse wave velocity Abstracts of the American Society of Hypertension, Inc. 28th Annual Scientific Meeting and Exposition, San Francisco, USA May 15-18, 2013 The Journal of Clinical Hypertension, 2013, Volume 15, May 2013 Abstract Supplement 28th Annual Scientific Meeting and Exposition San Francisco, USA May 15-18, 2013. ________________________________________ Acute Coronary Syndrome Patients: How Stiff are their Arteries? Deaconu Alexandru Ioan 1 , Tautu Oana Florentina 1 , Fruntelata Ana Gabriela 2 , Dorobantu Maria 1 1 Emergency Hospital of Bucharest, Bucharest, Romania; 2 Monza Cardiovascular Center, Bucharest, Romania Several non-invasive methods are currently used to assess vascular stiffness. Pulse wave velocity (PWV) and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. A large amount of evidence indicates that carotid-femoral PWV is an intermediate endpoint for cardiovascular (CV) events, either fatal or non-fatal. Central AIx and pulse pressure have shown an independent predictive value for CV events in hypertensives and patients with coronary disease. Studies of arterial stiffness in patients with cardiovascular emergencies and acute coronary syndromes, respectively, are missing. We performed measurements of arterial stiffness parameters using the TensioMed Arteriograph in 34 patients admitted for acute coronary syndromes (ACS), 24 hours after admission. The study group included 28 males (82.4%) and mean age was 61.7 ± 14.07 years. Arterial stiffness parameters as aortic PWV, aortic AIx, central systolic blood pressure (aortic SBP), central pulse pressure (aortic PP) were analyzed in relation to clinical, historical and paraclinical parameters in order to describe particularities in this patient population. We compared the results with an age and sex adjusted population of 34 controls randomly selected from the most recent Romanian cross-populational statistical survey, SEPHAR II. In our group, 45.7% of patients were hypertensive and 37.1% were diabetic. Most of the patients were on treatment with ACE inhibitors (91.4%) and beta-blockers (80%), while 71.1% were on intravenous or oral nitrates. Mean stiffness parameters in this group were: aortic AIx=28.51 + 10.81, with only 14.8% of patients showing normal values; aortic PWV = 9.71 ± 1.82 m/s; aortic SBP = 121.71 ± 21.07 mm Hg; aortic PP = 44.39 ± 13.74 mm Hg. No correlations were identified in this small group between arterial stiffness parameters and treatment, history of hypertension or diabetes, type of ACS and angiographic coronary anatomy. While aortic AIx was clearly abnormal, reflecting changes in endothelial function and waves' reflection, the other parameters of arterial stiffness were not different from other patient populations. Aortic AIx is abnormally increased in patients with acute coronary syndromes. Parameters of arterial stiffness in patients with ACS are not related to treatment, type of coronary disease or previous patient history.
Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniques. Noor A Jatoi, Azra Mahmud, Kathleen Bennett, John Feely Department of Pharmacology and Therapeutics, Trinity College Centre for Health Sciences and Hypertension Clinic, St. James's Hospital, Dublin, Ireland. Journal of hypertension (impact factor: 4.02). 10/2009; 27(11):2186-91. DOI:10.1097/HJH.0b013e32833057e8 Source: PubMed ABSTRACT Arterial stiffness, measured as aortic pulse wave velocity (PWV), and wave reflection, measured as augmentation index (AIx), are independent predictors for total and cardiovascular morbidity and mortality. The aim of this study was to compare a new device Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniques. Abstract BACKGROUND Arterial stiffness, measured as aortic pulse wave velocity (PWV), and wave reflection, measured as augmentation index (AIx), are independent predictors for total and cardiovascular morbidity and mortality. The aim of this study was to compare a new device, based on oscillometric pressure curves (Arteriograph), which simultaneously measures PWV and AIx, with standard techniques for measuring PWV (Complior) and AIx (SphygmoCor) in untreated hypertensive patients. METHODS We compared PWV and AIx measured using the Arteriograph with corresponding Complior and SphygmoCor measurements in 254 untreated hypertensive patients, age 48 +/- 14 years (mean +/- SD, range 17-85 years). RESULTS Arteriograph PWV and AIx were closely related with Complior (r = 0.60, P < 0.001) and SphygmoCor (r = 0.89, P < 0.001), respectively. Using stepwise regression analysis, the independent determinants of Arteriograph PWV were age, mean arterial pressure, heart rate and sex (r(2) = 0.44, P < 0.0001) and for AIx were age, weight, mean arterial pressure, heart rate and sex (r(2) = 0.65, P < 0.0001). The bias between the different techniques was determined by age and sex for PWV and age, body weight, sex, heart rate and mean arterial pressure for AIx. Bland-Altman plots showed that although the techniques were closely related, the limits of agreement were wide. CONCLUSION Although Arteriograph values and the determinants of PWV and AIx are in close agreement with corresponding parameters obtained by Complior and SphygmoCor, respectively, the techniques are not interchangeable.
Clin Cardiol. 2012 Jan;35(1):26-31. doi: 10.1002/clc.20999. Epub 2011 Nov 14. Comparison of aortic and carotid arterial stiffness parameters in patients with verified coronary artery disease. Gaszner B, Lenkey Z, Illy?s M, S?rszegi Z, Horv?th IG, Magyari B, Moln?r F, K?nyi A, Czir?ki A. Source Heart Institute, Faculty of Medicine, University of P?cs, Hungary. Abstract BACKGROUND: Arterial stiffness parameters are commonly used to determine the development of atherosclerotic disease. The independent predictive value of aortic stiffness has been demonstrated for coronary events. HYPOTHESIS: The aim of our study was to compare regional and local arterial functional parameters measured by 2 different noninvasive methods in patients with verified coronary artery disease (CAD). We also compared and contrasted these stiffness parameters to the coronary SYNTAX score in patients who had undergone coronary angiography. METHODS: In this study, 125 CAD patients were involved, and similar noninvasive measurements were performed on 125 healthy subjects. The regional velocity of the aortic pulse wave (PWVao) was measured by a novel oscillometric device, and the common carotid artery was studied by a Doppler echo-tracking system to determine the local carotid pulse wave velocity (PWVcar). The augmentation index (AIx), which varies proportionately with the resistance of the small arteries, was recorded simultaneously. RESULTS: In the CAD group, the PWVao and aortic augmentation index (Alxao) values increased significantly (10.1 ± 2.3 m/sec and 34.2% ± 14.6%) compared to the control group (9.6 ± 1.5 m/sec and 30.9% ± 12%; P < 0.05). We observed similar significant increases in the local stiffness parameters (PWVcar and carotid augmentation index [Alxcar]) in patients with verified CAD. Further, we found a strong correlation for PWV and AIx values that were measured with the Arteriograph and those obtained using the echo-tracking method (r = 0.57, P < 0.001 for PWV; and r = 0.65, P < 0.001 for AIx values). CONCLUSIONS: Our results indicate that local and regional arterial stiffness parameters provide similar information on impaired arterial stiffening in patients with verified CAD. ? 2011 Wiley Periodicals, Inc. Can arterial stiffness parameters be measured in the sitting position? Jens N?rnberger,Rene Michalski,Tobias R T?rk,Anabelle Opazo Saez,Oliver Witzke,Andreas Kribben DOI: 10.1038/hr.2010.196 Despite the introduction of arterial stiffness measurements in the European recommendation, pulse wave velocity (PWV) and augmentation index (AI) are still not used routinely in clinical practice. It would be of advantage if such measurements were done in the sitting position as is done for blood pressure. The aim of this study was to evaluate whether there is a difference in stiffness parameters in sitting vs. supine position. Arterial stiffness was measured in 24 healthy volunteers and 20 patients with cardiovascular disease using three different devices: SphygmoCor (Atcor Medical, Sydney, Australia), Arteriograph (TensioMed, Budapest, Hungary) and Vascular Explorer (Enverdis, Jena, Germany). Three measurements were performed in supine position followed by three measurements in sitting position. Methods were compared using correlation and Bland-Altman analysis. There was a significant correlation between PWV in supine and sitting position (Arteriograph: P<0.0001, r=0.93; Vascular Explorer; P<0.0001, r=0.87). There were significant correlations between AI sitting and AI supine using Arteriograph (P<0.0001, r=0.97), Vascular Explorer (P<0.0001, r=0.98) and SphygmoCor (P<0.0001, r=0.96). When analyzed by Bland-Altman, PWV and AI measurements in supine vs. sitting showed good agreement. There was no significant difference in PWV obtained with the three different devices (Arteriograph 7.5±1.6?m?s(-1), Vascular Explorer 7.3±0.9?m?s(-1), SphygmoCor 7.0±1.8?m?s(-1)). AI was significantly higher using the Arteriograph (17.6±15.0%) than Vascular Explorer and SphygmoCor (10.2±15.1% and 10.3±18.1%, respectively
Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. 18:59 EDT 12th September 2013 | BioPortfolio Home " Latest PubMed Articles " Journals " Journal of hypertension " Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity. Summary of "Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity." BACKGROUND: The importance of measuring aortic pulse wave velocity (PWVao), aortic augmentation index (Aix) and central systolic blood pressure (SBPao) has been shown under different clinical conditions; however, information on these parameters is hard to obtain. The aim of this study was to evaluate the accuracy of a new, easily applicable oscillometric device (Arteriograph), determining these parameters simultaneously, against invasive measurements. METHODS: Aortic Aix, SBPao and PWVao were measured invasively during cardiac catheterization in 16, 55 and 22 cases, respectively, and compared with the values measured by the Arteriograph. RESULTS: We found strong correlation between the invasively measured aortic Aix and the oscillometrically measured brachial Aix on either beat-to-beat or mean value per patient basis (r = 0.9, P < 0.001; r = 0.94, P < 0.001), which allowed the noninvasive calculation of the aortic Aix without using generalized transfer function. Similarly strong correlation (r = 0.95, P < 0.001) was found between the invasively measured and the noninvasively calculated central SBPao; furthermore, the BHS assessment of the paired differences fulfilled the 'B' grading. The PWVao values measured invasively and by Arteriograph were 9.41 +/- 1.8 m/s and 9.46 +/- 1.8 m/s, respectively (mean +/- SD); furthermore, the Pearson's correlation was 0.91 (P < 0.001). The limits of agreement were 11.4% for aortic Aix and 1.59 m/s for PWVao. CONCLUSION: Aix, SBPao and PWVao, measured oscillometrically, showed strong correlation with the invasively obtained values. The observed limits of agreement are encouragingly low for accepting the method for clinical use. Our results suggest that the PWVao values, measured by Arteriograph, are close to the true aortic PWV, determined invasively. Affiliation aHeart Institute, Medical School, University of P?cs, P?cs, Hungary bDepartment of Cardiology, University of Rome La Sapienza, Polo Pontino, Italy. Journal Details This article was published in the following journal. Am J Hypertens. 2013 Aug 31. [Epub ahead of print] Invasive Validation of Arteriograph Estimates of Central Blood Pressure in Patients With Type 2 Diabetes. Rossen NB, Laugesen E, Peters CD, Ebbeh?j E, Knudsen ST, Poulsen PL, B?tker HE, Hansen KW. Author information " Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark. Abstract BACKGROUND: Central blood pressure (BP) has attracted increasing interest because of a potential superiority over brachial BP in predicting cardiovascular morbidity and mortality. Several devices estimating central BP noninvasively are now available. The aim of our study was to determine the validity of the Arteriograph, a brachial cuff-based, oscillometric device, in patients with type 2 diabetes. METHODS: We measured central BP invasively and compared it with the Arteriograph-estimated values in 22 type 2 diabetic patients referred to elective coronary angiography. RESULTS: The difference (invasively measured BP minus Arteriograph-estimated BP) in central systolic BP (SBP) was 4.4±8.7mm Hg (P = 0.03). The limits of agreement were ±17.1mm Hg. CONCLUSIONS: Compared with invasively measured central SBP, we found a systematic underestimation by the Arteriograph. However, the limits of agreement were similar to the previous Arteriograph validation study and to the invasive validation studies of other brachial cuff-based, oscillometric devices. A limitation in our study was the large number of patients (n = 14 of 36) in which the Arteriograph was unable to analyze the pressure curves. In a research setting, the Arteriograph seems applicable in patients with type 2 diabetes. CLINICAL TRAIL REGISTRATION: ClinicalTrials.gov ID NCT01538290. KEYWORDS: blood pressure, brachial cuff-based, oscillometric devices for measurement of central BP, cardiovascular disease, cardiovascular risk, central blood pressure (BP), diabetes, hypertension, invasive validation of brachial cuff-based, oscillometric devices noninvasive measurement of central BP.

Invasive Validation of Arteriograph Estimates of Central Blood Pressure in Patients With Type 2 Diabetes 1. Niklas Blach Rossen1,2, 2. Esben Laugesen2, 3. Christian Daugaard Peters3, 4. Eva Ebbeh?j2, 5. S?ren Tang Knudsen2, 6. Per L?gstrup Poulsen2, 7. Hans Erik B?tker4 and 8. Klavs W?rgler Hansen1 + Author Affiliations 1. 1 Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark; 2. 2 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; 3. 3 Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; 4. 4 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 1. Correspondence: Niklas Blach Rossen (niklas.rossen@rm.dk). Received April 15, 2013. Revision received August 6, 2013. Accepted August 7, 2013. Abstract BACKGROUND Central blood pressure (BP) has attracted increasing interest because of a potential superiority over brachial BP in predicting cardiovascular morbidity and mortality. Several devices estimating central BP noninvasively are now available. The aim of our study was to determine the validity of the Arteriograph, a brachial cuff-based, oscillometric device, in patients with type 2 diabetes. METHODS We measured central BP invasively and compared it with the Arteriograph-estimated values in 22 type 2 diabetic patients referred to elective coronary angiography. RESULTS The difference (invasively measured BP minus Arteriograph-estimated BP) in central systolic BP (SBP) was 4.4±8.7mm Hg (P = 0.03). The limits of agreement were ±17.1mm Hg. CONCLUSIONS Compared with invasively measured central SBP, we found a systematic underestimation by the Arteriograph. However, the limits of agreement were similar to the previous Arteriograph validation study and to the invasive validation studies of other brachial cuff-based, oscillometric devices. A limitation in our study was the large number of patients (n = 14 of 36) in which the Arteriograph was unable to analyze the pressure curves. In a research setting, the Arteriograph seems applicable in patients with type 2 diabetes.
The Scientific World Journal Volume 2013 (2013), Article ID 792693, 6 pages http://dx.doi.org/10.1155/2013/792693 Clinical Study Evaluation of Arterial Stiffness for Predicting Future Cardiovascular Events in Patients with ST Segment Elevation and Non-ST Segment Elevation Myocardial Infarction Oguz Akkus,1 Durmus Yildiray Sahin,2 Abdi Bozkurt,3 Kamil Nas,4 Kaz?m Serhan Ozcan,1 Mikl?s Illy?s,5 Ferenc Moln?r,6 Serafettin Demir,7 M?cahit T?fenk,3 and Esmeray Acarturk3 1Sanliurfa Siverek State Hospital, 63600 Sanliurfa, Turkey 2Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey 3Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey 4Department of Radiology, Szent J?nos Hospital, Budapest, Hungary 5Heart Institute, Faculty of Medicine, University of P?cs, P?cs, Hungary 6Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary 7Department of Cardiology, Adana State Hospital, Adana, Turkey Received 18 August 2013; Accepted 15 September 2013 Academic Editors: H. Kitabata and E. Skalidis Copyright ? 2013 Oguz Akkus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). Methods. Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph. Results. Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure . There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE. Conclusions. Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI. 1. Introduction Acute myocardial infarction (AMI) continues a worldwide cause of mortality [1]. In-hospital and 6-month-mortality are approximately 5-7% versus 12-13%, respectively [2, 3]. Estimated risk of mortality for AMI is based on the clinical status of the patients [4]. Recent studies showed that conventional risk factors are inadequate for predicting cardiovascular (CV) mortality and morbidity. A novel risk factor called arterial stiffness, which is a defined reduction of the compliance of arterial wall, and relationship between coronary heart disease (CHD) have been demonstrated. Arterial stiffness results in faster reflection of the forward pulse wave from bifurcation points in peripheral vessels. As a result of new waveform, systolic blood pressure (SBP) increases, diastolic blood pressure (DBP) decreases, cardiac workload increases, and coronary perfusion falls down. It plays a major role in the determination of cardiovascular outcomes, and it is not inferior to the traditional risk factors to assess the future risk [5, 6]. Elevated arterial stiffness is associated with increased major adverse cardiovascular events (MACE) such as unstable angina, AMI, coronary revascularization, heart failure, stroke, and death [7]. Arterial stiffness parameters including mean arterial pressure (MAP), pulse pressure (PP), PWV (m/s), and augmentation index (AI) are directly proportional to the risk of MACE [8-10]. PWV is a susceptible diagnostic element, and it is also involved in risk stratification for subclinical organ damages [11]. Few studies regarding arterial stiffness demonstrated that PWV exhibits a close effect with coronary heart disease [5, 12, 13]. Whether arterial stiffness parameters are related to MACE after acute MI has not been studied sufficiently. The aim of our study was to compare arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) and to validate its prognostic value. 2. Patients Ninety-four patients with acute MI (72 men and 22 women, mean age 60,41 ± 11,17) were included in the study. There were 45 STEMI and 49 NSTEMI. Data of patients were analyzed within 24 hours after hospitalization. All patients received eligible treatment according to ESC guidelines. The choice of preparations was entrusted to the investigator. Hemodynamically compromised patients (Killip classifications II, III, and IV), patients with chronic atrial fibrillation and/or flutter, chronic renal failure, mild-severe valvular heart diseases and other chronic diseases were excluded. Our local ethics committee approved the study, and written informed consent was obtained from all participants. Patients were followed up for 12 months. 3. Diagnosis of Acute Myocardial Infarction Diagnosis of AMI was based on symptoms, elevated cardiac markers, and electrocardiogram (ECG) changes. Patients with typical chest pain plus ECG changes indicative of an AMI (pathologic Q waves, at least 1?mm ST segment elevation in any 2 or more contiguous limb leads or new left bundle branch block, or new persistent ST segment and T wave changes diagnostic of a non-Q wave myocardial infarction) or a plasma level of cardiac troponin-T level above normal. 4. Laboratory Findings Troponin T, creatine kinase-MB fraction (CK-MB), serum urea, creatinine, eGFR, and other hematological parameters were checked at the admission. Risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, and family history, were recorded. Hypertension was considered as SBP and DBP greater than 140?mmHg and 90?mmHg, respectively, using an antihypertensive medication. Diabetes mellitus, hyperlipidemia, and hypertriglyceridemia were defined as using antidiabetic drugs or fasting blood glucose over 126?mg/dL, as plasma low-density lipoprotein cholesterol (LDL-C) >130?mg/dL, using lipid-lowering drugs at the time of investigation, and as TG level >150?mg/dL, respectively, according to the Third Report of the National Cholesterol Education Program guidelines. First-degree relatives who are exposed to coronary artery disease (CAD) before the age for male is <55 and female <65 were considered as family history. 5. Pulse Waveform Analysis Assessment of arterial stiffness was performed noninvasively with the commercially available TensioMed Arteriograph. We collected the oscillometric pulse waves from the patients. We measured the distance between the jugulum-symphysis (which is equal to the distance between the aortic root and the aortic bifurcation), and PWV was calculated. Pulse waves were recorded at suprasystolic pressure. The oscillation signs were identified from the cuff inflated at least >35?mmHg above the systolic blood pressure. In this state there was a complete brachial artery occlusion, and it functions as a membrane before the cuff. Pulse waves hit the membrane, and oscillometric waves were measured by the device and we could see the waveforms on the monitor. The AI was defined as the ratio of the difference between the second (P2 appearing because of the reflection of the first pulse wave) and first systolic peaks (P1 induced by the heart systole) to pulse pressure (PP), and it was expressed as a percentage of the ratio (AI = [P2 ? P1]/PP × 100). SBP, DBP, PP, and heart rate and other hemodynamic parameters as return time (RT in sec.), diastolic reflection area (DRA), systolic area index (SAI %), and diastolic area index (DAI %) were measured noninvasively. DRA reflects the quality of the coronary arterial diastolic filling (SAI and DAI are the areas of systolic and diastolic portions under the pulse wave curve of a complete cardiac cycle, resp.). Hence, the bigger the DAI and DRA are, the better the coronary perfusion is. Furthermore, RT is the PWV time from the aortic root until the bifurcation and return, so this value is smaller as the aortic wall is stiffer. Smoking and Hypertension Associated With Greater Arterial Stiffness in People Aging With HIV By Fred Furtado From TheBodyPRO.com November 8, 2013 Having HIV is not independently associated with arterial stiffness -- a trait linked to cardiovascular disease risk -- despite HIV-infected individuals having a modest, but clinically significant, increase in arterial stiffness when compared to their uninfected counterparts. Instead, factors such as smoking and hypertension may account for the increase, according to study results presented at EACS 2013 in Brussels, Belgium. To provide some background, HIV infection has been associated with an increased risk of cardiovascular disease and one of the markers for this condition is arterial stiffness, which is measured by pulse wave velocity (PWV), or how fast blood moves through the circulatory system. With age, or other changes to the arterial wall, blood vessels become stiffer and blood moves faster through the system, giving the heart less time to rest. PWV is directly dependent on mean arterial pressure (MAP) and past research has shown that an increase of 1 m/s (meter per second) in PWV is associated with a 14% greater incidence in total cardiovascular events. However, studies measuring PWV in HIV-infected patients have been small and their results inconsistent. So, researchers led by Katherine Kooij, M.D., compared PWV in a cohort of HIV-infected and HIV-uninfected people to determine if there is an independent association between HIV and PWV, as well as possible determinants of PWV. Advertisement The study included 566 HIV-infected and 511 HIV-uninfected individuals, all 45 or older. Both groups had comparable median ages (52.8 versus 52), gender distribution (89.1% men versus 86% men) and proportion of men who have sex with men (76.4% versus 71.4%). However, the HIV-infected group included more current smokers (32.9% versus 24.8%) and users of antihypertensive drugs (31.3% versus 22.4%). The HIV-infected participants also displayed higher levels of inflammation and immune activation markers, such as hs-CRP and sCD163. The researchers performed three measurements of PWV, as well as systolic and diastolic blood pressure, using an Arteriograph system, which registers oscillometric pressure waves in the aorta through an upper arm cuff. Additional information on potential determinants of arterial stiffness was collected with laboratory measurements and questionnaires. The data underwent a statistical analysis with multivariable linear regression models using PWV as a dependent variable, adjusted for MAP. The analysis revealed a slightly higher, but significant unadjusted PWV in HIV-infected individuals than in HIV-uninfected individuals (7.9 m/s versus 7.7 m/s, P = .004). When these results were adjusted for MAP and gender, the difference between the two remained at 0.19 m/s (P = .04). If compared to a PWV increase due to age (+0.29 m/s per 5 years older, P < .001), having a positive HIV status would be the equivalent of being 3 to 3.5 years older. However, when the PWV values were adjusted for other factors, such as smoking and use of antihypertensive drugs, HIV-infected status was no longer independently associated with arterial stiffness. In this setting, the difference between HIV-infected and HIV-uninfected PWV was only 0.022 m/s (P = .8). In contrast, every 5 pack-years (smoking 20 cigarettes a day per year, about 7,305 cigarettes) for current smokers accounted for a difference of 0.121 m/s (P < .001), while use of antihypertensive drugs represented an increase of 0.527 m/s (P < .001). The researchers also found that the inflammation marker hs-CRP and the monocyte activation marker sCD163 were associated with a higher PWV: 0.039 m/s (P = .001) and 0.056 m/s (P = .04), respectively. But sCD163 was only a significant determinant in men.
画像例は下記をご参照願います。

http://www.din.or.jp/~meditekn/medi_hp/
上記の一番下部に解説付きで、応用例を掲載
http://www.din.or.jp/~meditekn/medi_hp/duna/
ラブテック社製マスターステップの使用例掲載
http://www.din.or.jp/~meditekn/medi_hp/duna2/
医大検査室での使用例、画面例及び記録例も掲載
http://www.din.or.jp/~meditekn/medi_hp/remoterunning12ecgs/
ソニーの超小型パソコンを利用したランニング仕様の用途例
http://www.din.or.jp/~meditekn/medi_hp/aerobicacc/
米国循環器学会で推奨された心臓病患者への心臓リハビリ法としてのエアロビックの効能についての発表
http://www.din.or.jp/~meditekn/medi_hp/gtec/
出力のRR間隔データの解析例、これは別売のソフトウエアとなります。
http://www.din.or.jp/~meditekn/medi_hp/stressdata/
負荷試験での重要な医学的指標、米国心臓病学会のスタンダードとして発布
http://www.din.or.jp/~meditekn/medi_hp/labtechholter/ ラブテックパソコンホルタのご紹介
http://www.din.or.jp/~meditekn/medi_hp/labtech1/
ラブテック社製品としてのパソコン式の利用価値 等を掲載しております
画像例は下記をご参照願います。

http://www.din.or.jp/~meditekn/medi_hp/
上記の一番下部に解説付きで、応用例を掲載
http://www.din.or.jp/~meditekn/medi_hp/duna/
ラブテック社製マスターステップの使用例掲載
http://www.din.or.jp/~meditekn/medi_hp/duna2/
医大検査室での使用例、画面例及び記録例も掲載
http://www.din.or.jp/~meditekn/medi_hp/remoterunning12ecgs/
ソニーの超小型パソコンを利用したランニング仕様の用途例
http://www.din.or.jp/~meditekn/medi_hp/aerobicacc/
米国循環器学会で推奨された心臓病患者への心臓リハビリ法としてのエアロビックの効能についての発表
http://www.din.or.jp/~meditekn/medi_hp/gtec/
出力のRR間隔データの解析例、これは別売のソフトウエアとなります。
http://www.din.or.jp/~meditekn/medi_hp/stressdata/
負荷試験での重要な医学的指標、米国心臓病学会のスタンダードとして発布
http://www.din.or.jp/~meditekn/medi_hp/labtechholter/ ラブテックパソコンホルタのご紹介
http://www.din.or.jp/~meditekn/medi_hp/labtech1/
ラブテック社製品としてのパソコン式の利用価値 等を掲載しております
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下記は、弊社ラインアップ品です、

PCの機能が向上し、Descrete Wavelet 手法が、お求めやすい低価格で

実現し、心房のP波を自動検出できるようになりました、

心房細動の自動解析能をお試し賜われれば幸いです


臨床用 薬事認可済


Labtech社は、当社独自の方法による

P波自動検出と心房細動自動解析手法

T Wave Alternans 解析手法を開発し、当社ホルターに搭載。


VectraCardiology,Heart Rate Variability ,TWA オルタナンス
Turbulence、3D可変表示、Spectral Analysis等が装備

Theory of the P wave detection

The algorithm first finds the  the possible positive and negative wave peaks
based on zero transition searching, then validates them with comparing
to reference P waves.

The P wave detection needs high amplitude resolution. This value is better,
than 0.6 uV / bit in the Cardiospy system.  With this resolution and
the effective filter system which uses wavelet transformation,
the Cardiospy system is able to detect P waves less than 50 uV of amplitude.

 

Validation of the P wave detector

The validation is carried out on 10 pcs 12 channel and 10 pcs 3 channel ECG
reference records. The reference records include the P wave  annotation.  12
of the 20 records are taken from the MitBih database, 8 records are
taken from the Labtech database (30000 ? 30007). 

12 ch records

s0014lre, s0292lre, s0302lre, s0331lre, s0364lre, s0422_re, s0431_re,
s0437_re, s0549_re, s0550_re

3 ch records

mgh001, mgh007, 30000, 30001, 30002, 30003, 30004, 30005, 30006, 30007

 

Validation result:

Sensitivity:                       95.42%

Positive predictivity:         97.16%


ケアテイカー研究用

非観血相対血圧・連続・ポータブル・ウエアラブル・一拍毎解析出力付き

httpswww.ncbi.nlm.nih.govpmcarticlesPMC5361833

 

BMC Anesthesiol. 2017; 17: 48.

Published online 2017 Mar 21. doi: 10.1186/s12871-017-0337-z

PMCID: PMC5361833

PMID: 28327093

Continuous Non-invasive finger cuff CareTakerR comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery

Irwin Gratz,1 Edward Deal,1 Francis Spitz,1 Martin Baruch,2 I. Elaine Allen,3 Julia E. Seaman,4 Erin Pukenas,1 and Smith Jean1

Author information Article notes Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

 

Associated Data

Data Availability Statement

The datasets generated during and analysed for the current study are available from the corresponding author on reasonable request.

 

Abstract

Background

Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060?2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTakerR (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis.

Methods

A convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created.

Results

The correlation of systolic, diastolic, and mean arterial pressures were 0.92, 0.86, 0.91, respectively (p?<?0.0001 for all the comparisons). The Bland-Altman comparison yielded a bias (as measured by overall mean difference) of ?0.57, ?2.52, 1.01 mmHg for systolic, diastolic, and mean arterial pressures, respectively with a standard deviation of 7.34, 6.47, 5.33 mmHg for systolic, diastolic, and mean arterial pressures, respectively (p?<?0.001 for all comparisons). The polar plot indicates little bias between the two methods (90%/95% CI at 31.5°/52°, respectively, overall bias?=?1.5°) with only a small percentage of points outside these lines. The 4Q plot indicates good concordance and no bias between the methods.

Conclusions

In this study, blood pressure measured using the non-invasive CT device was shown to correlate well with the arterial catheter measurements. Larger studies are needed to confirm these results in more varied settings. Most patients exhibited very good agreement between methods. Results were well within the limits established for the validation of automatic arterial pressure monitoring by the AAMI.

Keywords: Non-Invasive, CareTaker, Central blood pressure, Finger cuff, Intra-Arterial pressure


Tensiomed 社 Arteriograph 24 血管脈波検査装置

ご注意:中心血圧と関連機能は検証が必要です、


臨床用ー薬事認可済

Central blood pressure: current evidence

and clinical importance

Carmel M. McEniery1*, John R. Cockcroft2, Mary J. Roman3,

Stanley S. Franklin4, and Ian B.Wilkinson1

1Clinical Pharmacology Unit, University of Cambridge, Addenbrookes Hospital, Box 110, Cambridge CB22QQ, UK; 2Department of Cardiology,Wales Heart Research Institute, Cardiff

CF14 4XN, UK; 3Division of Cardiology,Weill Cornell Medical College, New York, NY 10021, USA; and 4University of California, UCI School of Medicine, Irvine, CA 92697-4101, USA

Received 29 April 2013; revised 27 November 2013; accepted 17 December 2013; online publish-ahead-of-print 23 January 2014

and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications

for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively

targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.

Central pressure Blood pressure Anti-hypertensive treatment Cardiovascular risk

Introduction

The brachial cuff sphygmomanometer was introduced into medical

practice well over 100 years ago, enabling the routine, non-invasive,

measurement of arterial blood pressure. Life insurance companies

were among the first to capitalize on the information provided by

cuff sphygmomanometry, by observing that blood pressure in

largely asymptomatic individuals relates to future cardiovascular

risk?observations that are nowsupported by a wealth of epidemiological

data.1 The most recent Global Burden of Disease report2

identified hypertension as the leading cause of death and disability

worldwide. Moreover, data from over 50 years of randomized controlled

trials clearly demonstrate that lowering brachial pressure,

in hypertensive individuals, substantially reduces cardiovascular

events.1,3 For these reasons, measurement of brachial blood pressure

has become embedded in routine clinical assessment throughout the

developed world, and is one of the most widely accepted surrogate

measures for regulatory bodies.

The major driving force for the continued use of brachial blood

pressure has been its ease of measurement, and the wide variety of

devices available for clinical use. However, we have known for over

half a century that brachial pressure is a poor surrogate for aortic

pressure, which is invariably lower than corresponding brachial

values. Recent evidence suggests that central pressure is also more

strongly related to future cardiovascular events4 ? 7 than brachial

pressure, and responds differently to certain drugs.8,9 Appreciating

this provides an ideal framework for understanding the much publicized

inferiority of atenolol and some other beta-blockers,10 compared

with other drug classes, in the management of essential

hypertension. Although central pressure can now be assessed noninvasively

with the same ease as brachial pressure, clinicians are unlikely

to discard the brachial cuff sphygmomanometer without

robust evidence that cardiovascular risk stratification, and monitoring

response to therapy, are better when based on central rather

than peripheral pressure. Central pressure assessment and accuracy

will also have to be standardized, as it has been for brachial pressure

assessment with oscillometric devices. This review will discuss our

current understanding about central pressure and the evidence

required to bring blood pressure measurement, and cardiovascular

risk assessment into the modern era.

Physiological concepts

Arterial pressure varies continuously over the cardiac cycle, but in

clinical practice only systolic and diastolic pressures are routinely

reported. These are invariably measured in the brachial artery

using cuff sphygmomanometry?a practice that has changed little

over the last century. However, the shape of the pressure waveform

* Corresponding author. Tel: +44 1223 336806, Fax: +44 1223 216893, Email: cmm41@cam.ac.uk

Published on behalf of the European Society of Cardiology. All rights reserved. &The Author 2014. For permissions please email: journals.permissions@oup.com

European Heart Journal (2014) 35, 1719?1725 doi:10.1093/eurheartj/eht565

 

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk.However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.As discussed earlier, a full synthesis of the available evidence concerning

central pressure and the risk of future cardiovascular events is now required. However, it will also be necessary to determine the clinical relevance of differences between brachial and central pressure

for the individual patient, especially given the relatively high correlation between the two. Emerging data support the prognostic superiority of both 24-h ambulatory blood pressure monitoring

(ABPM)79 ? 81 andhomemonitoring81 in comparison with office measurements. Interestingly, a recent study82 demonstrated that 24-h ambulatory cuff pressures were comparable with office central pressure

measurements in the prediction of risk, although the significance of this study awaits confirmation.83 As yet, there are no data comparing the predictive value ofhomemonitoring vs. central pressure in the

prediction of risk. Ultimately, it will be necessary to evaluate the prognostic value of 24-h ambulatory central pressure.With the recent development of ambulatory central pressure systems,84,85 this is now

possible and it may be reasonable to hypothesize that 24-h central, rather than brachial ABPM would be superior in terms of risk prediction.

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