クラウド カーディオロジ スマホ 富士の国 心電図伝送

スキー&スノーボード2004-2005

<   2014年 05月 ( 20 )   > この月の画像一覧

Arterial Stiffness

Invasive validation of a new oscillometric device
(Arteriograph) for measuring augmentation index, central
blood pressure and aortic pulse wave velocity
Iva´n G. Horva´ tha, A´ da´m Ne´metha, Zso´ fia Lenkeya, Nicola Alessandrib,
Fabrizio Tufanob, Pa´ l Kisa, Bala´ zs Gasznera and Attila Czira´ kia
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 (rU0.9, P<0.001; rU0.94, P<0.001), which allowed
the noninvasive calculation of the aortic Aix without using
generalized transfer function. Similarly strong correlation
(rU0.95, 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 9.41W1.8 m/s and
[PR]
by suwataisya | 2014-05-28 17:32 | 動脈硬化

Arterial Stiffness

Comparison of aortic pulse wave velocity measured by three
techniques: Complior, SphygmoCor and Arteriograph
Marek W. Rajzer, Wiktoria Wojciechowska, Marek Klocek, Ilona Palka,
Małgorzata Brzozowska-Kiszka and Kalina Kawecka-Jaszcz
Background New 2007 European Society of Hypertension
guidelines recommend measuring arterial stiffness in
patients with arterial hypertension, suggesting a
carotid–femoral pulse wave velocity over 12 m/s as an
estimate of subclinical organ damage. Considering this
cutoff point, it is worth exploring whether or not there are
significant differences in results obtained using various
techniques for measuring aortic pulse wave velocity. The
aim of the study was to compare aortic pulse wave velocity
measurements using Complior, SphygmoCor, and
Arteriograph devices, and to assess the effect of pulse wave
transit time and traveled distance on pulse wave velocity
values.
Methods Aortic pulse wave velocity was measured on a
single visit, using these devices, in randomized order, in a
group of 64 patients with grade 1 or 2 arterial hypertension.
Results Aortic pulse wave velocity measured using
Complior (10.1W1.7 m/s) was significantly higher than that
obtained using SphygmoCor (8.1W1.1 m/s) or Arteriograph
(8.6W1.3 m/s). No differences were noted between pulse
wave velocity measurements using SphygmoCor and
Arteriograph. Between-method comparison revealed that
differences in traveled distance were significant: Complior
[PR]
by suwataisya | 2014-05-28 17:31 | 動脈硬化

Arterial Stiffness

Assessment of arterial stiffness in hypertension: comparison
of oscillometric (Arteriograph), piezoelectronic (Complior)
and tonometric (SphygmoCor) techniquesM
Noor A. Jatoi, Azra Mahmud, Kathleen Bennett and John Feely1
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 48W14 years (meanWSD, range 17–85
years).
Results Arteriograph PWV and AIx were closely related with
Complior (rU0.60, P<0.001) and SphygmoCor (rU0.89,
P<0.001), respectively. Using stepwise regression analysis,
the independent determinants of Arteriograph PWV were
age, mean arterial pressure, heart rate and sex (r2U0.44,
P<0.0001) and for AIx were age, weight, mean arterial
pressure, heart rate and sex (r2U0.65, 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
[PR]
by suwataisya | 2014-05-28 17:30 | 動脈硬化

Arterial Stiffness

Evaluating aortic stiffness through an arm cuff oscillometric
device: is validation against invasive measurements enough?
Gianfranco Paratia,b and Marc De Buyzerec
Journal of Hypertension 2010, 28:2003–2006
aDepartment of Cardiology, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano,
bDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca,
Milan, Italy and cDepartment of Heart and Vessel Diseases, University Hospital
Ghent, Belgium
Correspondence to Professor Gianfranco Parati, MD, Department of Cardiology,
Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano, p.zza Brescia,
20, Milan 20149, Italy
Tel: +39 02 6191 12980; fax: +39 02 6191 12956;
e-mail: gianfranco.parati@unimib.it
See original paper on page 2068
Introduction
Following the 2006 expert consensus document of the
European Network for Noninvasive Investigation of
Large Arteries [1], arterial stiffness and central pressure
measurements should be considered as recommended
tests for the evaluation of cardiovascular risk, particularly
in patients in whom target organ damage is
not discovered by routine investigations. Within the
area of noninvasive methods, pulse wave recording
and analysis either from central (ascending aorta, carotid
artery) or peripheral (radial artery) sites have become
popular, particularly after the release of dedicated commercial
devices [2]. Theoretically, pulse wave analysis
[PR]
by suwataisya | 2014-05-28 17:29 | 動脈硬化

Arterial Stiffness

Obtaining arterial stiffness indices from simple arm cuff
measurements: the holy grail?
Pierre Boutouyriea,b, Miriam Reverac,d and Gianfranco Paratic,d
Journal of Hypertension 2009, 27:2159–2161
aUniversite´ Paris Descartes; INSERM, U970, bDepartment of Pharmacology,
Assistance Publique-Hoˆ pitaux de Paris, Hoˆ pital Europe´en Georges Pompidou,
Paris, France, cDepartment of Clinical Medicine and Prevention, Milano-Bicocca
University and dDepartment of Cardiology, IRCCS San Luca Hospital, Istituto
Auxologico Italiano, Milan, Italy
Correspondence to Professor Gianfranco Parati, MD, Department of Cardiology,
San Luca Hospital, Istituto Auxologico Italiano, Via Spagnoletto 3, 20149 Milan,
Italy
Tel: +39 02 6191 12890; fax: +39 02 6191 12956;
e-mail: gianfranco.parati@unimib.it
See original paper on page 2186
Precise assessment of cardiovascular risk factors is a
necessary step for the identification of patients at high
risk of developing cardiovascular events. When setting
the operating curve of the risk function, measurement of
blood glucose and lipids, estimation of blood pressure
(BP) levels, identification of smoking status, and assessment
of existing organ damage represent the main determinants
of the tendency to develop cardiac and vascular
problems over and above the impact of nonmodifiable
factors such as age and sex. Each of these classical risk
factors is included in a risk function specific to a given
population and aimed at yielding absolute quantitative
values of cardiovascular risk [1,2]. Such an approach
[PR]
by suwataisya | 2014-05-28 17:28 | 動脈硬化

Arterial Stiffness

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.
[PR]
by suwataisya | 2014-05-28 17:27 | 動脈硬化

Arterial Stiffness

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.
[PR]
by suwataisya | 2014-05-28 17:26 | 動脈硬化

Arterial Stiffness

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 Ebbehøj2,
5.Søren Tang Knudsen2,
6.Per Løgstrup Poulsen2,
7.Hans Erik Bøtker4 and
8.Klavs Würgler 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 ty
[PR]
by suwataisya | 2014-05-28 17:25 | 動脈硬化

Arterial Stiffness

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 Nürnberger1, Rene Michalski2, Tobias R Türk2, Anabelle Opazo Saez1, Oliver Witzke2 and Andreas Kribben2
1.1Department of Nephrology and Dialysis, HELIOS Kliniken Schwerin, Wismarsche Straße, Schwerin, Germany
2.2Department of Nephrology, University Hospital Essen, University Essen-Duisburg, Hufelandstraße, Essen, Germany
Correspondence: Dr J Nürnberger, Department of Nephrology, HELIOS Kliniken Schwerin, Wismarsche Straße 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
[PR]
by suwataisya | 2014-05-28 17:24 | 動脈硬化

Arterial Stiffness

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.
[PR]
by suwataisya | 2014-05-28 17:23 | 動脈硬化


お問い合わせはメディカルテクニカまで、gelertduna@gmail.com
by suwataisya
カテゴリ
全体
心電計
医師会
造影剤
心臓外科
医療機器
循環器
動脈硬化
外科
高血圧
以前の記事
お気に入りブログ
その他のジャンル
ファン
記事ランキング
ブログジャンル
画像一覧


Skin by Excite ism