Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study☆
Introduction
Arterial pulse has been recognized as a fundamental vital sign since antiquity. From the pioneering observations of William Harvey in 1960s [1], to recent developments in biomedical engineering and bioinformatics, the arterial pressure wave constitutes an unfailing source of information in research and clinical fields. Currently, several other biomarkers/parameters beyond maximum, minimum, mean values of pressure waves (namely systolic, diastolic, and mean pressure) can be derived by pulse wave analysis (PWA). Particularly, parameters characterizing wave reflection phenomena (i.e. augmentation index, reflection magnitude), arterial stiffness (most commonly assessed by pulse wave velocity), and the difference between central and peripheral pulse pressure (PP) defined as PP amplification, have been extensively investigated and proved to be independent predictors of cardiovascular morbidity and mortality [2], [3], [4], [5], [6].
In the last decades the non-invasive estimation of pressure wave parameters at central arteries (i.e. aorta, carotid artery) has been achieved [7], aiming to assess the hemodynamic profile at sites closer to target organs (heart, brain, and kidneys) compared to the brachial artery. However, PWA modalities offered only instantaneous measurements of the aforementioned parameters at the office/clinic or at home, until recently when 24-h ambulatory recording and measurement of PWA parameters has become feasible [8]. A novel device has been developed yielding multiple peripheral and aortic BP readings together with estimations of wave reflection and arterial stiffness during usual daily activities, including sleep. This technology offers a far better representation of the “central hemodynamic burden” than what is obtained by a few measurements taken in the doctor's office.
Considerable evidence is now available from longitudinal studies indicating that ambulatory blood pressure monitoring (ABPM) is a much stronger predictor of cardiovascular morbidity and mortality than conventional office measurement [9], [10], [11]. The respective 24-h monitoring of wave reflection and arterial stiffness parameters is expected to further enhance the diagnostic evaluation and optimize CV risk management.
Although technology for 24-h ambulatory monitoring of central hemodynamics is now available, the feasibility and reproducibility of central PWA parameters is still unexplored. The purpose of the present study was to investigate the feasibility and reproducibility of non-invasive assessment of aortic hemodynamic parameters using a novel non-invasive 24-h ambulatory cuff-based oscillometric technique.
Section snippets
Study design and population
From January to June 2011 consecutive subjects referred to Hypertension Clinics of two University Departments at “Laiko” and “Sotiria” hospitals, Athens, Greece were recruited. The study protocol and the examined population have been previously described [12]. Inclusion criteria were: age > 18 years, stable cardiovascular condition and unchanged cardiovascular medication for at least 2 months. Exclusion criteria were the presence of atrial fibrillation and modification of any vasoactive drug
Results
The demographic characteristics of the study population have been previously published [12] and are briefly presented herein (Table 1). The time intervals between day-1 and day-2 ranged from 1 to 6 weeks.
Discussion
The present study is the first that investigated the feasibility and reproducibility of non-invasive 24-hour ambulatory monitoring of wave reflection and arterial stiffness characteristics estimated using a novel automated, portable brachial cuff-based, oscillometric device. The results suggest that the estimation of wave reflection and arterial stiffness parameters on a 24-h basis is feasible and the calculated parameters by this apparatus are highly reproducible.
All aortic hemodynamic
Conclusions
The relevance of instantaneous measurements of wave reflection as well as arterial stiffness parameters is now indisputable [3], [32], [33]. However, there is an inherent variation of wave reflection, arterial stiffness and BP amplification during the day as shown by previous studies performing manual (non-automated) multiple measurements [34], [35], [36]. Environmental, life style, physiologic and more importantly pathologic and pharmacologic factors may affect the 24-h variability pattern of
Acknowledgments
The Mobil-O-Graph devices used in this study were kindly provided by IEM.
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