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.

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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

 

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 20^th 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.

 

Arterial Stiffness

Hungary's "tensio arteriograph" - a simple way of examining our veins

27-01-2006 11:38 | Sándor Laczkó

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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."

<script type="text/javascript"></script> 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:

<script type="text/javascript"></script> "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."

 

Arterial Stiffness

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 th

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

 

Arterial Stiffness

Invasive Validation of Arteriograph Estimates of Central Blood Pressure in Patients With Type 2 Diabetes

1. 1.   Niklas Blach Rossen¹,²,
2. 2.   Esben Laugesen²,
3. 3.   Christian Daugaard Peters³,
4. 4.   Eva Ebbehøj²,
5. 5.   Søren Tang Knudsen²,
6. 6.   Per Løgstrup Poulsen²,
7. 7.   Hans Erik Bøtker⁴ and
8. 8.   Klavs Würgler Hansen¹

+ Author Affiliations

1. 1.    ¹ Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark;
2. 2.    ² Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark;
3. 3.    ³ Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark;
4. 4.    ⁴ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
5. 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.

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.

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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.

 

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.

 

Arterial Stiffness

Invasive validation of arteriograph estimates of central blood pressure in patients with type 2 diabetes
American Journal of Hypertension, 09/03/2013  Clinical Article

Rossen NB et al. – Compared with invasively measured central SBP, the authors 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 this study was the large number of patients 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.

 

Arterial Stiffness

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 Pécs, Pécs, Hungary bDepartment of Cardiology, University of Rome La Sapienza, Polo Pontino, Italy.

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