Wittrock Marc, Scholze Alexandra, Compton Friederike, Schaefer Juergen-Heiner, Zidek Walter, Tepel Martin
Med. Klinik Nephrologie, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Microvasc Res. 2009 Mar;77(2):109-12. doi: 10.1016/j.mvr.2008.10.001. Epub 2008 Oct 21.
Central artery stiffness predicts cardiovascular structural damage and clinical outcome. It is controversial whether central artery stiffness can be determined by noninvasive measurements. We compared noninvasive determination of central artery stiffness obtained from applanation tonometry of the peripheral radial artery waveform with invasive measurements of the ratio of pulse-pressure-to-stroke-volume. A total of 112 invasive measurements of the ratio of pulse-pressure-to-stroke-volume and noninvasive determinations of central artery stiffness were performed in 49 patients on the intensive care unit. In 13 out of 112 attempts of noninvasive measurements (12%) radial pulse could not be obtained using applanation tonometry because of cardiac arrhythmia or radial pulse could not be detected. These 13 failing noninvasive measurements were attempted in 7 patients. In the remaining cases we found a significant correlation between noninvasively obtained central artery stiffness and invasive measurements of the ratio of pulse-pressure-to-stroke-volume (Spearman r=0.40; p<0.0001). The association between invasive and noninvasive measurements was confirmed using Bland-Altman plots. Furthermore, a norepinephrine-induced increase of arterial stiffness was detected both invasively and noninvasively. Noninvasive determination of central artery stiffness obtained from peripheral radial artery waveform should be useful in clinical practice although it cannot be performed in every patient.
中心动脉僵硬度可预测心血管结构损伤和临床结局。中心动脉僵硬度能否通过非侵入性测量来确定仍存在争议。我们将通过外周桡动脉波形压平式眼压测量法获得的中心动脉僵硬度的非侵入性测定结果与脉压与每搏量比值的侵入性测量结果进行了比较。对重症监护病房的49例患者进行了总共112次脉压与每搏量比值的侵入性测量以及中心动脉僵硬度的非侵入性测定。在112次非侵入性测量尝试中有13次（12%）由于心律失常或无法检测到桡动脉搏动，使用压平式眼压测量法未能获得桡动脉脉搏。这13次失败的非侵入性测量是在7例患者中进行的。在其余病例中，我们发现非侵入性获得的中心动脉僵硬度与脉压与每搏量比值的侵入性测量结果之间存在显著相关性（Spearman相关系数r = 0.40；p < 0.0001）。使用Bland-Altman图证实了侵入性和非侵入性测量之间的相关性。此外，通过侵入性和非侵入性方法均检测到去甲肾上腺素引起的动脉僵硬度增加。尽管并非每位患者都能进行，但通过外周桡动脉波形获得的中心动脉僵硬度的非侵入性测定在临床实践中应是有用的。
