用于无创估计主动脉收缩压的商用设备和方法的准确性：侵入性验证研究的系统评价和荟萃分析
Accuracy of commercial devices and methods for noninvasive estimation of aortic systolic blood pressure a systematic review and meta-analysis of invasive validation studies.
作者信息
Papaioannou Theodore G, Karageorgopoulou Theofani D, Sergentanis Theodoros N, Protogerou Athanase D, Psaltopoulou Theodora, Sharman James E, Weber Thomas, Blacher Jacques, Daskalopoulou Stella S, Wassertheurer Siegfried, Khir Ashraf W, Vlachopoulos Charalambos, Stergiopulos Nikolaos, Stefanadis Christodoulos, Nichols Wilmer W, Tousoulis Dimitrios
机构信息
aBiomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital bDepartment of Hygiene, Epidemiology and Medical Statistics cCardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece dMenzies Institute for Medical Research, Tasmania, University of Tasmania, Hobart, Australia eCardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria fFaculty of Medicine, Paris-Descartes University, Hôtel-Dieu Hospital, AP-HP, Diagnosis and Therapeutic Center, Paris, France gDivisions of Internal Medicine and Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada hAustrian Institute of Technology, Health & Environment Department, Vienna, Austria iBrunel Institute for Bioengineering, Brunel University, Uxbridge, UK jLaboratory of Hemodynamics and Cardiovascular Technology, Institute of Biotechnology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland kSchool of Medicine, Yale University, New Haven, Connecticut lDivision of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
出版信息
J Hypertens. 2016 Jul;34(7):1237-48. doi: 10.1097/HJH.0000000000000921.
BACKGROUND
Although compelling evidence has established the physiological and clinical relevance of aortic SBP (a-SBP), no consensus exists regarding the validity of the available methods/techniques that noninvasively measure it.
OBJECTIVES
The systematic review and meta-analysis aimed to determine the accuracy of commercial devices estimating a-SBP noninvasively, which have been validated by invasive measurement of a-SBP. Moreover their optimal mode of application, in terms of calibration, as well as specific technique and arterial site of pulse wave acquisition were further investigated.
METHODS
The study was performed according to the PRISMA guidelines; 22 eligible studies were included, which validated invasively 11 different commercial devices in 808 study participants.
RESULTS
Overall, the error in a-SBP estimation (estimated minus actual value) was -4.49 mmHg [95% confidence interval (CI): -6.06 to -2.92 mmHg]. The estimated (noninvasive) a-SBP differed from the actual (invasive) value depending on calibration method: by -1.08 mmHg (95% CI: -2.81, 0.65 mmHg) and by -5.81 mmHg (95% CI: -7.79, -3.84 mmHg), when invasively and noninvasively measured brachial BP values were used respectively; by -1.83 mmHg, (95% CI: -3.32, -0.34 mmHg), and by 7.78 mmHg (95% CI: -10.28, -5.28 mmHg), when brachial mean arterial pressure/DBP and SBP/DBP were used, respectively.
CONCLUSION
Automated recording of waveforms, calibrated noninvasively by brachial mean arterial pressure/DBP values seems the most promising approach that can provide relatively more accurate, noninvasive estimation of a-SBP. It is still uncertain whether a specific device can be recommended as 'gold standard'; however, a consensus is currently demanding.
背景
尽管有力的证据已证实主动脉收缩压（a-SBP）的生理和临床相关性，但对于无创测量a-SBP的现有方法/技术的有效性尚无共识。
目的
本系统评价和荟萃分析旨在确定通过a-SBP有创测量验证的无创估计a-SBP的商用设备的准确性。此外，还进一步研究了其在校准方面的最佳应用模式，以及脉搏波采集的具体技术和动脉部位。
方法
本研究按照PRISMA指南进行；纳入了22项符合条件的研究，这些研究在808名研究参与者中对11种不同的商用设备进行了有创验证。
结果
总体而言，a-SBP估计误差（估计值减去实际值）为-4.49 mmHg [95%置信区间（CI）：-6.06至-2.92 mmHg]。根据校准方法的不同，估计的（无创）a-SBP与实际（有创）值存在差异：分别使用有创和无创测量的肱动脉血压值时，差异为-1.08 mmHg（95% CI：-2.81，0.65 mmHg）和-5.81 mmHg（95% CI：-7.79，-3.84 mmHg）；分别使用肱动脉平均动脉压/舒张压和收缩压/舒张压时，差异为-1.83 mmHg（95% CI：-3.32，-0.34 mmHg）和7.78 mmHg（95% CI：-10.28，-5.28 mmHg）。
结论
通过肱动脉平均动脉压/舒张压值进行无创校准的波形自动记录似乎是最有前景的方法，能够提供相对更准确的无创a-SBP估计。目前仍不确定是否可将特定设备推荐为“金标准”；然而，目前需要达成共识。
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