Miszkowska-Nagórna Eliza, Neubauer-Geryk Jolanta, Wolf Jacek, Wielicka Melanie, Raczak Grzegorz, Narkiewicz Krzysztof, Bieniaszewski Leszek
a Department of Hypertension and Diabetology , Medical University of Gdańsk , Gdańsk , Poland.
b Clinical Physiology Unit, Medical Simulation Centre , Medical University of Gdańsk , Gdańsk , Poland.
Blood Press. 2018 Feb;27(1):3-9. doi: 10.1080/08037051.2017.1356200. Epub 2017 Jul 24.
Irregular heart rhythm in the course of atrial fibrillation (AFib) results in lower blood pressure (BP) measurements reproducibility which is further limited by various BP-monitors used. Therefore the aim of our study was to estimate accuracy of oscillometric BP measurement (SpaceLabs 90207) with reference to mercury manometer-based readings.
Study was performed in 47 hemodynamically stable patients aged 63 ± 12 yo with paroxysmal or persistent AFib, at baseline. Patients were reassessed within one week after effective cardioversion (SR; n = 29). BP was measured using Y-tube connection allowing for simultaneous measurements on the same arm with SpaceLabs 90207 and referral method. Mean values were tested with paired t-tests. Additionally, concordance correlation coefficient (ρc) and Bland-Altman plots were assessed. Results were confronted with AAMI, and ESH-IP criteria.
Both during arrhythmia and sinus rhythm diastolic BP differed significantly (Δ = 4.6 ± 6.0 mm Hg, p < .001 and 2.1 ± 4.0 mm Hg, p < .001; for AFib, and SR, respectively), which was not the case for systolic BP. The ρc during arrhythmia equaled 0.89, and 0.75 for systolic and diastolic BP, respectively, which further improved while SR (0.96 and 0.89, respectively). Results confronted against AAMI and ESH-IP showed that all criteria were met except for one (60% vs. required 65% of paired differences of less than 5 mm Hg) during AFib.
The direct comparisons of BP readings allowed to conclude that diastolic blood pressure tended to be slightly overestimated when assessed with SpaceLabs 90207 in patients with both, AFib and SR, which was not a case for systolic BP. When the results were confronted with available validation protocols requirements, all referral criteria were met except for one. Taken together, our results suggest acceptable BP readings dispersion of SpaceLabs 90207 in BP monitoring of patients with both AFib and SR.
心房颤动(AFib)过程中的心律不齐会导致血压(BP)测量的可重复性降低,而使用的各种血压监测仪会进一步限制这一可重复性。因此,我们研究的目的是参照基于汞柱式血压计的读数来评估示波法血压测量(SpaceLabs 90207)的准确性。
在47名年龄为63±12岁、血流动力学稳定的阵发性或持续性AFib患者的基线期进行研究。在有效心律转复(窦性心律;n = 29)后一周内对患者进行重新评估。使用Y形管连接测量血压,以便在同一手臂上同时使用SpaceLabs 90207进行测量和采用对照方法进行测量。使用配对t检验对平均值进行检验。此外,评估一致性相关系数(ρc)和布兰德-奥特曼图。将结果与美国医疗仪器促进协会(AAMI)和欧洲高血压学会-国际高血压学会(ESH-IP)标准进行对照。
在心律失常和窦性心律期间,舒张压均存在显著差异(分别为Δ = 4.6±6.0 mmHg,p <.001和2.1±4.0 mmHg,p <.001;分别对应AFib和窦性心律),收缩压则不然。心律失常期间收缩压和舒张压的ρc分别为0.89和0.75,在窦性心律时进一步改善(分别为0.96和0.89)。与AAMI和ESH-IP对照的结果表明,除了一项标准外,所有标准均得到满足(AFib期间为60%,而要求配对差异小于5 mmHg的比例为65%)。
血压读数的直接比较得出结论,在AFib和窦性心律患者中,使用SpaceLabs 90207评估舒张压时往往会略有高估,收缩压则不然。当将结果与现有验证方案要求进行对照时,除了一项标准外,所有对照标准均得到满足。综上所述,我们的结果表明SpaceLabs 90207在AFib和窦性心律患者的血压监测中血压读数的离散度是可接受的。