Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
School of Sport and Exercise, University of Gloucestershire, Gloucester, UK.
J Hum Hypertens. 2019 Jun;33(6):444-453. doi: 10.1038/s41371-019-0179-x. Epub 2019 Feb 25.
Pulse wave analysis (PWA) utilizes arm blood pressure (BP) waveforms to estimate aortic waveforms. The accuracy of central BP waveform estimation may be influenced by assessment site local haemodynamics. This study investigated whether local haemodynamic changes, induced via arm tilting ±30° relative to heart level, affect estimated central systolic BP (cSBP) and arterial wave reflection (central augmentation index, cAIx; aortic backward pressure wave, Pb). In 20 healthy adults (26.7 years [SD 5.2], 10 F) brachial BP waveforms were simultaneously recorded on experimental and control arms. The experimental arm was randomly repositioned three times (heart level, -30° heart level, +30° heart level), while the control arm remained fixed at heart level. For the experimental arm, arm repositioning resulted in a large (partial eta-squared > 0.14) effect size (ES) change in SBP (ES = 0.75, P < 0.001), cSBP (ES = 0.81, P < 0.001), and cAIx (ES = 0.75, P = 0.002), but not Pb (ES = 0.06, P = 0.38). In the control arm, cAIx (ES = 0.22, P = 0.013) but not SBP or cSBP significantly changed. Change in experimental arm cSBP was partially explained by brachial systolic blood velocity (P = 0.026) and mean diameter (P = 0.012), while change in cAIx was associated with brachial retrograde blood velocity (P = 0.020) and beta stiffness (P = 0.038). In conclusion, manipulation of assessment site local haemodynamics, including the blood velocity profile and local arterial stiffness, had a large effect on estimated cSBP and cAIx, but not on Pb. These findings do not invalidate PWA devices but do suggest that the accuracy of the estimated aortic pressure waveform is dependent on stable peripheral haemodynamics.
脉搏波分析（PWA）利用手臂血压（BP）波形来估计主动脉波形。中心 BP 波形估计的准确性可能受到评估部位局部血液动力学的影响。本研究旨在探讨手臂相对于心脏水平倾斜±30°引起的局部血液动力学变化是否会影响估计的中心收缩压（cSBP）和动脉反射（中心增强指数，cAIx；主动脉后向压力波，Pb）。在 20 名健康成年人（26.7 岁[标准差 5.2]，10 名女性）中，同时记录实验臂和对照臂的肱动脉 BP 波形。实验臂随机重新定位三次（心脏水平，-30°心脏水平，+30°心脏水平），而对照臂保持在心脏水平。对于实验臂，手臂重新定位导致 SBP（ES=0.75，P<0.001）、cSBP（ES=0.81，P<0.001）和 cAIx（ES=0.75，P=0.002）的变化较大（部分 eta-平方>0.14），但 Pb（ES=0.06，P=0.38）无明显变化。在对照臂中，cAIx（ES=0.22，P=0.013）但 SBP 或 cSBP 明显变化。实验臂 cSBP 的变化部分与肱动脉收缩期血流速度（P=0.026）和平均直径（P=0.012）相关，而 cAIx 的变化与肱动脉逆行血流速度（P=0.020）和β僵硬度（P=0.038）相关。总之，评估部位局部血液动力学的变化，包括血流速度分布和局部动脉僵硬度，对估计的 cSBP 和 cAIx 有很大影响，但对 Pb 没有影响。这些发现并没有使 PWA 设备失效，但确实表明估计的主动脉压力波形的准确性取决于稳定的外周血液动力学。
