Elmenhorst Julia, Weberruss Heidi, Mayr Martina, Pfister Karin, Oberhoffer Renate
Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Centre, Munich, Germany.
Faculty of Sport and Health Sciences, Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany.
Front Pediatr. 2019 Aug 20;7:334. doi: 10.3389/fped.2019.00334. eCollection 2019.
Vascular alterations may lead to manifest cardiovascular disease in future life. There is a tremendous time delay between the onset and obvious clinical appearance of vascular alterations. Pulse wave velocity (PWV) is one subclinical parameter to detect vascular alterations at a very early stage. Different techniques exist to measure PWV non-invasively as a vascular parameter-all with their own technique-inherent advantages, challenges, and pitfalls. The aim of this study was to compare two techniques to measure PWV, to assess their agreement, and interchangeability. In 780 (♀ = 49.4%) healthy children and adolescents (mean age: 11.61 ± 2.11 years), PWV was obtained with two different techniques. Ultrasound-measured local PWV (PWVβ) at the carotid artery was graphically compared by a Bland-Altman plot with aortic PWV (aPWV), measured oscillometrically on the brachial artery. Reproducibility was assessed with the concordance correlation coefficient by Lin (ρc). Furthermore, participants were categorized by BMI as normal weight (N) or overweight/obese (O) to identify differences in PWVβ and aPWV caused by an increased BMI. Mean PWVβ was lower (4.01 ± 0.44 m/s) than mean aPWV (4.67 ± 0.34 m/s). The two methods differ by mean Δ0.66 ± 0.47 m/s (95% CI: 0.62 to 0.69 m/s; < 0.001). Bland-Altman analysis indicated the 95% limits of agreement (-0.26 to 1.57) without any evidence of systemic difference. Lin's ρc represented a weak concordance between PWVβ and aPWV (ρc = 0.122; 95% CI: 0.093-0.150). There was no difference in PWVβ between N and O, whereas aPWV was higher in O: 4.81 ± 0.42 m/s than in N: 4.65 ± 0.32 m/s ( < 0.001). The difference, Δ0.16 m/s, 95% CI [-0.25; -0.08], was significant, = -3.76, < 0.001, with a medium-sized effect. PWVβ (ultrasound) and aPWV (oscillometry) show a level of disagreement that includes clinically important discrepancies. A discrimination between normal and altered vascular function was possible with aPWV but not with PWVβ.
血管改变可能会在未来导致明显的心血管疾病。从血管改变开始到出现明显的临床症状之间存在很长的时间延迟。脉搏波速度（PWV）是在非常早期阶段检测血管改变的一个亚临床参数。存在不同的技术以非侵入方式测量PWV作为血管参数——所有这些技术都有其自身技术固有的优点、挑战和缺陷。本研究的目的是比较两种测量PWV的技术，评估它们的一致性和互换性。在780名（女性占49.4%）健康儿童和青少年（平均年龄：11.61±2.11岁）中，用两种不同技术获得PWV。通过Bland - Altman图将超声测量的颈动脉局部PWV（PWVβ）与通过肱动脉示波法测量的主动脉PWV（aPWV）进行图形比较。用Lin的一致性相关系数（ρc）评估可重复性。此外，根据BMI将参与者分为正常体重（N）或超重/肥胖（O）组，以确定BMI增加导致的PWVβ和aPWV的差异。平均PWVβ（4.01±0.44米/秒）低于平均aPWV（4.67±0.34米/秒）。两种方法的平均差异为0.66±0.47米/秒（95%CI：0.62至0.69米/秒；P<0.001）。Bland - Altman分析表明一致性界限为95%（-0.26至1.57），没有任何系统性差异的证据。Lin的ρc表明PWVβ和aPWV之间存在弱一致性（ρc = 0.122；95%CI：0.093 - 0.150）。N组和O组之间的PWVβ没有差异，而O组的aPWV（4.81±0.42米/秒）高于N组的aPWV（4.65±0.32米/秒）（P<0.001）。差异为0.16米/秒，95%CI[-0.25；-0.08]，具有统计学意义，t = -3.76，P<0.001，效应量为中等。PWVβ（超声）和aPWV（示波法）显示出一定程度的不一致，包括临床上重要的差异。使用aPWV可以区分正常和改变的血管功能，但使用PWVβ则不行。
