Gotzmann Michael, Hogeweg Maximilian, Bauer Frederic, Seibert Felix S, Rohn Benjamin J, Mügge Andreas, Babel Nina, Westhoff Timm H
Department of Cardiology, University Hospital St Josef Hospital Bochum.
Medical Department 1, University Hospital Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany.
J Hypertens. 2020 Nov;38(11):2154-2160. doi: 10.1097/HJH.0000000000002563.
Two fully automated oscillometric devices have become available for the noninvasive assessment of central aortic blood pressure (BP). They tend, however, to underestimate SBP. It has been proposed that calibration by mean/diastolic instead of systolic/diastolic brachial BP may reduce this bias. The present work compares the accuracy of these two calibrations in the Mobil-O-Graph.
Post-hoc analysis of the largest validation study on noninvasive assessment of central BP so far. Data on both calibration approaches were available in 159 patients without atrial fibrillation, who underwent simultaneous invasive and noninvasive assessment of central BP. Noninvasive BP measurements were conducted using the SphygmoCor XCEL (calibration by systolic/diastolic brachial BP only) and the Mobil-O-Graph (calibration by both systolic/diastolic and mean/diastolic brachial BP).
Measurements of both devices and both calibration methods revealed highly significant correlations for systolic and diastolic central BP with invasively assessed BP (P < 0.001 each). Calibration by mean/diastolic and systolic/diastolic BP yielded similar correlations for central DBP (R 0.56 vs. R 0.55, P = 0.919). Correlation of central SBP, however, was significantly lower using calibration by mean/diastolic brachial BP (R 0.86 vs. R 0.74, P = 0.002). Numerically, the SphygmoCor device revealed the highest correlation (R 0.92 for central SBP and 0.72 for central DBP; P < 0.001 each). Calibration by systolic/diastolic brachial BP was associated with an underestimation of central SBP using both the SphygmoCor and the Mobil-O-Graph. Calibration by mean/diastolic brachial BP, instead, was associated with an overestimation, which was numerically comparable (4.8 ± 11.3 vs. -4.2 ± 8.0). The calibration method had little effects on the biases of diastolic measurements.
Calibration by mean/diastolic instead of systolic/diastolic brachial BP led to an overestimation instead of underestimation of central SBP without improving accuracy. Hence, mean/diastolic calibration is not necessarily superior to systolic/diastolic calibration and the optimal approach has to be determined in a device-specific manner.
两种全自动示波装置已可用于无创评估中心动脉血压（BP）。然而，它们往往会低估收缩压。有人提出，用平均压/舒张压而非收缩压/舒张压进行校准可能会减少这种偏差。本研究比较了这两种校准方法在Mobil-O-Graph中的准确性。
对迄今为止最大规模的无创评估中心血压的验证研究进行事后分析。159例无房颤患者同时接受了中心血压的有创和无创评估，两种校准方法的数据均可用。使用SphygmoCor XCEL（仅通过收缩压/舒张压进行校准）和Mobil-O-Graph（通过收缩压/舒张压和平均压/舒张压进行校准）进行无创血压测量。
两种设备和两种校准方法的测量结果均显示，中心收缩压和舒张压与有创评估血压之间存在高度显著的相关性（均P<0.001）。通过平均压/舒张压和收缩压/舒张压校准得到的中心舒张压相关性相似（R分别为0.56和0.55，P=0.919）。然而，使用平均压/舒张压校准时，中心收缩压的相关性显著降低（R分别为0.86和0.74，P=0.002）。从数值上看，SphygmoCor设备显示出最高的相关性（中心收缩压R为0.92，中心舒张压R为0.72；均P<0.001）。使用SphygmoCor和Mobil-O-Graph时，通过收缩压/舒张压校准均与中心收缩压低估有关。相反，通过平均压/舒张压校准则与高估有关，数值上相当（4.8±11.3对-4.2±8.0）。校准方法对舒张压测量偏差的影响很小。
用平均压/舒张压而非收缩压/舒张压进行校准导致中心收缩压高估而非低估，且未提高准确性。因此，平均压/舒张压校准不一定优于收缩压/舒张压校准，最佳方法必须根据具体设备确定。
