Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
A&D Co, Tokyo, Japan.
Hypertens Res. 2022 Aug;45(8):1345-1352. doi: 10.1038/s41440-022-00925-0. Epub 2022 May 2.
We evaluated the accuracy of a 24-hr ambulatory blood pressure monitoring (ABPM) device with a new irregular heartbeat (IHB) algorithm for detecting atrial fibrillation (AF) during each BP measurement. Ninety patients with a history of elevated BP and some type of arrhythmia (mean age 63.2 ± 10.3 years; 94% with hypertension; 81% with previously diagnosed AF) simultaneously underwent evaluation by 24-hr ABPM with the IHB algorithm and 24-hr Holter electrocardiography (ECG). Among the 3,347 valid readings, 843 readings were considered to indicate an IHB. Among these IHB readings, 195 readings were found to have an AF rhythm by 24-hr Holter ECG. The IHB algorithm showed 100% sensitivity and 79.4% specificity for accurately detecting AF rhythm. An IHB was detected in 12.1% of the measurements during normal rhythm, 48.8% of those during atrial premature complex, and 54.4% of those during ventricular premature complex. The percentage of IHBs detected during normal rhythm was higher in the daytime than at nighttime (16.3% vs. 4.5%, respectively), suggesting that daytime physical activity sometimes induces a false detection of IHBs. The optimal IHB parameters for suggesting potential AF were (1) an IHB burden defined as a percentage of IHB-positive readings in total valid BP measurements >22.5% (84.6% sensitivity, 85.1% specificity; AUC 0.906, p < 0.0001) and (2) 2.5 or more consecutive IHBs during 24-hr ABPM (84.6% sensitivity, 83.0% specificity; AUC 0.881, p < 0.0001). The novel 24-hr ABPM device with the IHB algorithm assessed herein could contribute to the future comprehensive management of hypertensive patients, with the main goal of preventing cerebrovascular events.
我们评估了一种新的不规则心跳（IHB）算法的 24 小时动态血压监测（ABPM）设备在每次血压测量时检测心房颤动（AF）的准确性。90 名有高血压病史和某种类型心律失常的患者（平均年龄 63.2±10.3 岁；94%患有高血压；81%有先前诊断的 AF）同时接受了 24 小时 ABPM 与 IHB 算法和 24 小时动态心电图（ECG）的评估。在 3347 次有效读数中，843 次读数被认为是 IHB。在这些 IHB 读数中，通过 24 小时动态心电图发现 195 次读数有 AF 节律。IHB 算法对准确检测 AF 节律的敏感性为 100%，特异性为 79.4%。在正常节律时检测到 IHB 的比例为 12.1%，在房性早搏复合波时为 48.8%，在室性早搏复合波时为 54.4%。在正常节律时检测到的 IHB 百分比白天高于夜间（分别为 16.3%和 4.5%），表明白天的身体活动有时会导致 IHB 的假阳性检测。提示潜在 AF 的最佳 IHB 参数为：（1）定义为 IHB 阳性读数占总有效 BP 测量值的百分比>22.5%的 IHB 负荷（84.6%的敏感性，85.1%的特异性；AUC 0.906，p<0.0001）和（2）24 小时 ABPM 期间连续 2.5 次或更多次 IHB（84.6%的敏感性，83.0%的特异性；AUC 0.881，p<0.0001）。本文评估的具有 IHB 算法的新型 24 小时 ABPM 设备有助于未来对高血压患者进行综合管理，主要目标是预防脑血管事件。
