Podrug Mario, Šunjić Borna, Koren Pjero, Đogaš Varja, Mudnić Ivana, Boban Mladen, Jerončić Ana
Laboratory of Vascular Aging, University of Split School of Medicine, 21000 Split, Croatia.
Department of Health Studies, University of Split, 21000 Split, Croatia.
J Cardiovasc Dev Dis. 2023 Jan 25;10(2):44. doi: 10.3390/jcdd10020044.
Pulse wave velocity (PWV), a direct measure of arterial stiffness, is a promising biomarker of cardiovascular risk and a cardiovascular surrogate outcome. The resolution for detecting its smallest clinically significant change is dependent on the expected reproducibility, but there is currently no consensus on this. We estimated the PWV reproducibility in a range of intra-subject values that were observed over a 2 week period in a broad range of participants and under clinically relevant experimental conditions (two observers, morning/afternoon sessions, and number of visits) using SphygmoCor and Arteriograph devices. Each participant was recorded 12 times with each device over three visits, one week apart, and two morning and two afternoon recordings were taken per visit. The factors affecting reproducibility and the discrepancies between the consecutive PWV measurements for each device were also examined using multilevel mixed-effect models. We show that current PWV estimation guidance recommending 2 + 1 measurements is suboptimal because the PWV range was outside of the 1 m/s threshold for most of the participants, which is proposed as a minimal clinically important difference. The best reproducibility was yielded with median of four measurements and a 1.1 m/s threshold. Although PWV reproducibility and repeatability are frequently used interchangeably in studies, we demonstrated that despite their relative measures of variability (e.g., coefficient of variation) being comparable, their ranges revealed a clinically significant difference between them. We also found that different physiological variables were predictors of the discrepancy between the consecutive measurements made by the two devices, which is likely due to their distinct modes of operation. The evidence base for PWV reproducibility is limited, and more research is needed to deepen our understanding of the variation in arterial stiffness over time, as well as fluctuations within a population group and in an intervention setting.
脉搏波速度（PWV）是动脉僵硬度的直接测量指标，是一种很有前景的心血管风险生物标志物和心血管替代结局指标。检测其最小临床显著变化的分辨率取决于预期的可重复性，但目前对此尚无共识。我们在广泛的参与者中，于临床相关实验条件下（两名观察者、上午/下午时段以及就诊次数），使用SphygmoCor和Arteriograph设备，在2周内观察到的一系列受试者内值范围内估计了PWV的可重复性。每位参与者使用每种设备在三次就诊时记录12次，每次就诊间隔一周，每次就诊进行两次上午和两次下午记录。还使用多水平混合效应模型检查了影响可重复性的因素以及每种设备连续PWV测量之间的差异。我们表明，当前推荐2 + 1次测量的PWV估计指南并不理想，因为对于大多数参与者而言，PWV范围超出了1 m/s的阈值，而该阈值被提议作为最小临床重要差异。四次测量的中位数和1.1 m/s的阈值产生了最佳的可重复性。尽管在研究中PWV的可重复性和重复性经常互换使用，但我们证明，尽管它们的相对变异性度量（例如变异系数）具有可比性，但它们的范围显示出它们之间存在临床显著差异。我们还发现，不同的生理变量是两种设备连续测量之间差异的预测因素，这可能是由于它们不同的操作模式所致。PWV可重复性的证据基础有限，需要更多研究来加深我们对动脉僵硬度随时间变化、人群组内波动以及干预环境中波动的理解。
