Scalia Alessandro, Ghafari Chadi, Navarre Wivine, Delmotte Philippe, Phillips Rob, Carlier Stéphane
Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, 7000 Mons, Belgium.
Department of Cardiology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium.
Biomedicines. 2023 Apr 21;11(4):1235. doi: 10.3390/biomedicines11041235.
Central blood pressure (cBP) is known to be a better predictor of the damage caused by hypertension in comparison with peripheral blood pressure. During cardiac catheterization, we measured cBP in the ascending aorta with a fluid-filled guiding catheter (FF) in 75 patients and with a high-fidelity micromanometer tipped wire (FFR) in 20 patients. The wire was withdrawn into the brachial artery and aorto-brachial pulse wave velocity (abPWV) was calculated from the length of the pullback and the time delay between the ascending aorta and the brachial artery pulse waves by gating to the R-wave of the ECG for both measurements. In 23 patients, a cuff was inflated around the calf and an aorta-tibial pulse wave velocity (atPWV) was calculated from the distance between the cuff around the leg and the axillary notch and the time delay between the ascending aorta and the tibial pulse waves. Brachial BP was measured non-invasively and cBP was estimated using a new suprasystolic oscillometric technology. The mean differences between invasively measured cBP by FFR and non-invasive estimation were -0.4 ± 5.7 mmHg and by FF 5.4 ± 9.4 mmHg in 52 patients. Diastolic and mean cBP were both overestimated by oscillometry, with mean differences of -8.9 ± 5.5 mmHg and -6.4 ± 5.1 mmHg compared with the FFR and -10.6 ± 6.3 mmHg and -5.9 ± 6.2 mmHg with the FF. Non-invasive systolic cBP compared accurately with the high-fidelity FFR measurements, demonstrating a low bias (≤5 mmHg) and high precision (SD ≤ 8 mmHg). These criteria were not met when using the FF measurements. Invasively derived average Ao-brachial abPWV was 7.0 ± 1.4 m/s and that of Ao-tibial atPWV was 9.1 ± 1.8 m/s. Non-invasively estimated PWV based on the reflected wave transit time did not correlate with abPWV or with atPWV. In conclusion, we demonstrate the advantages of a novel method of validation for non-invasive cBP monitoring devices using acknowledged gold standard FFR wire transducers and the possibility to easily measure PWV during coronary angiography with the impact of cardiovascular risk factors.
与外周血压相比，中心血压（cBP）能更好地预测高血压所造成的损害。在心脏导管插入术期间，我们对75例患者使用充满液体的引导导管（FF）测量升主动脉中的cBP，对20例患者使用高保真微测压头导线（FFR）进行测量。将导线撤回肱动脉，通过测量回撤长度以及升主动脉和肱动脉脉搏波之间的时间延迟（两者均通过门控心电图的R波进行测量）来计算主动脉-肱动脉脉搏波速度（abPWV）。在23例患者中，在小腿周围充气袖带，根据腿部袖带与腋窝切口之间的距离以及升主动脉和胫动脉脉搏波之间的时间延迟来计算主动脉-胫动脉脉搏波速度（atPWV）。无创测量肱动脉血压，并使用一种新的超收缩示波技术估计cBP。在52例患者中，通过FFR有创测量的cBP与无创估计值之间的平均差异为-0.4±5.7 mmHg，通过FF测量的平均差异为5.4±9.4 mmHg。示波法高估了舒张期和平均cBP，与FFR相比平均差异分别为-8.9±5.5 mmHg和-6.4±5.1 mmHg，与FF相比分别为-10.6±6.3 mmHg和-5.9±6.2 mmHg。无创收缩期cBP与高保真FFR测量结果相比准确，偏差低（≤5 mmHg）且精度高（标准差≤8 mmHg）。使用FF测量时未达到这些标准。有创得出的平均主动脉-肱动脉abPWV为7.0±1.4 m/s，主动脉-胫动脉atPWV为9.1±1.8 m/s。基于反射波传播时间的无创估计PWV与abPWV或atPWV均无相关性。总之，我们证明了使用公认的金标准FFR导线换能器对无创cBP监测设备进行验证的新方法的优势，以及在冠状动脉造影期间轻松测量PWV的可能性及其对心血管危险因素的影响。
