Arterial Stiffness

Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity Iva´n G. Horva´ tha, A´ da´m Ne´metha, Zso´ fia Lenkeya, Nicola Alessandrib, Fabrizio Tufanob, Pa´ l Kisa, Bala´ zs Gasznera and Attila Czira´ kia Background The importance of measuring aortic pulse wave velocity (PWVao), aortic augmentation index (Aix) and central systolic blood pressure (SBPao) has been shown under different clinical conditions; however, information on these parameters is hard to obtain. The aim of this study was to evaluate the accuracy of a new, easily applicable oscillometric device (Arteriograph), determining these parameters simultaneously, against invasive measurements. Methods Aortic Aix, SBPao and PWVao were measured invasively during cardiac catheterization in 16, 55 and 22 cases, respectively, and compared with the values measured by the Arteriograph. Results We found strong correlation between the invasively measured aortic Aix and the oscillometrically measured brachial Aix on either beat-to-beat or mean value per patient basis (rU0.9, P<0.001; rU0.94, P<0.001), which allowed the noninvasive calculation of the aortic Aix without using generalized transfer function. Similarly strong correlation (rU0.95, P<0.001) was found between the invasively measured and the noninvasively calculated central SBPao; furthermore, the BHS assessment of the paired differences fulfilled the ‘B’ grading. The PWVao values measured invasively and by Arteriograph were 9.41W1.8 m/s and 9.46W1.8 m/s, respectively (meanWSD); furthermore, the Pearson’s correlation was 0.91 (P<0.001). The limits of agreement were 11.4% for aortic Aix and 1.59 m/s for PWVao. Conclusion Aix, SBPao and PWVao, measured oscillometrically, showed strong correlation with the invasively obtained values. The observed limits of agreement are encouragingly low for accepting the method for clinical use. Our results suggest that the PWVao values, measured by Arteriograph, are close to the true aortic PWV, determined invasively. J Hypertens 28:2068–2075 Q 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Hypertension 2010, 28:2068–2075 Keywords: arterial stiffness, Arteriograph, augmentation index, invasive measurement, oscillometric method, pulse wave velocity, validation Abbreviations: Aix-ao, aortic augmentation index; Aix-br, brachial augmentation index; BP, blood pressure; CAS, coronary artery stenosis; cf PWV, carotid–femoral pulse wave velocity; GTF, generalized transfer function; Jug-Sy, Jugulum-Symphisis; PWVao, aortic pulse wave velocity; RT, return time; SBPao, central systolic blood pressure aHeart Institute, Medical School, University of Pe´ cs, Pe´ cs, Hungary and bDepartment of Cardiology, University of Rome La Sapienza, Polo Pontino, Italy Correspondence to Attila Czira´ ki, Heart Institute, Medical School, University of Pe´ cs, H-7624 Ifju´sa´g str. 13. Pe´ cs, Hungary Tel: +36 302177464; e-mail: acziraki@t-online.hu Received 3 December 2009 Revised 19 May 2010 Accepted 27 May 2010 See editorial comment on page 2003 Introduction The importance of the parameters (aortic pulse wave velocity, PWVao; aortic augmentation index, Aix; central systolic blood pressure, SBPao) describing the arterial function (stiffness) has been shown on different groups of patients: end-stage renal disease [1–3], coronary artery disease [4,5], hypertension [6,7], diabetes [8]) and, on general, apparently healthy population [9]. Based on these results, the evaluation of arterial stiffness was included in the 2007ESH/ESC guidelines for the management of arterial hypertension, both in evaluating organ damage and in the cardiovascular risk calculation of patients with hypertension [10]. However, the examination of the above-mentioned parameters has not become part of the daily routine in clinical work so far [10]. A possible cause may be that the methods used did not allow to determine these parameters at the same time, were fairly complicated