Abstract
IntroductionArterial stiffness is an independent risk factor for cardiovascular morbidity and can be assessed by applanation tonometry by measuring pulse wave velocity (PWV) and augmentation index (AIX) by pressure pulse wave analysis (PWA). As an inexpensive and operator independent alternative, photoelectric plethysmography (PPG) has been introduced with analysis of the digital volume pulse wave (DPA) and its second derivatives of wave reflections.ObjectiveThe objective was to investigate the repeatability of arterial stiffness parameters measured by digital pulse wave analysis (DPA) and the associations to applanation tonometry parameters.Methods and Results112 pregnant and non-pregnant individuals of different ages and genders were examined with SphygmoCor arterial wall tonometry and Meridian DPA finger photoplethysmography. Coefficients of repeatability, Bland-Altman plots, intraclass correlation coefficients and correlations to heart rate (HR) and body height were calculated for DPA variables, and the DPA variables were compared to tonometry variables left ventricular ejection time (LVET), PWV and AIX. No DPA variable showed any systematic measurement error or excellent repeatability, but dicrotic index (DI), dicrotic dilatation index (DDI), cardiac ejection elasticity index (EEI), aging index (AI) and second derivatives of the crude pulse wave curve, b/a and e/a, showed good repeatability. Overall, the correlations to AIX were better than to PWV, with correlations coefficients >0.70 for EEI, AI and b/a. Considering the level of repeatability and the correlations to tonometry, the overall best DPA parameters were EEI, AI and b/a. The two pansystolic time parameters, ejection time compensated (ETc) by DPA and LVET by tonometry, showed a significant but weak correlation.ConclusionFor estimation of the LV function, ETc, EEI and b/a are suitable, for large artery stiffness EEI, and for small arteries DI and DDI. The only global parameter, AI, showed a high repeatability and the overall best correlations with AIX and PWV.
Highlights
Arterial stiffness is an independent risk factor for cardiovascular morbidity and can be assessed by applanation tonometry by measuring pulse wave velocity (PWV) and augmentation index (AIX) by pressure pulse wave analysis (PWA)
Coefficients of repeatability, Bland-Altman plots, intraclass correlation coefficients and correlations to heart rate (HR) and body height were calculated for digital volume pulse wave (DPA) variables, and the DPA variables were compared to tonometry variables left ventricular ejection time (LVET), PWV and AIX
Regarding PW properties, the relation between the forward PW and the PW reflection in distal arteries is commonly expressed as augmentation index (AIX), i.e. the amplification of the forward PW curve caused by the overlap of the reflected PW
Summary
The study was performed at the Medical Research Unit, Department of Internal Medicine, Skåne University Hospital in Malmö, Sweden. It was approved by the Regional Research Ethics Committee in Lund (Dnr. 532/2006) and all participants gave their oral and written informed consent. Volunteers recruited for the study were men and women age 64 years and above recruited from an ongoing screening study at the Medical Research Unit, and non-pregnant women up to 64 years and pregnant women recruited from the Department of Obstetrics and Gynecology (Table 1). All participants were asked to avoid alcohol for at least 12 h and large meals, coffee, tea and nicotine for at least 3 h prior to the examinations. Three tonometry measurements and two DPA recordings were performed in series during the same séance. High quality recordings according to the apparatuses’ own quality securing system were accepted
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