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Pulse wave analysis with two tonometric devices: a comparison study
This content has been downloaded from IOPscience. Please scroll down to see the full text. 2014 Physiol. Meas. 35 1837 (http://iopscience.iop.org/0967-3334/35/9/1837) View the table of contents for this issue, or go to the journal homepage for more Download details: IP Address: 132.174.250.220 This content was downloaded on 09/07/2017 at 02:35 Please note that terms and conditions apply.
You may also be interested in: Carotid artery pressure from scaled diameter waveforms S J Vermeersch, E R Rietzschel, M L De Buyzere et al. The use of diameter distension waveforms as an alternative for tonometric pressure Jan Kips, Floris Vanmolkot, Dries Mahieu et al. Photoplethysmographic signal waveform index for detection of increased arterial stiffness K Pilt, K Meigas, R Ferenets et al. A piezo-film-based measurement system for global haemodynamic assessment Fabrizio Clemente, Pasquale Arpaia and Pasquale Cimmino A survey on signals and systems in ambulatory blood pressure monitoring using pulse transit time Dilpreet Buxi, Jean-Michel Redouté and Mehmet Rasit Yuce Non-invasive measurement of local PP by PWUM J Vappou, J Luo, K Okajima et al. On measuring the instantaneous blood pressure in an artery via the tissue control method Albert Chin-Yuh Lin, Huang-Nan Huang, Yi-Chang Su et al. Impact of heart disease and calibration interval on accuracy of pulse transit time–based blood pressure estimation Xiaorong Ding, Yuanting Zhang and Hon Ki Tsang Calibration of oscillometric non-invasive devices for monitoring blood pressure Il Doh, Hyun Kyoon Lim and Bongyoung Ahn
Institute of Physics and Engineering in Medicine Physiol. Meas. 35 (2014) 1837–1848
Physiological Measurement doi:10.1088/0967-3334/35/9/1837
Pulse wave analysis with two tonometric devices: a comparison study D Agnoletti1,2, S C Millasseau3, J Topouchian1, Y Zhang4, M E Safar1 and J Blacher1 1
Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France 2 Department of Internal Medicine, University of Bologna, Bologna, Italy 3 Pulse wave consulting, Saint Leu la Forêt, France 4 Department of Cardiology Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic Of China E-mail: [email protected] Received 20 September 2013, revised 19 February 2014 Accepted for publication 11 June 2014 Published 26 August 2014 Abstract
Pulse wave analysis is a pivotal tool to estimate central haemodynamic parameters. Available commercial devices use applanation tonometry and have been validated against invasive catheterism. We previously observed differences on a radial second systolic peak (rSPB2) between two commonly used devices: SphygmoCor (AtCor, Australia) and PulsePen (DiaTecne, Italy). The aim of our study was to further quantify differences in radial and carotid signals from the two devices.We measured radial and carotid waveforms in 38 patients with minimal changes between systolic, diastolic blood pressure and heart rate. rSBP2, mean pressure, form factor and augmentation index were different with SphygmoCor providing lower values (mean differences: 2.2 ± 3.8 mmHg; 1.5 ± 1.7 mmHg; 3.2 ± 3.5%; 4.2 ± 8.4%, respectively). Carotid augmentation index and form factor were similar. However carotid systolic pressure (cSBP) from PulsePen was higher than cSBP from SphygmoCor (2.7 ± 4.4 mmHg, p 5% - 76 with BP variations >3mmHg - on SBP: 59 - on DBP: 45
43 patients
10sec of radial PPen signal
37 excluded due to missing recording: - 24 with missing radial PPen - 5 with missing radial SCor - 12 with missing carotid Ppen - 17 with missing carotid SCor
5 excluded due to poor data quality: - 3 on radial PPen - 2 on carotid SCor
38 patients analyzed
Compute Average PPen pulse
Calibrate SCor and PPen pulse to average cuff SBP and DBP and pulse duration to mean HR
Arbitrary units
Arbitrary units
Average SCor pulse
Superimpose calibrated waveforms Avg cuff SBP
Compute MeanBP, Form Factor, shape difference, harmonics analysis, RMS error
Avg cuff DBP Figure 1. Analysis process for radial traces.
1840
D Agnoletti et al
Physiol. Meas. 35 (2014) 1837
Table 1. Patients’ characteristics (n = 38).
Variables
Mean ± SD
Age, years Male gender, n(%) Body Mass Index, kg/m2 Metabolic syndrome, n(%) Systolic BP, mmHg Diastolic BP, mmHg Heart rate, bpm
48 ± 8 34 (90) 23 ± 3 15 (43) 125 ± 18 80 ± 13 72 ± 13
DBP of SCor measurements were used to calibrate the carotid SCor PWs and rMAP and cuff DBP of PPen measurement to calibrate the carotid PPen PWs. Carotid SBP (cSBP_scor and cSBP_ppen) and carotid AIx (cAIx_scor and cAIx_ppen) were then measured and compared. A second calibration methodology was used in order to quantify wave shape differences: in order to compare PWs without the influence of the calibration, we forced carotid PWs to have the same amplitude. PPen and SCor PWs were calibrated to the same amplitude with mean cSBP (= (cSBP_scor + cSBP_ppen)/2) and DBP. Carotid PWs were then superimposed to calculate the RMS error and the FF. Frequency analysis was also performed. 2.3. Statistics
Statistical analysis was performed with MatLab (Mathworks, US). All variables were normally distributed. Paired t-tests were used to compare values obtained from SCor and PPen waveforms and on moduli from the frequency analysis. P ≪ 0.05 was taken as significant. 3. Results Out of the 178 consecutive patients, only 43 subjects fulfilled our strict haemodynamic inclusion criteria (figure 1): 37 patients were excluded due to the absence of one or more of the four tonometric measurements (radial or carotid with PPen or SCor). Of the remaining patients, 43 patients were excluded due to high HR variation, and 76 patients due to BP variation (figure 1). Finally, five patients were further excluded due to poor tonometric data quality (operator index lower than 80): three due to poor radial PPen and two due to poor carotid SCor PWs. Characteristics of the remaining 38 subjects are presented in table 1. Brachial systolic blood pressure ranged from 96 to 194 mmHg and diastolic pressure from 60 to 119 mmHg. 3.1. Radial artery
An example of superimposed radial PWs is shown in figure 2a. Results on the comparison of radial PWs (table 2) showed that the RMS error was 2.7 ± 1.4 mmHg (p ≪ 0.001 from zero), while the difference between the arithmetic mean radial pressures was 1.5 ± 1.7 mmHg (p ≪ 0.001), with radial SCor PWs being under PPen PWs in 33 out of 38 subjects. This discrepancy induced statistical differences between pulse wave analysis parameters: FF, rSBP2 and rAIx (all p value 0.05). 1841
D Agnoletti et al
Physiol. Meas. 35 (2014) 1837
(a)
RADIAL
(b)
CAROTID calibrated on radial MAP and cuff DBP
(c)
115
115
115
110
110
110
105
105
cSBP_ppen = 106 mmHg
CAROTID calibrated on mean cSBP and cuff DBP
SphygmoCor PulsePen
105
cSBP_scor = 103 mmHg 100
100
100
95
95
95
90
90
90
85
85
85
80
80
80
75
75
75
arbitrary unit
arbitrary unit
arbitrary unit
rMAP_scor = 89 mmHg
cMAP_scor = 89 mmHg
cMAP_scor = 90.2 mmHg
rMAP_ppen = 91 mmHg
cMAP_ppen = 91 mmHg
cMAP_ppen = 90.5 mmHg
Figure 2. Example of waveforms from patient ID 64 (male, 49 years old). Solid lines:
waveforms from SphygmoCor device Dash lines: waveforms from PulsePen device.
3.2. Carotid artery
On figure 2b and 2c, an example of superimposed carotid PWs with the two calibration methodologies is presented. As expected, because carotid PWs were less ‘peaky’ than radial PWs, cFF was higher than rFF. The difference between cFF_scor and cFF_ppen was small and did not reach statistical significance (p = 0.07, table 2). With the first calibration method the RMS error was 2.9 ± 1.5 mmHg (p ≪ 0.001), and the error on cSBP reached 2.7 ± 4.4 mmHg (p ≪ 0.001), with cSBP_scor being lower than cSBP_ppen in 31 out 38 patients. The difference in cAIx was however not significant with a relatively large spread (−1.2 ± 5.9, p = 0.22). With the second calibration method, the RMS error was 1.8 ± 1.3 mmHg (p ≪ 0.001). As expected, we found the same results on FF and cAIx, because they are ratios, and hence are independent of calibration.Figure 3b shows the frequency analysis of the carotid PWs with a small difference on the 1st and 2nd harmonics (0.87 and 0.45 mmHg respectively, p ≪ 0.05) and no statistical difference for higher harmonics (p > 0.05). 4. Discussion Our investigation on potential differences between SCor and PPen PWs showed that SCor tended to give lower value for integration of the carotid and radial curves than PPen, with significant clinical differences in MAP, central SBP and FF between the two devices. 1842
D Agnoletti et al
Physiol. Meas. 35 (2014) 1837
Table 2. Comparison of pulse wave analysis parameters.
RADIAL
CAROTID calibrated on radial MAP and cuff DBP CAROTID calibrated on cSBP and cuff DBP
SphygmoCor
PulsePen
difference
p
rMAP (mmHg) rFF (%) rSBP2 (mmHg)* rAIx (%) cSBP (mmHg) Form Factor (%) cAIx (%)
94.9 ± 14.9 33.9 ± 4.0 110.2 ± 20.0 67.4 ± 17.8 114.8 ± 19.1 43,6 ± 3.6 −4.1 ± 17.1
96.4 ± 15.1 37.2 ± 4.6 111.7 ± 20.9 70.9 ± 17.2 117.5 ± 19.7 44.5 ± 4.0 −2.9 ± 17.8
−1.5 ± 1.7 −3.2 ± 3.5 −2.2 ± 3.8 −4.2 ± 8.4 −2.7 ± 4.4 −0.8 ± 2.8 −1.2 ± 5.9
Search
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About
Contact us
My IOPscience
Pulse wave analysis with two tonometric devices: a comparison study
This content has been downloaded from IOPscience. Please scroll down to see the full text. 2014 Physiol. Meas. 35 1837 (http://iopscience.iop.org/0967-3334/35/9/1837) View the table of contents for this issue, or go to the journal homepage for more Download details: IP Address: 132.174.250.220 This content was downloaded on 09/07/2017 at 02:35 Please note that terms and conditions apply.
You may also be interested in: Carotid artery pressure from scaled diameter waveforms S J Vermeersch, E R Rietzschel, M L De Buyzere et al. The use of diameter distension waveforms as an alternative for tonometric pressure Jan Kips, Floris Vanmolkot, Dries Mahieu et al. Photoplethysmographic signal waveform index for detection of increased arterial stiffness K Pilt, K Meigas, R Ferenets et al. A piezo-film-based measurement system for global haemodynamic assessment Fabrizio Clemente, Pasquale Arpaia and Pasquale Cimmino A survey on signals and systems in ambulatory blood pressure monitoring using pulse transit time Dilpreet Buxi, Jean-Michel Redouté and Mehmet Rasit Yuce Non-invasive measurement of local PP by PWUM J Vappou, J Luo, K Okajima et al. On measuring the instantaneous blood pressure in an artery via the tissue control method Albert Chin-Yuh Lin, Huang-Nan Huang, Yi-Chang Su et al. Impact of heart disease and calibration interval on accuracy of pulse transit time–based blood pressure estimation Xiaorong Ding, Yuanting Zhang and Hon Ki Tsang Calibration of oscillometric non-invasive devices for monitoring blood pressure Il Doh, Hyun Kyoon Lim and Bongyoung Ahn
Institute of Physics and Engineering in Medicine Physiol. Meas. 35 (2014) 1837–1848
Physiological Measurement doi:10.1088/0967-3334/35/9/1837
Pulse wave analysis with two tonometric devices: a comparison study D Agnoletti1,2, S C Millasseau3, J Topouchian1, Y Zhang4, M E Safar1 and J Blacher1 1
Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France 2 Department of Internal Medicine, University of Bologna, Bologna, Italy 3 Pulse wave consulting, Saint Leu la Forêt, France 4 Department of Cardiology Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic Of China E-mail: [email protected] Received 20 September 2013, revised 19 February 2014 Accepted for publication 11 June 2014 Published 26 August 2014 Abstract
Pulse wave analysis is a pivotal tool to estimate central haemodynamic parameters. Available commercial devices use applanation tonometry and have been validated against invasive catheterism. We previously observed differences on a radial second systolic peak (rSPB2) between two commonly used devices: SphygmoCor (AtCor, Australia) and PulsePen (DiaTecne, Italy). The aim of our study was to further quantify differences in radial and carotid signals from the two devices.We measured radial and carotid waveforms in 38 patients with minimal changes between systolic, diastolic blood pressure and heart rate. rSBP2, mean pressure, form factor and augmentation index were different with SphygmoCor providing lower values (mean differences: 2.2 ± 3.8 mmHg; 1.5 ± 1.7 mmHg; 3.2 ± 3.5%; 4.2 ± 8.4%, respectively). Carotid augmentation index and form factor were similar. However carotid systolic pressure (cSBP) from PulsePen was higher than cSBP from SphygmoCor (2.7 ± 4.4 mmHg, p 5% - 76 with BP variations >3mmHg - on SBP: 59 - on DBP: 45
43 patients
10sec of radial PPen signal
37 excluded due to missing recording: - 24 with missing radial PPen - 5 with missing radial SCor - 12 with missing carotid Ppen - 17 with missing carotid SCor
5 excluded due to poor data quality: - 3 on radial PPen - 2 on carotid SCor
38 patients analyzed
Compute Average PPen pulse
Calibrate SCor and PPen pulse to average cuff SBP and DBP and pulse duration to mean HR
Arbitrary units
Arbitrary units
Average SCor pulse
Superimpose calibrated waveforms Avg cuff SBP
Compute MeanBP, Form Factor, shape difference, harmonics analysis, RMS error
Avg cuff DBP Figure 1. Analysis process for radial traces.
1840
D Agnoletti et al
Physiol. Meas. 35 (2014) 1837
Table 1. Patients’ characteristics (n = 38).
Variables
Mean ± SD
Age, years Male gender, n(%) Body Mass Index, kg/m2 Metabolic syndrome, n(%) Systolic BP, mmHg Diastolic BP, mmHg Heart rate, bpm
48 ± 8 34 (90) 23 ± 3 15 (43) 125 ± 18 80 ± 13 72 ± 13
DBP of SCor measurements were used to calibrate the carotid SCor PWs and rMAP and cuff DBP of PPen measurement to calibrate the carotid PPen PWs. Carotid SBP (cSBP_scor and cSBP_ppen) and carotid AIx (cAIx_scor and cAIx_ppen) were then measured and compared. A second calibration methodology was used in order to quantify wave shape differences: in order to compare PWs without the influence of the calibration, we forced carotid PWs to have the same amplitude. PPen and SCor PWs were calibrated to the same amplitude with mean cSBP (= (cSBP_scor + cSBP_ppen)/2) and DBP. Carotid PWs were then superimposed to calculate the RMS error and the FF. Frequency analysis was also performed. 2.3. Statistics
Statistical analysis was performed with MatLab (Mathworks, US). All variables were normally distributed. Paired t-tests were used to compare values obtained from SCor and PPen waveforms and on moduli from the frequency analysis. P ≪ 0.05 was taken as significant. 3. Results Out of the 178 consecutive patients, only 43 subjects fulfilled our strict haemodynamic inclusion criteria (figure 1): 37 patients were excluded due to the absence of one or more of the four tonometric measurements (radial or carotid with PPen or SCor). Of the remaining patients, 43 patients were excluded due to high HR variation, and 76 patients due to BP variation (figure 1). Finally, five patients were further excluded due to poor tonometric data quality (operator index lower than 80): three due to poor radial PPen and two due to poor carotid SCor PWs. Characteristics of the remaining 38 subjects are presented in table 1. Brachial systolic blood pressure ranged from 96 to 194 mmHg and diastolic pressure from 60 to 119 mmHg. 3.1. Radial artery
An example of superimposed radial PWs is shown in figure 2a. Results on the comparison of radial PWs (table 2) showed that the RMS error was 2.7 ± 1.4 mmHg (p ≪ 0.001 from zero), while the difference between the arithmetic mean radial pressures was 1.5 ± 1.7 mmHg (p ≪ 0.001), with radial SCor PWs being under PPen PWs in 33 out of 38 subjects. This discrepancy induced statistical differences between pulse wave analysis parameters: FF, rSBP2 and rAIx (all p value 0.05). 1841
D Agnoletti et al
Physiol. Meas. 35 (2014) 1837
(a)
RADIAL
(b)
CAROTID calibrated on radial MAP and cuff DBP
(c)
115
115
115
110
110
110
105
105
cSBP_ppen = 106 mmHg
CAROTID calibrated on mean cSBP and cuff DBP
SphygmoCor PulsePen
105
cSBP_scor = 103 mmHg 100
100
100
95
95
95
90
90
90
85
85
85
80
80
80
75
75
75
arbitrary unit
arbitrary unit
arbitrary unit
rMAP_scor = 89 mmHg
cMAP_scor = 89 mmHg
cMAP_scor = 90.2 mmHg
rMAP_ppen = 91 mmHg
cMAP_ppen = 91 mmHg
cMAP_ppen = 90.5 mmHg
Figure 2. Example of waveforms from patient ID 64 (male, 49 years old). Solid lines:
waveforms from SphygmoCor device Dash lines: waveforms from PulsePen device.
3.2. Carotid artery
On figure 2b and 2c, an example of superimposed carotid PWs with the two calibration methodologies is presented. As expected, because carotid PWs were less ‘peaky’ than radial PWs, cFF was higher than rFF. The difference between cFF_scor and cFF_ppen was small and did not reach statistical significance (p = 0.07, table 2). With the first calibration method the RMS error was 2.9 ± 1.5 mmHg (p ≪ 0.001), and the error on cSBP reached 2.7 ± 4.4 mmHg (p ≪ 0.001), with cSBP_scor being lower than cSBP_ppen in 31 out 38 patients. The difference in cAIx was however not significant with a relatively large spread (−1.2 ± 5.9, p = 0.22). With the second calibration method, the RMS error was 1.8 ± 1.3 mmHg (p ≪ 0.001). As expected, we found the same results on FF and cAIx, because they are ratios, and hence are independent of calibration.Figure 3b shows the frequency analysis of the carotid PWs with a small difference on the 1st and 2nd harmonics (0.87 and 0.45 mmHg respectively, p ≪ 0.05) and no statistical difference for higher harmonics (p > 0.05). 4. Discussion Our investigation on potential differences between SCor and PPen PWs showed that SCor tended to give lower value for integration of the carotid and radial curves than PPen, with significant clinical differences in MAP, central SBP and FF between the two devices. 1842
D Agnoletti et al
Physiol. Meas. 35 (2014) 1837
Table 2. Comparison of pulse wave analysis parameters.
RADIAL
CAROTID calibrated on radial MAP and cuff DBP CAROTID calibrated on cSBP and cuff DBP
SphygmoCor
PulsePen
difference
p
rMAP (mmHg) rFF (%) rSBP2 (mmHg)* rAIx (%) cSBP (mmHg) Form Factor (%) cAIx (%)
94.9 ± 14.9 33.9 ± 4.0 110.2 ± 20.0 67.4 ± 17.8 114.8 ± 19.1 43,6 ± 3.6 −4.1 ± 17.1
96.4 ± 15.1 37.2 ± 4.6 111.7 ± 20.9 70.9 ± 17.2 117.5 ± 19.7 44.5 ± 4.0 −2.9 ± 17.8
−1.5 ± 1.7 −3.2 ± 3.5 −2.2 ± 3.8 −4.2 ± 8.4 −2.7 ± 4.4 −0.8 ± 2.8 −1.2 ± 5.9
