Clinical utility of aortic pulses and pressures calculated from applanated radial-artery pulses
Clinical utility of aortic pulses and pressures calculated from applanated radial-artery pulses
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DOI：
10.1161/01.hyp.0000084051.34269.a9
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发表时间：
2003-08-01
期刊：
影响因子：
8.3
通讯作者：
Safar, ME
中科院分区：
文献类型：
--
作者：
Smulyan, H;Siddiqui, DS;Safar, ME
肱动脉袖带血压只是中央主动脉压力的近似值。如果以无创方式获得，左心室泵血所必须承受的实际压力将是有用的临床信息。我们的目的是确定根据无创获得的桡动脉脉搏计算出的主动脉脉搏和压力的临床效用。通过压平记录桡动脉脉搏，并用手臂/袖带示波压力进行校准。主动脉脉搏和压力是通过傅立叶分析和传递函数从桡动脉脉搏计算出来的。将这些计算出的主动脉搏动与通过换能器尖端导管在 50 名接受心导管插入术的患者中直接记录的主动脉搏动进行比较。测量的主动脉收缩压与计算的主动脉收缩压的相关系数 (r) 为 + 0.89，但分散度很大（差异的标准偏差 = +/- 11.3 mm Hg）。脉压相关性较差 (r = + 0.79)，而且分散性也较大 (+/- 13.6 mm Hg)。计算得出的平均脉压比测量值低 11.5 mm Hg，因为用于校准桡动脉脉搏的袖带舒张压总体上高于主动脉中的舒张压 (8.9 mm Hg)。将身高、年龄、心率和射血分数作为附加自变量的多变量分析消除了新的“预测”压力和测量压力之间的平均差异，显着改善了相关系数，并减少了分散性。然而，改进很小。用于测量手臂血压的示波袖带方法的不准确性似乎是预测临床有用的无创主动脉压的限制因素。
Brachial artery cuff blood pressures are but approximations of central aortic pressures. The actual pressures against which the left ventricle must pump would be useful clinical information if obtained noninvasively. Our aim was to determine the clinical utility of aortic pulses and pressures calculated from noninvasively obtained radial-artery pulses. Radial-arterial pulses were recorded by applanation and calibrated with arm/cuff oscillometric pressures. Aortic pulses and pressures were calculated from the radial pulses by Fourier analysis and transfer functions. These calculated aortic pulses were compared with directly recorded aortic pulses by a transducer-tip catheter in a series of 50 patients undergoing cardiac catheterization. The correlation coefficient (r) of the measured versus the calculated aortic systolic blood pressure was + 0.89, but the scatter was large ( standard deviation of the differences = +/- 11.3 mm Hg). The pulse pressure correlations were less good ( r = + 0.79) and also had a large scatter ( +/- 13.6 mm Hg). The average calculated pulse pressure was 11.5 mm Hg lower than the measured value because the cuff diastolic blood pressures, used to calibrate the radial pulses, were systematically higher than those in the aorta ( 8.9 mm Hg). Multivariable analysis incorporating height, age, heart rate, and ejection fraction as additional, independent variables eliminated mean differences between the new "predicted" and measured pressures, significantly improved correlation coefficients, and reduced the scatter. However, the improvements were small. The inaccuracy of the oscillometric cuff method for measuring arm blood pressure appears to be the limiting factor in the prediction of clinically useful, noninvasive aortic pressures.