Noninvasive method to validate the variability of blood pressure during arrhythmias
Noninvasive method to validate the variability of blood pressure during arrhythmias
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验证心律失常期间血压变异性的无创方法
DOI：
10.1038/s41440-021-00835-7
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发表时间：
2021
影响因子：
5.4
通讯作者：
Kario Kazuomi
中科院分区：
文献类型：
--
作者：
Watanabe Tomonori;Hoshide Satoshi;Kario Kazuomi
对于高血压的管理，基于袖带的无创血压（BP）测量已经建立了准确性，并广泛应用于各种环境（例如，办公室，家庭和门诊条件）。通过该技术测量的所有血压值都提供了准确诊断高血压和心血管疾病（CVD）事件预后所必需的信息，并且高血压水平的降低导致CVD事件的预防。此外，各种血压变异性参数，如办公室血压、家庭血压和动态血压监测评估的短期、中期和长期变异性，与靶器官损伤的进展和CVD事件的风险相关，独立于患者的平均血压值[2-4]。然而，这些关联背后的证据是在没有心律失常的人群的研究中获得的，或者在忽视心律失常的调查中获得的，因为用于血压测量的设备仅在窦性心律下得到验证。每个BP值是从袖带充气到放气的时间点的脉冲波中获得的。这些值可能受到与心跳不规则相关的脉冲波的时间变化和幅度变化的影响。心脏周期包括收缩期和舒张期，如果心室收缩性正常，循环动力学除了血管弹性外，还受收缩期左室射血和舒张期左室充盈的调节。心率波动影响左室搏量。此外，由于房室结顺行传导导致房室收缩连接丧失，室性心律失常容易导致血压降低。心电图监测中从QRS复合体到外周动脉最大脉搏波的时间长度被定义为常规脉冲传递时间（cPTT）[5,6]，该时间变量已被用于一种新的无袖带连续血压监测形式。Miao等人基于cPTT的概念报道了一个可用于准确评估室性心律失常期间血压变异性的参数，他们报道了调整后的PTT= cPTT2/RR是由室性心律失常期间心周期的RR间隔[7]计算得出的。在该研究中，与cPTT相比，调整后的PTT与有创方法评估的室性心律失常期间的BP之间存在很强的负相关。假设室性早搏和室性心动过速耦合周期短，导致左室充盈不足，从而导致左室每搏容量减少。调整后的PTT似乎是一个强调cPTT延长和BP降低并伴有短耦合期室性心律失常的指标。Miao等人证明调整后的PTT可作为评估室性心律失常时血压的指标。然而，关于调整后的PTT有几个限制需要考虑。
For the management of hypertension, cuff-based noninvasive blood pressure (BP) measurement has established accuracy and is widely used in various settings (eg, office, home, and ambulatory conditions). All BP values measured by this technique provide both the information necessary for an accurate diagnosis of hypertension and prognostic power for cardiovascular disease (CVD) events, and the reduction of high BP levels leads to the prevention of CVD events [1]. In addition, various BP variability parameters, such as short-, mid-, and long-term variability assessed by office BP, home BP, and ambulatory BP monitoring, are associated with the progression of target organ damage and a risk of CVD events, independent of the patients’ average BP values [2–4]. However, the evidence underlying these associations was obtained in studies of populations without arrhythmia or in investigations that ignored the contribution of arrythmias, since the device used for the BP measurements had been validated only under sinus rhythm. Each BP value is obtained from the pulse wave from the time point at which the cuff is inflated to the time it is deflated. The values may be affected by the temporal variation and magnitude variation of the pulse wave associated with the irregularity of the heartbeats. The cardiac cycle consists of systolic and diastolic phases, and if ventricular contractility is normal, circulatory dynamics are regulated by left ventricular (LV) ejection during the systolic phase and LV filling during the diastolic phase, in addition to vascular elasticity. Fluctuations in heart rate affect LV stroke volume. Moreover, ventricular arrhythmias are prone to decrease BP because of the loss of atrioventricular (AV) contractile linking by antegrade AV node conduction.The length of time from the QRS complex in electrocardiography monitoring to the maximum pulse wave in the peripheral arteries was defined as the conventional pulse transit time (cPTT)[5, 6], and this time variable has been used in a novel cuffless form of continuous BP monitoring. Miao et al. reported a parameter that can be used for accurate assessment of BP variability during ventricular arrhythmia based on the concept of the cPTT, and they reported that adjusted PTT= cPTT2/RR was calculated from the RR interval of the cardiac cycle during ventricular arrhythmias [7]. In that study, there was a strong negative correlation between the adjusted PTT and the BP assessed by an invasive method during ventricular arrhythmia compared to cPTT. It is assumed that premature ventricular complex and ventricular tachycardia (VT) with a short coupled period results in insufficient LV filling and consequently a decrease in the LV stroke volume. The adjusted PTT appears to be an index that emphasizes the prolongation of the cPTT and decreased BP along with ventricular arrhythmias with a short coupled period. Miao et al. demonstrated that the adjusted PTT is useful as an index to evaluate BP during ventricular arrhythmia. However, there are several limitations regarding the adjusted PTT to consider.
DOI：
10.1016/s1062-1458(01)00458-5
发表时间：
2001-11
期刊：
JAMA
影响因子：
--
作者：
B. Gage;A. Waterman;W. Shannon;M. Boechler;M. Rich;M. Radford
通讯作者：
B. Gage;A. Waterman;W. Shannon;M. Boechler;M. Rich;M. Radford