Measuring FMD in the brachial artery: how important is QRS gating?
Measuring FMD in the brachial artery: how important is QRS gating?
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DOI：
10.1152/japplphysiol.00532.2010
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发表时间：
2010-10-01
影响因子：
3.3
通讯作者：
Widlansky, Michael E.
中科院分区：
文献类型：
--
作者：
Kizhakekuttu, Tinoy J.;Gutterman, David D.;Widlansky, Michael E.
测量肱血流介导的舒张（FMD）的建议通常建议在心脏周期的相同时间获得图像，通常是舒张末期（QRS复杂发作）。该建议假定动脉顺应性的个体差异最小。然而，公开的证据是相互矛盾的。此外，ECG门控在许多超声系统上是不可用的；它需要昂贵的软件升级或增加图像处理时间。我们测试了用QRS门控或更简化的图像平均方法获得的图像分析是否会产生类似的结果。我们分析了29名2型糖尿病成年人、31名老年人和12名非糖尿病年轻人的FMD和硝酸甘油介导的扩张（NMD），得出了一系列肱动脉扩张的结果。FMD和NMD采用推荐的qrs门控肱动脉直径测量方法测量，或者采用整个R-R区间的平均肱动脉直径测量。我们发现两种方法对FMD和NMD的检测结果非常一致（类内相关系数= 0.88-0.99）。使用平均直径测量FMD和NMD显著减少了图像后处理时间（658.9 +/- 71.6 s vs. qrs门控分析的1,024.1 +/- 167.6 s, P < 0.001）。基于平均直径测量的FMD和NMD测量可以在不降低精度的情况下进行。这一发现可能简化口蹄疫的测量，并有助于发展口蹄疫作为一种潜在的有用的临床工具。
Recommendations for the measurement of brachial flow-mediated dilation (FMD) typically suggest images be obtained at identical times in the cardiac cycle, usually end diastole (QRS complex onset). This recommendation presumes that inter-individual differences in arterial compliance are minimized. However, published evidence is conflicting. Furthermore, ECG gating is not available on many ultrasound systems; it requires an expensive software upgrade or increased image processing time. We tested whether analysis of images acquired with QRS gating or with the more simplified method of image averaging would yield similar results. We analyzed FMD and nitroglycerin-mediated dilation (NMD) in 29 adults with type 2 diabetes mellitus and in 31 older adults and 12 young adults without diabetes, yielding a range of brachial artery distensibility. FMD and NMD were measured using recommended QRS-gated brachial artery diameter measurements and, alternatively, the average brachial diameters over the entire R-R interval. We found strong agreement between both methods for FMD and NMD (intraclass correlation coefficients = 0.88-0.99). Measuring FMD and NMD using average diameter measurements significantly reduced post-image-processing time (658.9 +/- 71.6 vs. 1,024.1 +/- 167.6 s for QRS-gated analysis, P < 0.001). FMD and NMD measurements based on average diameter measurements can be performed without reducing accuracy. This finding may allow for simplification of FMD measurement and aid in the development of FMD as a potentially useful clinical tool.