Validation of an ambulatory blood pressure monitoring device employing a novel method to detect atrial fibrillation
Validation of an ambulatory blood pressure monitoring device employing a novel method to detect atrial fibrillation
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DOI：
10.1038/s41440-022-00925-0
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发表时间：
2022-05-02
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;Tomitani, Naoko;Kario, Kazuomi
我们评估了24小时动态血压监测（ABPM）装置的准确性，该装置采用新的不规则心跳（IHB）算法在每次血压测量期间检测心房颤动（AF）。90例有血压升高和某种类型心律失常病史的患者（平均年龄63.2±10.3岁，94%合并高血压，81%既往诊断为房颤）同时采用IHB算法的24小时ABPM和24小时动态心电图（ECG）进行评估。在3347个有效读数中，843个读数被认为是IHB。在这些IHB读数中，通过24小时动态心电图发现195个读数有AF节律。IHB算法对房颤节律的准确检测灵敏度为100%，特异性为79.4%。在正常心律期间检测到IHB的比例为12.1%，在房性早搏期间为48.8%，在室性早搏期间为54.4%。在正常节律下检测到的IHBs百分比在白天高于夜间（分别为16.3%和4.5%），这表明白天的身体活动有时会导致IHBs的错误检测。提示潜在房颤的最佳IHB参数为：(1)IHB负荷，定义为IHB阳性读数占总有效血压测量值的百分比，约为22.5%（敏感性84.6%，特异性85.1%;AUC 0.906, p < 0.0001）；(2) 24小时ABPM期间连续2.5次或以上IHB（敏感性84.6%，特异性83.0%;AUC 0.881, p < 0.0001）。本文评估的采用IHB算法的新型24小时ABPM设备有助于未来高血压患者的综合管理，其主要目标是预防脑血管事件。
We evaluated the accuracy of a 24-hr ambulatory blood pressure monitoring (ABPM) device with a new irregular heartbeat (IHB) algorithm for detecting atrial fibrillation (AF) during each BP measurement. Ninety patients with a history of elevated BP and some type of arrhythmia (mean age 63.2 +/- 10.3 years; 94% with hypertension; 81% with previously diagnosed AF) simultaneously underwent evaluation by 24-hr ABPM with the IHB algorithm and 24-hr Holter electrocardiography (ECG). Among the 3,347 valid readings, 843 readings were considered to indicate an IHB. Among these IHB readings, 195 readings were found to have an AF rhythm by 24-hr Holter ECG. The IHB algorithm showed 100% sensitivity and 79.4% specificity for accurately detecting AF rhythm. An IHB was detected in 12.1% of the measurements during normal rhythm, 48.8% of those during atrial premature complex, and 54.4% of those during ventricular premature complex. The percentage of IHBs detected during normal rhythm was higher in the daytime than at nighttime (16.3% vs. 4.5%, respectively), suggesting that daytime physical activity sometimes induces a false detection of IHBs. The optimal IHB parameters for suggesting potential AF were (1) an IHB burden defined as a percentage of IHB-positive readings in total valid BP measurements >22.5% (84.6% sensitivity, 85.1% specificity; AUC 0.906, p < 0.0001) and (2) 2.5 or more consecutive IHBs during 24-hr ABPM (84.6% sensitivity, 83.0% specificity; AUC 0.881, p < 0.0001). The novel 24-hr ABPM device with the IHB algorithm assessed herein could contribute to the future comprehensive management of hypertensive patients, with the main goal of preventing cerebrovascular events.