New concept of pulse irregularity for the detection of atrial fibrillation during blood pressure measurement
New concept of pulse irregularity for the detection of atrial fibrillation during blood pressure measurement
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血压测量过程中脉搏不规则检测心房颤动的新概念
DOI：
10.1038/s41440-022-00971-8
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发表时间：
2022
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
房颤（AF）是导致栓塞性卒中和心力衰竭相关住院负担的重要因素[1]。高血压是合并AF的主要病因。因此，优化血压（BP）管理对于预防AF非常重要[2]。此外，早期发现高血压患者的无症状房颤非常重要[3，4]。然而，即使使用长期心电图（ECG）监测进行详细评估，检测阵发性AF的能力也有限[5]。事实上，大多数无症状房颤患者在年度健康检查中被诊断出来。作为用于检测阵发性AF的新方法，对安装有AF检测算法的可穿戴BP监测设备的研究和开发一直在进行中[6，7]。Omnoni等人报告了使用配备AF检测算法的动态BP监测（ABPM）器械在65岁以上的大型受试者组中检测到AF的频率[8]。他们证明，ABPM中脉搏不规则频率较高的受试者平均收缩压较低，平均舒张压和脉率（PR）较高，BP和PR的变异性增加，夜间睡眠BP和PR的降低不明显。他们发现，12%的受试者具有AF检测算法检测到的高AF发生率（> 30%），还有脉搏不规则和高血压变异。脉搏不规则和收缩压降低的一种可能解释是，这些效应是由于左心室舒张期充盈不足和心输出量减少引起的血流动力学不稳定。此外，快速AF期间的脉搏不规则可能导致BP测量值被低估[9]。此外，Omnoni等人指出，脉搏不规则频率高的受试者平均舒张压较高。较高的舒张压水平可能提示循环容量增加、自主神经受损和睡眠质量差，可能是由于睡眠呼吸暂停。在他们的研究中，频繁脉搏不规则的受试者在夜间睡眠期间也表现出血压降低，即所谓的“非杓型或立型”，这被认为是心血管事件的独立风险因素[10-13]。这些结果提示，较高频率的脉搏不规则性可增加心血管事件的危险性，另一方面，脉搏不规则性本身可随心律失常的日变化而沿着日变化。由于血压水平在脉搏不规则期间可能波动，因此频繁脉搏不规则的患者的血压控制可能不足。正常脉搏节律时的收缩压水平似乎高于脉搏不规则时。无论血压波动和脉搏不规则是原因还是后果，这项研究表明了严格血压管理的重要性，特别是在那些脉搏不规则频率高的人中。在亚临床房颤的检测中，虽然在24小时监测期内是否会出现房颤也有局限性，但如果观察到一定比例的脉搏不规则，则应怀疑房颤，并建议进行24小时霍尔特心电图检查。需要进一步研究以确定何种程度的脉搏不规则构成AF的真正风险，以预防AF相关事件，即卒中和心力衰竭。尽管脉搏不规则也可能由任何其他心律失常（包括室性心律失常）引起，但在临床实践中，其可能主要由室上性异位（包括AF）引起。此外，众所周知，AF患者通常有...
Atrial fibrillation (AF) is an important factor contributing to the hospitalization burden associated with embolic stroke and heart failure [1]. Hypertension is the major etiologic factor of comorbid AF. Optimal management of blood pressure (BP) is thus important for the prevention of AF [2]. In addition, the early detection of silent AF in hypertensive patients is very important [3, 4]. However, even a detailed assessment using long-term electrocardiographic (ECG) monitoring has limited ability to detect paroxysmal AF [5]. Indeed, the majority of asymptomatic AF patients are diagnosed at annual health check-up examinations. As a new method for the detection of paroxysmal AF, research and development into wearable BP-monitoring devices mounted with an AF detection algorithm has been ongoing [6, 7]. Omboni et al. reported the frequency of AF detection in a large group of subjects over 65 years of age using an ambulatory BP-monitoring (ABPM) device equipped with an AF detection algorithm [8]. They demonstrated that subjects with a high frequency of pulse irregularity in ABPM had a lower average systolic BP and higher average diastolic BP and pulse rate (PR), increased variability in both BP and PR, and blunted reduction in nighttime sleep BP and PR. They found that 12% of the subjects had a high incidence (> 30%) of AF as detected by the AF detection algorithm, in addition to pulse irregularity and high BP variability. One possible explanation for the pulse irregularity and reduction in systolic BP may be that these effects were due to hemodynamic instability caused by inadequate left ventricular diastolic filling and reduction in cardiac output. In addition, pulse irregularity during rapid AF may result in underestimated values by BP measurement [9]. Furthermore, Omboni et al. indicated that subjects with a high frequency of pulse irregularity had a high average diastolic BP. A higher diastolic BP level could suggest an increased circulating volume, autonomic nervous impairment, and poor sleep quality, possibly due to sleep apnea. In their study, the subjects with frequent pulse irregularity also presented with a blunted BP reduction during nighttime sleep, a so-called “nondipper or riser pattern,” which is known as an independent risk factor for cardiovascular events [10–13]. These results suggest that a higher frequency of pulse irregularity could increase the risk for cardiovascular events.On the other hand, the pulse irregularity itself could have diurnal variation along with the diurnal variation of the arrhythmias. Because BP levels may fluctuate during pulse irregularity, BP control may be inadequate in patients with frequent pulse irregularities. The systolic BP levels during normal pulse rhythm seem to be higher than those during pulse irregularity. Whether BP fluctuations and pulse irregularities are the causes or consequences, this study suggested the importance of strict BP management, especially in those who have a high frequency of pulse irregularities. In the detection of subclinical AF, although there is also a limitation in terms of whether AF will appear within the 24-h monitoring period, if a certain percentage of pulse irregularities are observed, AF should be suspected, and a 24-h Holter ECG should be recommended. Further investigation is needed to determine what degree of pulse irregularity constitutes a true risk of AF to be managed for prevention of AF-related events, ie, stroke and heart failure. Although pulse irregularity can also be caused by any other arrhythmias, including ventricular arrhythmias, it may be mainly caused by supraventricular ectopies, including AF, in clinical practice. Furthermore, it is also known that patients with AF often have a …
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影响因子：
2.8
作者：
Kyriakoulis, Konstantinos G.;Kollias, Anastasios;Stergiou, George S.
通讯作者：
Stergiou, George S.
影响因子：
24
作者：
Larsen, Bjorn Stroier;Kumarathurai, Preman;Sajadieh, Ahmad
通讯作者：
Sajadieh, Ahmad
杓斗式和非杓斗式
DOI：
10.1016/s0140-6736(88)92867-x
发表时间：
1988
期刊：
The Lancet
影响因子：
--
作者：
E. O’Brien;J. Sheridan;K. O’malley
通讯作者：
K. O’malley
影响因子：
2.8
作者：
Kabutoya, Tomoyuki;Imai, Yasushi;Kario, Kazuomi
通讯作者：
Kario, Kazuomi
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