Non-Invasive Monitoring of Central Blood Pressure in Humans

人体中心血压的无创监测

• 批准号: 8454415
• 负责人: RAMAKRISHNA MUKKAMALA
• 金额: $ 7.25万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-15 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8454415
• 关键词: Accounting; Age; Aging; Agreement; Animal Testing; Animals; Blood Pressure; Blood Pressure Monitors; Blood flow; Catheterization; Clinical; Data; Data Collection; Diastole; Hand; Health; Heart; Human; Institution; Lead; Measurement; Measures; Medical; Methods; Noise; Patients; Peripheral Resistance; Physiological; Pulse Pressure; Relative (related person); Severity of illness; Speed; Systolic Pressure; Techniques; Testing; Time; Trees; Universities; Update; Validation; age related; base; clinical practice; follow-up; improved; interest; non-invasive monitor; peripheral blood; physiologic model; prospective

DESCRIPTION (provided by applicant): Central blood pressure (BP) is physiologically and clinically more relevant than peripheral BP, especially in aging. However, peripheral BP waveforms can be measured more safely via catheterization and even non-invasively. The broad objective of this project is to establish a technique for mathematically deriving a central BP waveform from a peripheral BP waveform. While such techniques have been developed in the past, they are based on the assumption that a single, universal transfer function exists that can faithfully relate a peripheral BP waveform to a central BP waveform of any subject over any physiologic condition. These "generalized transfer functions" (GTF) techniques therefore do not adapt to the inter-subject and temporal variability of the arterial tree due to, for example, age-related arterial compliance differences and neuro-humoral modulation of peripheral resistance and are consequently prone to serious central BP error. In this project, a new technique, which is able to adapt the transfer function relating peripheral BP to central BP to the arterial parameters of the subject at the time of measurement by exploiting the fact that ascending aortic blood flow is negligible during diastole, will be rigorously investigated in humans as a follow-up to successful animal testing. The specific aims are: (1) to optimize the adaptive transfer function (ATF) technique for application in humans; (2) to broadly validate the technique in humans; and (3) to demonstrate that the technique is superior to previous techniques in humans. To accomplish these specific aims, existing data comprising non-invasive peripheral BP waveforms for analysis and reference central BP waveforms from a large number of diverse subjects under multiple physiologic conditions will be analyzed. A portion of the data will be used to maximize the accuracy of the ATF technique and enhance it in other ways including augmenting its computational speed. These data will likewise be used to optimize GTF techniques and other previous, related techniques. The remaining data will be used to evaluate the techniques in terms of accuracy and clinical value of the derived central BP as well as robustness to actual noise in the analyzed peripheral BP waveforms. Statistical comparisons will then be performed to establish the relative capabilities and any limitations of the ATF technique. Successful completion of this project will be followed by prospective patient testing of the ATF technique and may ultimately lead to improved BP monitoring in clinical practice.

描述（由申请人提供）：中枢血压（BP）在生理和临床上比周围血压更相关，特别是在衰老方面。然而，外周血压波形可以通过导管甚至无创测量更安全。该项目的总体目标是建立一种从外围BP波形中推导出中心BP波形的数学技术。虽然这种技术在过去已经发展起来，但它们是基于一个假设，即存在一个单一的、通用的传递函数，可以忠实地将任何受试者在任何生理条件下的外围血压波形与中心血压波形联系起来。因此，这些“广义传递函数”（GTF）技术不适应动脉树的主体间和时间变异性，例如，由于年龄相关的动脉顺应性差异和周围阻力的神经-体液调节，因此容易出现严重的中枢血压误差。在这个项目中，一种新的技术，能够利用在舒张期升主动脉血流量可以忽略不计的事实，在测量时将周围血压和中心血压的传递函数与受试者的动脉参数相适应，作为成功的动物试验的后续，将在人类中进行严格的研究。具体目标是：(1)优化自适应传递函数（ATF）技术在人体中的应用；(2)在人体上广泛验证该技术；(3)证明该技术优于以前的人类技术。为了实现这些具体目标，将分析大量不同受试者在多种生理条件下的非侵入性外周血压波形和参考中枢血压波形的现有数据。部分数据将用于最大限度地提高ATF技术的准确性，并以其他方式增强它，包括提高其计算速度。这些数据同样将用于优化GTF技术和其他先前的相关技术。剩余的数据将用于评估技术的准确性和临床价值，以及分析的周围血压波形对实际噪声的鲁棒性。然后进行统计比较，以确定ATF技术的相对能力和任何局限性。该项目成功完成后，将对ATF技术进行前瞻性的患者测试，最终可能在临床实践中改善血压监测。