title: Indices of cardiovascular function derived from peripheral pulse wave analysis using radial applanation tonometry: a measurement repeatability study.
abstract: Pulse wave analysis (PWA) using applanation tonometry is a non-invasive technique for assessing cardiovascular function. It produces three important indices: ejection duration index (ED%), augmentation index adjusted for heart rate (AIX@75), and subendocardial viability ratio (SEVR%). The aim of this study was to assess within- and between-observer repeatability of these measurements. After resting supine for 15 minutes, 20 ambulant patients (16 male) in sinus rhythm underwent four PWA measurements on a single occasion. Two nurses (A & B) independently and alternately undertook PWA measurements using the same equipment (Omron HEM-757; SphygmoCor with Millar hand-held tonometer) blind to the other nurse's PWA measurements. Within- and between-observer differences were analysed using the Bland-Altman ;limits of agreement' approach (mean difference +/- 2 standard deviations, 2SD). Mean age was 56 (blood pressure, BP 136/79; pulse rate 64). BP/PWA measurements remained stable during assessment. Based on the average of two PWA measurements the mean +/- 2SD between-observer difference in ED% was 0.3 +/- 2.0; AIX@75 1.0 +/- 3.9; and SEVR% 1.7 +/- 14.2. Based on a single PWA measurement the between-observer difference was ED% 0.3 +/- 3.3; AIX@75 1.7 +/- 6.9; and SEVR% 0.6 +/- 22.6. Within-observer differences for nurse-A were ED% 0.0 +/- 5.4; AIX@75 1.5 +/- 7.0; and SEVR% 1.7 +/- 39.0 (nurse-B: 0.1 +/- 3.8; 0.1 +/- 8.0; and 0.6 +/- 23.3, respectively). PWA demonstrates high levels of repeatability even when used by relatively inexperienced staff and has the potential to be included in the routine cardiovascular assessment of ambulant patients.
authors.affiliation: Department of Public Health, University of Aberdeen Medical School, Aberdeen, UK. mike.crilly@ abdn.ac.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Crilly
authors.forename: Christoph
authors.initials: C
authors.lastname: Coch
authors.forename: Margaret
authors.initials: M
authors.lastname: Bruce
authors.forename: Hazel
authors.initials: H
authors.lastname: Clark
authors.forename: David
authors.initials: D
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002320:Cardiovascular Physiological Phenomena; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011674:Pulse; D017534:Radial Artery / Q000502:physiology