Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: the first feasibility and reproducibility study.
BACKGROUND
Surrogates of aortic wave reflection and arterial stiffness, such as augmentation index (AIx), augmentation pressure, pulse wave velocity (PWV) and pulse pressure amplification (PPampl) are independent predictors of cardiovascular risk. A novel ambulatory, brachial cuff-based oscillometric device has been recently developed and validated, yielding 24-h assessment of the aforementioned parameters (Mobilo-O-Graph). Aim of this study was to investigate the feasibility and reproducibility of wave reflection and arterial stiffness estimation by pulse wave analysis using this device.


METHODS
Thirty treated or untreated hypertensives (mean age: 53.6 ± 11.6 years, 17 men) had test-retest 24-h monitoring one week apart using the test device.


RESULTS
Mean numbers of valid aortic readings per subject, between test and retest, were comparable. Approximately 12 aortic readings per subject (17%) were not feasible or valid. No differences were observed for any 24-h parameter between the two assessments. Bland-Altman plots showed no systemic difference, while the limits of agreement for each parameter indicated high reproducibility (AIx: -7.2 to 8.2%, AP: -3.7 to 4.1mm Hg, PWV: -0.39 to 0.41 m/s, PPampl: -0.08 to 0.06). This was further verified by intraclass correlation coefficients which were >0.8 for each parameter.


CONCLUSIONS
Non-invasive 24-h estimation of wave reflection and arterial stiffness indices, derived by the test device, appear to be highly reproducible. Future studies should investigate whether these measurements have additive prognostic value for cardiovascular risk stratification, beyond common brachial blood pressure measurements or single estimations of wave reflection and PWV at office settings.
Cardiovascular Research Laboratory and Hypertension Center, 1st University Dept. of Propaedeutic Medicine, "Laiko" Hospital, Athens, Greece; Biomedical Engineering Unit, 1st University Dept. of Cardiology, "Hippokration" Hospital, Athens, Greece. Electronic address: thepap@med.uoa.gr.
Theodore G
TG
Papaioannou
Antonios
A
Argyris
Athanase D
AD
Protogerou
Dimitrios
D
Vrachatis
Efthymia G
EG
Nasothimiou
Petros P
PP
Sfikakis
George S
GS
Stergiou
Christodoulos I
CI
Stefanadis
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D001916:Brachial Artery / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods / Q000592:standards*; D009991:Oscillometry / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D013997:Time Factors; D059289:Vascular Stiffness / Q000502:physiology*
Ambulatory blood pressure monitoring; Aortic pressure; Augmentation index; Pulse wave velocity; Wave reflections