Validation of blood pressure monitoring using pulse transit time in heart failure patients with Cheyne-Stokes respiration undergoing adaptive servoventilation therapy.
OBJECTIVE
Using pulse transit time (PTT) and an ECG appears to be a promising alternative for invasive or noninvasive monitoring of blood pressure (BP). This study assessed the validity of PTT for BP monitoring in clinical practice.


METHODS
Twenty-nine patients with chronic heart failure (HF; 27 male, 70.5 ± 9.9 years) and nocturnal Cheyne-Stokes respiration were noninvasively ventilated for one hour using adaptive servoventilation (ASV) therapy (PaceWave, ResMed). BP was measured using two devices (oscillometrically via Task Force Monitor, CNSystems and PTT via SOMNOscreen, Somnomedics) at least every 7 min for 30 min before, during, and after ASV.


RESULTS
Mean systolic BP was 118.1 ± 14.4 mmHg vs. 115.9 ± 14.1 mmHg for oscillometric method vs PTT, respectively. Corresponding values for diastolic BP were 72.3 ± 10.3 mmHg and 69.4 ± 11.1 mmHg. While clinically comparable, differences between the two methods were statistically significant (p < 0.05). The difference between the two methods showed an increasing trend over time. A total of 18.5 % of PTT-based measurements could not be analyzed. The direction of a change in BP was opposite for PTT vs oscillometry for 17.0 % and 32.8 % of systolic and diastolic BP measurements, respectively.


CONCLUSIONS
When monitoring BP in HF patients, overall BP monitoring using PTT is comparable to oscillometry for a period of 2 h (including a 1-h ASV phase). However, PTT shows a tendency to underestimate BP over time and during ASV.
Department of Cardiology, Heart and Diabetes Centre North Rhine - Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
Jens
J
Spießhöfer
Jessica
J
Heinrich
Thomas
T
Bitter
Christina
C
Efken
Roman
R
Lehmann
Siegfried
S
Eckert
Dieter
D
Horstkotte
Olaf
O
Oldenburg
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D015924:Blood Pressure Monitors; D002639:Cheyne-Stokes Respiration / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009991:Oscillometry / Q000295:instrumentation; D063177:Pulse Wave Analysis