测量颈动脉股脉搏波速度 (Cf PWV) 评价动脉僵硬度
Summary
本协议描述了一种规范颈动脉股脉搏波速度测量的方法, 以评估动脉僵硬度。
Abstract
对老年人来说, 动脉僵硬是评价衰老的一个很好的标志, 建议通过测量颈动脉对股脉搏波速度 (无创性 PWV) 来确定动脉僵硬度 (I. 类;A 级证据 A)。在文学方面, 许多以社区为基础或针对疾病的研究报告说, 高 PWV 与心血管风险增加有关。在这里, 我们讨论的策略, 评估动脉僵硬的 PWV。根据这里详细定义的步骤,例如, 适当的位置运算符, 距离测量和血压计位置, 我们将获得一个标准的 cf PWV 值来评估动脉刚度。本文将讨论一种利用非侵入测量器件记录良好质量 PWV 和脉冲波分析的详细逐步方法。
Introduction
动脉僵硬是血管老化评估的好标志1,2。动脉僵硬的测量传统上使用脉搏波速度 (PWV) 方法, 是一个重要和可靠的测量动脉刚度1,3,4,5。具体地说, PWV 代表特定动脉段的刚度。脉冲波通过特定段的动脉血管传输, 其速度与墙体本身的粘弹性特性6呈反比关系。PWV 值随动脉僵硬而增加。
颈动脉-股 PWV (cf PWV) 和臂踝 PWV (ba PWV) 是2最常用的 PWV 测量。它们广泛应用于临床实践中, PWV 在西方国家很受欢迎, PWV 在亚洲国家很受欢迎。7,8. 事实上, cf PWV 已被认为是 “金标准” 测量的动脉僵硬度1。对于 cf PWV, 它是作为 PWV 的代表整个主动脉。此外, 对于 ba-PWV, 没有真正的动脉通路连接测量点 (臂到脚踝)。估计的 ba-PWV 代表中央和外周动脉系统的整体 PWV9。先前的一项研究报告说, PWV 比 PWV 在无症状高血压靶器官损害 (TOD)10 (图 1) 的关联中优于 ba————-
具有特定血压计的区域刚性的非侵入性装置越来越多地被用来测量颈动脉到股骨段的刚度1。在 cf PWV 测量中, 此设备和手持血压计在计算机上创建一个稳定的波形, 可以记录高分辨率的数字波形图像和特定的 PWV 值 (图 2)。所有这些测量都需要标准化。在这里, 我们展示如何记录一个良好的质量 PWV 与这个无创测量的设备在现实世界的设置。
一些建立的心血管风险预测模型, 如弗雷明汉风险评分和评分风险图表主要是计算和排序的常规风险因素11,12。但是, 应将一些新的生物标志物添加到风险评估模型中, 以改进风险分层13。在文献中, 动脉僵硬被认为是常规危险因素与临床心血管事件之间的中间状态14。因此, 将 cf PWV 添加到风险评估模型中可能是风险分层的工具15,16。
在这里, 我们生成一个方法学计划来评估参与者的 PWV, 连同 PWA, 建立一个标准的动脉硬化评估协议。
Protocol
Representative Results
Discussion
在这里, 我们展示了一个广泛的方法, 以评估参与者的新的前血管托德, 动脉僵硬, 评估 PWV。为了比较 PWs 与设备前测量的最小血流动力学差异, 只有当臂收缩和舒张血压变化小于 3 mmHg 时才接受数据。这减少了人为操作造成的偏差。在这项议定书中, 关键步骤是使用80% 的直接直接距离在颈动脉和股动脉之间的标准的病人条件, 并使用10米/秒作为基准截止值的颈动脉股 PWV 作为动脉僵硬。
<p class="jov…Divulgazioni
The authors have nothing to disclose.
Acknowledgements
这项工作是由中国国家重点研究开发项目 (2017YFC0111800) 和上海市政府 (批准号: 2013ZYJB0902 和 15GWZK1002) 资助的。一张博士获得中国国家自然科学基金 (批准 ID 81300239 和 81670377) 的支持。
Materials
| SphygmoCor tonometry-based device | AtCor Medical, Australia | For central blood pressures and cf-PWV | |
| Electrodes | AtCor Medical, Australia | To record the ECG | |
| Semiautomatic Oscillometric device | OMRON Healthcare, kyoto, Japan | To measure brachial BP |
Riferimenti
- Laurent, S., et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 27 (21), 2588-2605 (2006).
- Townsend, R. R., et al. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension. 66 (3), 698-722 (2015).
- Niiranen, T. J., et al. Prevalence, Correlates, and Prognosis of Healthy Vascular Aging in a Western Community-Dwelling Cohort: The Framingham Heart Study. Hypertension. 70 (2), 267-274 (2017).
- Reference Values for Arterial Stiffness, C., et al. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values. Eur Heart J. 31 (19), 2338-2350 (2010).
- Van Bortel, L. M., et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 30 (3), 445-448 (2012).
- Salvi, P. . Pulse waves: how vascular hemodynamics affect blood pressure. , (2011).
- Mancia, G., et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 31 (7), 1281-1357 (2013).
- Yamashina, A., et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 25 (3), 359-364 (2002).
- Tanaka, H., et al. Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness. J Hypertens. 27 (10), 2022-2027 (2009).
- Lu, Y., et al. Comparison of Carotid-Femoral and Brachial-Ankle Pulse-Wave Velocity in Association With Target Organ Damage in the Community-Dwelling Elderly Chinese: The Northern Shanghai Study. J Am Heart Assoc. 6 (2), (2017).
- D’Agostino, R. B., et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 117 (6), 743-753 (2008).
- Conroy, R. M., et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 24 (11), 987-1003 (2003).
- Zethelius, B., et al. Use of multiple biomarkers to improve the prediction of death from cardiovascular causes. N Engl J Med. 358 (20), 2107-2116 (2008).
- Vernooij, J. W., et al. Hypertensive target organ damage and the risk for vascular events and all-cause mortality in patients with vascular disease. J Hypertens. 31 (3), 492-499 (2013).
- van der Veen, P. H., et al. Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function: The Second Manifestations of Arterial Disease-Magnetic Resonance Study. Hypertension. 66 (6), 1152-1158 (2015).
- Ji, H., et al. Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design. BMJ Open. 7 (3), (2017).
- O’Brien, E., et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 23 (4), 697-701 (2005).
- Agnoletti, D., et al. Pulse wave analysis with two tonometric devices: a comparison study. Physiol Meas. 35 (9), 1837-1848 (2014).
- Ji, H., et al. Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design. BMJ Open. 7 (3), e013880 (2017).
- Zhang, Y., et al. Comparison study of central blood pressure and wave reflection obtained from tonometry-based devices. Am J Hypertens. 26 (1), 34-41 (2013).
- Sharman, J. E., et al. Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization. Eur Heart J. 38 (37), 2805-2812 (2017).
- Millasseau, S., Agnoletti, D. Non-invasive estimation of aortic blood pressures: a close look at current devices and methods. Curr Pharm Des. 21 (6), 709-718 (2015).
- Olsen, M. H., et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 388 (10060), 2665-2712 (2016).
