Comparison of blood pressure monitoring by applanation tonometry and invasively assessed blood pressure in cardiological patients

Abstract

The aim of this study was to evaluate the accuracy and precision of non-invasive continuous blood pressure measurement by applanation tonometry (AT) in awake or anaesthetised cardiological intensive care patients. Patients suffering from highly impaired left ventricular function atrial fibrillation or severe aortic valve stenosis were included into the study. Arterial blood pressure was recorded by applanation tonometry (T-Line 400, Tensys Medical, USA) and an arterial line in awake or anaesthetised patients. Discrepancies in mean (MAP), systolic (SAP), and diastolic (DAP) arterial pressure between the two methods were assessed as bias, limits of agreement and percentage error respectively. In 31 patients a total of 27,900 measurements were analyzed. The concordance correlation coefficient was 0.23, 0.45 and 0.06 for MAP, SAP and DAP, respectively. For all patients bias for MAP compared to MAP was 14.96 mmHg (SAP 4.51 mmHg; DAP 19.12 mmHg) with limits of agreement for MAP of 46.25 and - 16.33 mm Hg (SAP 48.00 and - 38.98 mmHg; DAP 50.12 and - 11.89 mmHg). Percentage error for MAP was 56.8% (42.7% for SAP; 75.2% for DAP). We conclude that the AT method is not reliable in ICU patients with severe cardiac comorbidities.

Review of emerging methods and techniques for arterial pressure and flow waves acquisition and analyses

“…Similar studies on cardiac patients with severe cardiac comorbidities revealed the correlation coefficients for MAP, SAP and DAP to be 0.23, 0.45 and 0.06, respectively; the bias 14.96, 4.51 and 19.12 mmHg; the percentage errors 56.8, 42.7 and 75.2% accordingly. 62 Automated AP measurement tools were found acceptable for MAP, partially acceptable for DAP, and unacceptable SAP estimations in cardiovascular postsurgical intensive care patients. 63 Statistical analysis of twelve validations (566 patients; five home, three ambulatory and three office devices) revealed the automatic AP monitors are accurate in measuring SAP but not DAP in patients with atrial fibrillation.…”

“…57 Recent studies on simultaneous measurements of AP by AT (T-Line 400, Tensys Medical®, USA) and the direct intra-artery data in patients with cardiac comorbidities revealed the percentage error 56.8% for MAP, 42.7% for SAP, and 75.2% for DAP. 58 AT is used for central AP estimations based on the transfer functions radial artery-aorta. 59,60 AT of the radial artery may not be used in patients of the cardiac intensive care unit.…”

Towards wearable blood pressure measurement systems from biosignals: a review

“…In the literature, there are some artificial machine learning models for the estimation of oscillometric blood pressure. Tonometric measurement: Some pressure is applied on the wrist or arm [34][35][36][37][38][39][40][41][42]. Blood is not entirely stopped as it is in oscillometric and Korotkov's measurement systems.…”

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

“…In the October issue, Greiwe et al [10] evaluated the performance of automated radial artery applanation tonometry using the T-Line 400 (Tensys Medical, San Diego, CA, USA) in awake or anesthetized patients in a cardiological ICU. The authors conducted a total of 27,900 measurements in 31 patients with severe cardiac comorbidities, including highly impaired left ventricular function, atrial fibrillation, and severe aortic valve stenosis (< 1.0 cm 2 ).…”