Validation of Arteriograph – A New Oscillometric Device to Measure Arterial Stiffness in Patients on Maintenance Hemodialysis

Abstract

Background: Measuring arterial stiffness (augmentation index (AI), aortic pulse wave velocity (PWV)) in hemodialysis (HD) patients has prognostic significance. To assess its validity, the new oscillometric Arteriograph device (AI_A, PWV_A) was compared to the validated PulsePen tonometer (AI_P, PWV_P). Methods: AI and PWV were measured in 98 patients with both devices before HD. Validity was evaluated by Pearson’s correlation, Bland-Altman analysis, and by assessing the prognostic value of AI and PWV to predict cardiovascular (CV) mortality over 29 months. Results: Correlation between AI_P and AI_A was significant (R = 0.527, p < 0.001). The mean difference of AI values obtained by the two devices was –20.6%, and 30% of the paired AI differences fall outside the ±1 SD boundary of the mean between-device difference. There was no significant correlation between the PWV_P and PWV_A readings (R = 0.173, p = 0.097). The average difference of PWV values by the two devices was –1.2 m/s, and 20.6% of the paired PWV differences fall outside the ±1 SD boundary. In survival analyses, only PWV_P but not PWV_A was significantly related to CV mortality. Conclusion: Lack of correlation between PWV_P and PWV_A and lack of prognostic significance of PWV_A suggest limited validity of Arteriograph to determine PWV in patients on HD.

Measurement of pulse wave velocity in children and young adults: a comparative study using three different devices

“…[23][24][25] Survival studies in adults indicate that PWV measured by applanation tonometry has a good clinical predictive value. 20 Involving more than 1000 children, our research group has furthermore confirmed the applicability of the PP device to mass screening of children of different age groups. 10 The method proved to be fairly reproducible and provided reference values for PWV in children and teenagers.…”

“…10 A multitude of various methods and techniques have been used to assess PWV in adults such as applanation tonometry, 11,12 ultrasound, 13,14 methods using mechanotransducers 15 and computerized oscillometry; 16 furthermore, a number of comparative studies with diverging results have been published concerning the comparability of the different methods. [17][18][19][20][21] Instruments based on the principle of applanation tonometry (PulsePen (PP) (DiaTecne, Milan, Italy) and Sphygmocor (SC) (AtCor, Sydney, Australia) have been extensively used. They are easily applied in adults and children and have a fair reproducibility.…”

Pulse wave analysis and pulse wave velocity techniques: are they ready for the clinic?

“…Although new methods to assess PWA have been partially validated, [18][19][20][21] non-invasive assessment of aortic wave reflection characteristics is normally performed via applanation tonometry. High-fidelity radial artery pressure waveforms are recorded using a 'pencil type' micromanometer (Millar Instruments, Houston, TX, USA).…”

“…Although new methods to assess PWV have been partially validated, the gold standard method of non-invasive assessment of PWV continues to be applanation tonometry. 5,10,14,16,[18][19][20][21] In general, pressure waveforms are gated with simultaneous electrocardiographs and are used to calculate the PWV between the two sites (carotidfemoral). Foot-to-foot PWV is calculated by determining the delay between the appearance of the pressure waveform foot in the carotid and femoral sites (Dt).…”

“…Regrettably, to date, validation studies for the oscillometric and piezoelectronic devices have not generated convincing data. 21 For example, indwelling catheter validation of an oscillometric device showed a strong linear relationship for AIx, Ps and PWV (R 2 ¼0.813, Po0.001; R 2 ¼0.901, Po0.001; and R 2 ¼0.833, Po0.001, respectively); however, confidence intervals of BlandAltman agreement tests showed low sensitivity between both methods for AIx and Ps ( ± 2 s.d.¼(À12.1-11.6%), and ± 2 s.d.¼ (À17.6-16.5 mm Hg), respectively), whereas sensitivity improved only for PWV ( ± 2 s.d.¼(À1.6-1.5 m s À1 )). 19 Several other inter-technique validations for PWA and PWV have showed similar results.…”