Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children

Papaioannou, Theodore G.; Karageorgopoulou, Theofani D.; Stefanadis, Christodoulos; Tousoulis, Dimitrios

doi:10.1161/hypertensionaha.115.05666

Hypertension

2015

DOI: 10.1161/hypertensionaha.115.05666

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Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children

Theodore G. Papaioannou

Theofani D. Karageorgopoulou

Christodoulos Stefanadis

et al.

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“…1 They raise several related concerns regarding the influence of errors in the determination of peripheral blood pressure (BP; which our study did not address) on estimates of central blood pressure. 2 We agree that this is a most important point.…”

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Response to Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children

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We thank Papaioannou and colleagues for their interest in our study. 1 They raise several related concerns regarding the influence of errors in the determination of peripheral blood pressure (BP; which our study did not address) on estimates of central blood pressure. 2 We agree that this is a most important point.All of the current noninvasive methods for measuring central blood pressure require calibration from peripheral BP measurements. However, errors in peripheral BP are transferred to central blood pressure, so that the difference between central and peripheral systolic blood pressure is affected little by peripheral calibration 3 and the ratio of central to peripheral pulse pressure is not affected by calibration. Thus, if relative differences (eg, effects of treatment on central versus peripheral BP) are of interest, the issue of calibration is less critical. For absolute measurements though calibration remains crucial and we await more accurate technology for the measurement of peripheral BP. We did not measure brachial BP during our invasive studies, but these comparisons have been performed in previous studies and demonstrate significant errors, underlining the point made by Papaioannou and colleagues.The aneroid sphygmomanometer instruments were checked for accuracy annually and the mean of 3 readings used for the measurement of peripheral BP. The brachial BP measurements were performed initially followed by measurement of central blood pressure using ART.LAB and SphygmoCor devices (with order varied but not strictly randomized). Although an order effect could have influenced results, there was minimal systematic change through sequential readings, making a substantial order effect unlikely.The quality control of recorded radial waveforms was as per the inbuilt criteria of the SphygmoCor device. Only those waveforms meeting these criteria were ensemble averaged and converted to a corresponding aortic waveform using the inbuilt SphygmoCor radialto-aortic transfer function from which central blood pressures were calculated. ART.LAB waveform recordings were accepted if the SD of maximum distention was <50 μm.With regard to statistical methods of assessing agreement, we followed the approach in previous studies so that results could be compared. The 9 children who underwent invasive testing had ≤5 repeat recordings of 5 to 10 second periods when simultaneous carotid and aortic waveform recordings were obtained. The results of each recording in the same individual are shown accounting for the >9 pairs of measurements.The determinants of systolic amplification in this cohort are important to understand, and we agree that both the impact of body position and heart rate on central systolic blood pressure amplification may be important and an area for further investigation.at University College London (ucl) / England on June 26, 2016 http://hyper.ahajournals.org/ Downloaded from

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Central aortic blood pressure estimation in children and adolescents: results of the KidCoreBP study

Mynard

Goldsmith

Springall

et al. 2020

Journal of Hypertension

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Background: Central aortic SBP (cSBP) may have superior prognostic value compared with peripheral SBP (pSBP), but noninvasive cSBP measurement techniques have not been formally validated in children and adolescents. Method: This study assessed the accuracy of two automated devices and the radial tonometry/transfer function method (RT-TF) for estimating central pressures and pulse pressure amplification (PPA) in this population, with adherence to validation guidelines for central pressure devices. In 69 children/adolescents aged 3–18 years undergoing clinically indicated aortic catheterization, high fidelity ascending aortic cSBP was measured with a micromanometer-tipped wire and compared with values from SphygmoCor XCEL, Mobil-O-Graph (systolic/diastolic calibration, MoG-C1, or mean/diastolic calibration, MoG-C2) and RT-TF. Reference intra-arterial pSBP was derived from the tonometry pulse calibrated to central mean/diastolic pressures. Results: XCEL, MoG-C1 and MoG-C2 overestimated cSBP by 7.9 ± 6.8 mmHg (mean ± SD), 5.7 ± 10.3 mmHg, and 19.1 ± 14.9 mmHg, exceeding the validation cut-off (5 ± 8 mmHg). Brachial pSBP was also overestimated by XCEL (10.9 ± 8.4 mmHg) and Mobil-O-Graph (11.5 ± 12.3 mmHg). By contrast, central and brachial diastolic pressures were underestimated by the automated devices, albeit mostly within acceptable limits; pulse pressures were, therefore, substantially overestimated. Central-brachial PPA (4.5 ± 4.4 mmHg) was overestimated by XCEL (8.7 ± 3.2 mmHg) and MoG-C1 (11.1 ± 6.4 mmHg), but underestimated by MoG-C2 (−3.0 ± 6.6 mmHg). Given accurate pulse calibration, RT-TF achieved acceptable accuracy for cSBP (−0.2 ± 4.6 mmHg) and central-radial PPA (1.9 ± 5.1 mmHg). Conclusion: In conclusion, XCEL and Mobil-O-Graph overestimated pSBP and cSBP in children and adolescents. cSBP can be obtained via the same transfer function used in adults, but accurate pressure pulse calibration is critical. Video Abstracts: http://links.lww.com/HJH/B222

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Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children

Cited by 2 publications

References 4 publications

Response to Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children

Response to Validation of Devices and Methods for Noninvasive Estimation of Central Aortic Blood Pressure in Children

Central aortic blood pressure estimation in children and adolescents: results of the KidCoreBP study

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