Feasibility and Reproducibility of Noninvasive 24-h Ambulatory Aortic Blood Pressure Monitoring With a Brachial Cuff-Based Oscillometric Device

Protogerou, Athanase D.; Argyris, Antonis; Nasothimiou, Efthimia; Vrachatis, Dimitrios; Παπαϊωάννου, Θεόδωρος; Tzamouranis, D; Blacher, Jacques; Safar, Michel E.; Sfikakis, Petros P.; Stergiou, George S.

doi:10.1038/ajh.2012.63

Cited by 80 publications

(68 citation statements)

References 26 publications

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“…Previous validation studies in hypertensive and healthy volunteers showed acceptable agreement between Mobil-O-Graph-derived variables and invasive and noninvasive measurements (24,(28)(29)(30). In a validation study in hemodialysis patients, Mobil-O-Graph provided estimates of aortic SBP, AIx, and PWV similar to those obtained by SphygmoCor (ArtCor, Sydney, Australia) (31), the most widely applied method for noninvasive assessment of these measures.…”

Section: Abpm With Mobil-o-graph Devicementioning

confidence: 57%

Ambulatory Recording of Wave Reflections and Arterial Stiffness during Intra- and Interdialytic Periods in Patients Treated with Dialysis

Καρπέτας

Sarafidis

Georgianos

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Wave reflections and arterial stiffness are independent cardiovascular risk factors in ESRD. Previous studies in this population included only static recordings before and after dialysis. This study investigated the variation of these indices during intra-and interdialytic intervals and examined demographic, clinical, and hemodynamic variables related to arterial function in patients undergoing hemodialysis.Design, setting, participants, & measurements Between February 2013 and May 2014, a total of 153 patients receiving maintenance hemodialysis in five dialysis centers of northern Greece underwent ambulatory BP monitoring with the newly introduced Mobil-O-Graph device (IEM, Stolberg, Germany) over a midweek dialysis session and the subsequent interdialytic period. Mobil-O-Graph is an oscillometric device that records brachial BP and pulse waves and estimates, via generalized transfer function, aortic BP, augmentation index (AIx) as a measure of wave reflections, and pulse wave velocity (PWV) as an index of arterial stiffness.Results AIx was lower during dialysis than in the interdialytic period of dialysis-on day (Day 1) (mean6SD, 24.7% 69.7% versus 26.8%69.4%; P,0.001). In contrast, PWV remained unchanged between these intervals (9.3162.2 versus 9.2962.3 m/sec; P=0.60). Both AIx and PWV increased during dialysis-off day (Day 2) versus the out-ofdialysis period of Day 1 (28.8%69.8% versus 26.8%69.4% [P,0.001] and 9.3962.3 versus 9.2962.3 m/sec [P,0.001]). Older age (odds ratio [OR], 1.09; 95% confidence interval [95% CI], 1.02 to 1.15), female sex (OR, 7.56; 95% CI, 1.64 to 34.81), diabetic status (OR, 8.84; 95% CI, 1.76 to 17.48), and higher mean BP (OR, 1.17; 95% CI, 1.09 to 1.27) were associated with higher odds of high AIx; higher heart rate was associated with lower odds (OR, 0.71; 95% CI, 0.63 to 0.80) of high AIx. Older age (OR, 2.04; 95% CI, 1.61 to 2.58) and higher mean BP (OR, 1.15; 95% CI, 1.05 to 1.27) were independent correlates of high PWV.Conclusions This study showed a gradual interdialytic increase in AIx, whereas PWV was only slightly elevated during Day 2. Future studies are needed to elucidate the value of these ambulatory measures for cardiovascular risk prediction in ESRD.

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Section: Abpm With Mobil-o-graph Devicementioning

confidence: 57%

Ambulatory Recording of Wave Reflections and Arterial Stiffness during Intra- and Interdialytic Periods in Patients Treated with Dialysis

Καρπέτας

Sarafidis

Georgianos

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Previous validation studies in hypertensive and healthy volunteers showed acceptable agreement between Mobil-O-Graph-derived parameters and invasive and noninvasive measurements. 20,[22][23][24] In hemodialysis patients, Mobil-O-Graph provided comparable estimates of office aortic SBP, AIx, and PWV with that obtained by Sphygmocor (ArtCor, Sydney, Australia), which is the most widely applied method for noninvasive assessment of these parameters. 14 …”

Section: Study Procedures and Ambulatory Bp Monitoringmentioning

confidence: 94%

Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients

et al. 2017

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Arterial stiffness and augmentation of aortic blood pressure (BP) measured in office are known cardiovascular risk factors in hemodialysis patients. This study examines the prognostic significance of ambulatory brachial BP, central BP, pulse wave velocity (PWV), and heart rate–adjusted augmentation index [AIx(75)] in this population. A total of 170 hemodialysis patients underwent 48-hour ambulatory monitoring with Mobil-O-Graph-NG during a standard interdialytic interval and followed-up for 28.1±11.2 months. The primary end point was a combination of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. Secondary end points included: (1) all-cause mortality; (2) cardiovascular mortality; and (3) a combination of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, coronary revascularization, or hospitalization for heart failure. During follow-up, 37(21.8%) patients died and 46(27.1%) had cardiovascular events. Cumulative freedom from primary end point was similar for quartiles of predialysis-systolic BP (SBP), 48-hour peripheral-SBP, and central-SBP, but was progressively longer for increasing quartiles for 48-hour peripheral-diastolic BP and central-diastolic BP and shorter for increasing quartiles of 48-hour central pulse pressure (83.7%, 71.4%, 69.0%, 62.8% [log-rank P =0.024]), PWV (93.0%, 81.0%, 57.1%, 55.8% [log-rank P <0.001]), and AIx(75) (88.4%, 66.7%, 69.0%, 62.8% [log-rank P =0.014]). The hazard ratios for all-cause mortality, cardiovascular mortality, and the combined outcome were similar for quartiles of predialysis-SBP, 48-hour peripheral-SBP, and central-SBP, but were increasing with higher ambulatory PWV and AIx(75). In multivariate analysis, 48-hour PWV was the only vascular parameter independently associated with the primary end point (hazard ratios, 1.579; 95% confidence intervals, 1.187–2.102). Ambulatory PWV, AIx(75), and central pulse pressure are associated with increased risk of cardiovascular events and mortality, whereas office and ambulatory SBP are not. These findings further support that arterial stiffness is the prominent cardiovascular risk factor in hemodialysis.

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“…The "gold standard" method for evaluation of PWV is the measurement of cf-PWV [15]. In this study, PWV was measured by the device Mobil-O-Graph and calculated by complex mathematical estimation, which could be a focus for criticism, although validation was proved in several studies [23,[32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…The device uses the integrated ARCSolver algorithms (Austrian Institute of Technology, Vienna, Austria) to derive aortic stiffness surrogates based on brachial BP readings by a generalized transfer function [31,32]. Previous studies have proven the validity of the Mobil-O-Graph for BP monitoring and pulse wave analysis against established invasive and noninvasive techniques in various populations, including hemodialysis patients [23,[32][33][34][35]. The measurements were taken of the non-fistula arm with circumference-adapted arm cuffs and started before the midweek dialysis session independent of the dialysis shift.…”

Section: Data Collection and Measurementsmentioning

confidence: 99%

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

et al. 2019

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Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

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Feasibility and Reproducibility of Noninvasive 24-h Ambulatory Aortic Blood Pressure Monitoring With a Brachial Cuff-Based Oscillometric Device

Abstract: In conclusion, these data suggest that noninvasive 24-h ABPM is feasible and provides reproducible values. Future studies should validate the prognostic ability of 24-h aortic hemodynamics.

Cited by 80 publications

References 26 publications

Ambulatory Recording of Wave Reflections and Arterial Stiffness during Intra- and Interdialytic Periods in Patients Treated with Dialysis

Ambulatory Recording of Wave Reflections and Arterial Stiffness during Intra- and Interdialytic Periods in Patients Treated with Dialysis

Ambulatory Pulse Wave Velocity Is a Stronger Predictor of Cardiovascular Events and All-Cause Mortality Than Office and Ambulatory Blood Pressure in Hemodialysis Patients

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

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