Arteriograph24 (ARG24),

 

 

 

- Primary Care/GP/

 

• One of the most essential tasks of the GP is to provide an accurate cardiovascular risk assessment of the patient. The usage of Arteriograph contributes to improve the CV risk stratification as the measurement not only provides the brachial blood pressure values, but additionally, the arterial stiffness parameters as well, which are known to be independent markers of the adverse cardiac outcomes and deaths. The measurement with Arteriograph is fast, easy, user independent and simultaneously provides the values of the Pulse Wave Velocity in the Aorta (PWVao), the Augmentation Index (Aixao) and the Central Systolic Blood Pressure (SBPao).
• According to the survival study performed with Arteriograph, it was proved that the elevated values of the above mentioned three parameters are in close correlation with and strong predictors of the cardiovascular events (heart attack, stroke, cardiac arrest) and sudden death.
• Unique points to communicate towards the GPs:

 

ü  Improve the level of patient care

 

ü  Save your patients’ lives and health by an early diagnosis of arterial damage

 

ü  The prognostic value of the parameters measured by Arteriograph has strong and unquestionable evidence considering CV morbidity and mortality.

 

 

 

- Cardiology

 

• In addition to the above mentioned factors, the importance of Arteriograph is that it provides information about the risk of recurrent events in those patients, who have already suffered a myocardial infarction (MI). The proof emerged from the long-term survival study performed with Arteriograph, which showed prognostic value of the measurements of the arterial stiffness parameters to those patients who previously had a cardiovascular event as well. Additionally, measurements showed evidence in predicting a forthcoming CV event by detecting elevated stiffness parameters after a heart attack.
• According to previous studies and those performed with Arteriograph it is also proved that Pulse Wave Velocity, Augmentation Index and Central Systolic Blood Pressure are in close correlation with the coronary heart disease.
• It is a well known fact that there is a significant difference between the antihypertensive drugs concerning their lowering efficacy of central systolic blood pressure and the arterial stiffness parameters’ values. With Arteriograph we can monitor how effective the therapy is and it helps to find the ideal, individual blood pressure lowering strategy.

 

 

 

• Unique  points to communicate towards the Cardiologists:

 

ü  Monitor the central effects of your antihypertensive therapy with Arteriograph

 

ü  Improve the diagnostic quality of your surgery

 

ü  Improve the effectiveness of the risk assessment of your post-MI patients

 

 

 

 

 

 

 

 

 

- Nephrology

 

• In case of end-stage renal disease, the majority of the patients die not because of the renal disease but because of cardiovascular events.
• Consequently the cardiovascular risk assessment is of high importance in the field of Nephrology. A large number of evidence proved the prognostic value of the aortic PWV for CV morbidity and mortality in ESRD.

 

 

 

• Unique  points to communicate towards the Nephrologists:

 

ü  The measurement of arterial stiffness plays an important role in the assessment of the cardiovascular survival of ESRD patients.

 

 

 

- Diabetology

 

• Professor Kennedy Cruickshank pointed out in his elegant study, that the increased arterial stiffness measured as aortic pulse wave velocity, has significant prognostic value for adverse cardiac outcomes in type 2 diabetic population.
• The formerly mentioned longitudinal study with Arteriograph confirmed the cited results, because a considerable number of the studied population received antidiabetic therapy.

 

 

 

•  for diabetologists;

 

ü  The measurement of arterial stiffness in diabetology helps to assess the CV risk more effectively.

 

 

 

- Obstetrics

 

• Ashma Khalil and Cypros Nicolaides (King’s College Hospital, London, UK) performed Arteriograph examinations on a large cohort (6,766) of pregnant women at the 11-13^th weeks of their pregnancy, in order to reveal the later developing preeclampsia after the 20^th week of gestation.  The Arteriograph measured elevated central systolic BP and aortic stiffness turned to be significant predictors of preeclampsia.

 

 

 

•  gynaecologists;

 

ü  We have evidence that elevated central systolic BP and arterial stiffness measured with Arteriograph helps to identify those subjects whom preeclampsia develops in the later stage of pregnancy.

 

 

 

- Gynaecology

 

• The oestrogen production of ovaries used to fall much earlier than menopause occurs. The diminished oestrogen level accelerates the atherosclerotic procedures causing decreased NO (nitrogen monoxide) synthesis, which increases the peripheral arterial tone of the small arteries and arterioles; furthermore endothelial/vascular dysfunction develops.  As the increased arterial stiffness the above mentioned vascular remodeling can be detected with Arteriograph, thus women who are candidates for an increased level of medical care, can be detected in due time.

 

•  gynecologists;

 

ü  The early arterial dysfunction in perimenopause can be revealed with Arteriograph, thus provide indication for a timely initialized hormonal replacement therapy (HRT) and for an increased medical care.

 

- Andrology

 

• The erectile dysfunction is one of the earliest sign of increased CV risk among males, reflecting to the endothelial dysfunction and decreased production of NO. The strong and significant relationship between the increased Augmentation index (Aix), measured with Arteriograph, and the impaired endothelial function (decreased NO) assessed with flow mediated vasodilatation (FMD) have been pointed out by Soltész and colleagues at the University of Debrecen. The more unfavorable the FMD (the smaller the achieved vasodilatation of the brachial artery after 5 minutes of occlusion), the higher the Aix.

 

 

 

•  andrologist;

 

ü  Erectile dysfunction used to go together with endothelial dysfunction that could be detected with Arteriograph as an increased Aix.

 

 

 

- Pediatrics

 

• Thanks to the large cohort (3374) of healthy, normotensive children and adolescents measured with Arteriograph by Hidvégi et al., the normal reference values of arterial stiffness (aortic PWV) have been known.
• The importance of the reference values is high because the hypertension and obesity could occur even in young age. Shocking data had become available from the PDAY study; 13.1% of boys and 6.8% of girls in the age of 15-19 had fibrous atherosclerotic plaques in the abdominal part of the aorta! Thus, detecting early stage of atherosclerosis is very important even in young age. Juvenile hypertension, type-1 diabetes, familiar hypercholesterinaemia, intrauterine growth retardation, renal diseases, etc. are characterized by increased arterial stiffness even in the young population.

 

 

 

•  pediatrician;

 

ü  We have normal standards for Arteriograph measured stiffness parameters, published recently. Obesity, hypertension, hypercholesterinaemia, type 1 diabetes are all seen in pediatrics and adolescent population, so the measurement of arterial stiffness provides important information about the early vascular damage even in pediatric population. The screening for early, asymptomatic atherosclerosis cannot be started early enough.

 

 

 

 

 

- Scientific (clinico-pharmacologic) studies and other researches

 

• Arteriograph and Arteriograph 24 can be used widely in all of the researches, dealing with the assessment of the arterial stiffness. Especially pharmaceutical companies used to be very interested in applying newer methods to monitor the action of their drugs (mostly cardiac and antihypertensives) on the central hemodynamics. In this respect Arteriograph provides a much easier and more effective approach, with better reproducibility and repeatability as compared to the former applanation tonometric (ShygmoCor) or piezo-electric (Complior) methods. The good reproducibility and low variance (see Baulmann et al J Hypertens 2008, 26:523–52) plays a very crucial role in the scientific field.

 

 

 

•  the scientific field;

 

ü  Scientific evidence proves that Arteriograph has better reproducibility and lower variance than the former applanation tonometric or piezo-electric methods assessing arterial stiffness. Due to its user independent operation the data acquisition is much easier and more comfortable.

 

 

 

- Occupational medicine

 

• For cardiovascular screening programs the occupational medicine is an ideal place, because effective, but simple and fast enough point of care diagnostic methods, such as Arteriograph can easily be applied at working places, offices, where a large number of employees in their active age are available. The employers are motivated to provide different bonuses to employees and are willing to bear the costs fully or partly of the screening. Cardiovascular screening with a “point of care” Arteriograph method does not require medical surroundings. 

 

•  occupational medicine;

 

ü  For CV screening the occupational medical care is an ideal place. The employers are motivated to provide different bonuses to employees and are willing to bear the costs of the screening fully or partly.

 

 

 

 

 

- Sport medicine

 

• The sudden cardiac death among athletes is one of the most threatening tragedies that happen from time to time. Sometimes it happens in front of the television cameras shocking millions of TV viewers. In athletes older than 35 years of age, 80% of SCD is frequently due to atherosclerotic coronary artery disease. The strong relationship between CAD and increased arterial stiffness has been proven by several studies. Thus the detection of increased Aix, SBPao and/or PWVao among athletes aged over 35 years with Arteriograph could help to reveal those subjects who are in risk.  The Arteriograph measurement in fitness centers or gyms might be also very important, because older and potentially diseased population used to attend these sites.
•  sport medicine;

 

ü  The detection of an increased Aix, SBPao and/or PWVao among athletes aged over 35 years with Arteriograph could help to reveal those subjects who are in risk. The Arteriograph measurement in fitness centers might be also very important, because older and potentially diseased population used to attend the fitness clubs.

 

 

 

 

 

- Anesthesiology

 

• We have scientific evidence for the relationship of the increased arterial stiffness and severe complications during anesthesia, such as severe hypotension. Thus the arterial stiffness measurement with an easy to use, oscillometric method, like Arteriograph during the routine anesthesiologist check-up before anesthesia could help to reduce the intraoperative anesthesiologic complications.

 

 

 

 

 

•  anesthesiology;

 

ü  Arteriograph measurement during the routine anesthesiologist check-up before operation might help to avoid severe complications during anesthesia.

 

 

 

 

 

- Complementary (alternative) medicine

 

• Billions of Euros are spent yearly in the EU and even more in the USA using complementary medicine preparates. These agents are not considered medical drugs, but a kind of alimentary supplementation. Consequently thousands of preparates are available and the competition among the producers is very strong. The major weakness in this field is to prove the efficacy of the preparates and to choose those subjects who could be the candidates of the use. In this respect Arteriograph - providing a series of hemodynamic parameters with user independent, reliable, repeatable way - can fulfill both of the requirements. Big sold volumes could be expected in this huge market.

 

•  complementary (alternative) medicine;

 

ü  Players in the field of alternative medicine can find an excellent and easy to use tool (the user independent, simple operation is mandatory in this field) in order to find the potential users of their preparates, furthermore to monitor the action of the applied complementary medicine.

 

 

 

 

 

 

 

- Population health

 

• Atherosclerosis is a silent killer. It can begin in a surprisingly young age and could exist without any symptoms for decades. In a later stage of this procedure complications and clinical manifestations occur; CAD, stroke or PAD.  Unfortunately the first symptom of the atherosclerosis is often the last one; i.e. the patient does not survive the firstly developed myocardial infarction or stroke. Thus screening among apparently healthy, middle age (35-65 years) population for detecting early, asymptomatic arterial damage (atherosclerosis) is a very reasonable approach in the population health. Today the only technology which can fulfill the above described needs is the Arteriograph. Why? Because any method used to determine the cardiovascular risk of a subject has to be validated by longitudinal, hard endpoint (fatal and non-fatal cardio- and cerebrovascular events) study on large population. Indeed among the oscillometric arterial stiffness measuring devices only the Arteriograph has more than 5 years follow up study, which clearly points out that all of the Arteriograph measured stiffness parameters (PWVao, Aix, SBPao) are independent, highly significant predictors of cardio- and cerebrovascular diseases and total mortality, thus Arteriograph is suitable for population screening.
•  population health;

 

ü  Atherosclerosis is a silent killer. Screening among apparently healthy, middle age (35-65 years) population for detecting early, asymptomatic arterial damage (atherosclerosis) is a very reasonable approach to reduce CV morbidity and mortality in the population. Today the only oscillometric technology which can be used for this purpose is the Arteriograph, because it has been validated by longitudinal, hard endpoint study on large population.