動脈硬化を測ろう

ドイツ　　医学　科学誌掲載　　　　　　　　　２００５年

oszillometrisch mit Arteriograph (TensioMed, Budapest)

J. Baulmann - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)
S. Rickert - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)
U. Schillings - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)
S. Uen - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)
R. D・ing - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)
H. Vetter - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)
T. Mengden - Medizinische Polliklinik der Unviersit Bonn (Bonn, D)

Hypertonie 2005. 29. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Berlin, 23.-25.11.2005. D・seldorf, Kn: German Medical Science; 2006. Doc05hochP109

Die elektronische Version dieses Artikels ist vollstdig und ist verf・bar unter: http://www.egms.de/de/meetings/hoch2005/05hoch109.shtml

Veröffentlicht:

8. August 2006

© 2006 Baulmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf舁tigt, verbreitet und fentlich zug舅glich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

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Einleitung: Der Augmentations-Index (AIx) quantifiziert die Pulswellen-Reflexion, ist ein direktes Maﾟ f・ Gefalter, ein indirektes Maﾟ f・ arterielle Gefsteifigkeit und eng verkn・ft mit kardiovaskulem Gesamt-Risiko. K・zlich wurde eine neue Methode entwickelt, welche aus oszillometrisch am Oberarm aufgezeichneten Blutdruckkurven den AIx analysiert. Ziel unserer Studie ist, die herkmliche, als Goldstandard angesehene, applanationstonometrische (SphygmoCor) mit der neuen oszillometrischen Methode, die Augmentation zu bestimmen, (Arteriograph) zu vergleichen.

Material und Methoden: Bei 41 Patienten und Probanden im Alter von 22-74 Jahren wurde jeweils 2 mal tonometrisch mit SphygmoCor (AtCor Medical, Sydney) sowie 4mal oszillometrisch mit Arteriograph (TensioMed, Budapest) der AIx bestimmt. Anschlieﾟend wurden die Korrelationen zueinander sowie zum Alter berechnet.

Ergebnisse: Die Korrelation des AIx von Applanationstonometrie zu oszillometrischer Methode ist hoch signifikant mit r=0,809 (p<0,0001) und rｲ=0,655. Zum Alter waren beiden Methoden nlich hoch signifikant mit r=0,76 (SphygmoCor) und r=0,72 (Arteriograph).

Schlussfolgerung: Die oszillometrische Bestimmung der Augmentation mittels des sehr einfach anzuwendenden, Untersucher-unabhgigen und kosteng・stigen Arteriograph birgt ein groﾟes klinisches Potential zur kardiovaskulen Risikostratifizierung.

Arterial stiffness

The term “arterial stiffness” once referred only to the loss of compliance in the large arteries, now it is a comprehensive term encompassing the characteristics of the entire arterial system, including the biochemical-structural-mechanical changes in the small and large arteries, as well as the comparative pressures.

Cardiovascular disease is the No. 1 cause of death worldwide. Heart attack, heart failure and stroke are the top three within the category.

A sudden jump in blood pressure is the most frequent cause of stroke, while myocardial infarctions (heart attacks) are most often caused by a partial or full coronary occlusion, a rupture of vulnerable plaque built up during severe coronary atherosclerosis. In nearly every case, some stage of the process of sclerosis is present.

In order to prevent severe vascular crises, it is essential to identify individuals who are at risk but have not yet developed symptoms. Identification of at-risk individuals, examination of the patient for the signs of preclinical atherosclerosis, as well as the identification and treatment of the classical risk factors are included in the European Guidelines for the management of arterial hypertension since 2007.

“Sudden heart attack,” in the literal sense of the word, does not exist. The arterial system prepares for a plaque rupture over the course of years, or even decades, like a ticking time bomb. Most severe events can, therefore, be prevented with early detection of atherosclerosis (with the help of functional and structural tests) and preventive treatment begun in a timely manner.

European Guidelines list the types of target organ damage that can occur even in asymptomatic patients. The screening is recommended and mandatory in every hypertension patient. The Guidelines emphasize the screening for asymptomatic atherosclerosis in as large a pool of individuals as possible, as well as the importance of such testing for high risk of cardiovascular disease because together with the traditional risk factors, it has a greater degree of predictive value.

It is a simple, proven fact today that arterial stiffness is a truly important and independent indicator of cardiovascular risk. The functional and structural changes in the large arteries are partly age-related, but there are several conditions that show a link with accelerated arterial stiffening, such as hypertension, atherosclerosis, end-stage renal disease, as well as the traditional risk factors (diabetes, dyslipidemia, smoking etc.). That is why arterial stiffness has become a main topic of clinical research in recent years, indicated by the huge increase in publications on the subject.

Can arterial stiffness parameters be measured in the sitting position?

Jens Nürnberger,Rene Michalski,Tobias R Türk,Anabelle Opazo Saez,Oliver Witzke,Andreas Kribben

DOI: 10.1038/hr.2010.196

Despite the introduction of arterial stiffness measurements in the European recommendation, pulse wave velocity (PWV) and augmentation index (AI) are still not used routinely in clinical practice. It would be of advantage if such measurements were done in the sitting position as is done for blood pressure. The aim of this study was to evaluate whether there is a difference in stiffness parameters in sitting vs. supine position. Arterial stiffness was measured in 24 healthy volunteers and 20 patients with cardiovascular disease using three different devices: SphygmoCor (Atcor Medical, Sydney, Australia), Arteriograph (TensioMed, Budapest, Hungary) and Vascular Explorer (Enverdis, Jena, Germany). Three measurements were performed in supine position followed by three measurements in sitting position. Methods were compared using correlation and Bland-Altman analysis. There was a significant correlation between PWV in supine and sitting position (Arteriograph: P<0.0001, r=0.93; Vascular Explorer; P<0.0001, r=0.87). There were significant correlations between AI sitting and AI supine using Arteriograph (P<0.0001, r=0.97), Vascular Explorer (P<0.0001, r=0.98) and SphygmoCor (P<0.0001, r=0.96). When analyzed by Bland-Altman, PWV and AI measurements in supine vs. sitting showed good agreement. There was no significant difference in PWV obtained with the three different devices (Arteriograph 7.5±1.6 m s(-1), Vascular Explorer 7.3±0.9 m s(-1), SphygmoCor 7.0±1.8 m s(-1)). AI was significantly higher using the Arteriograph (17.6±15.0%) than Vascular Explorer and SphygmoCor (10.2±15.1% and 10.3±18.1%, respectively

Breakthrough in Early Diagnosis of Arteriosclerosis

The TensioClinic Arteriograph analyses the cardiovascular system from five highly important aspects to assure Comprehensive Cardiovascular Risk Assessment. Measuring Central and Peripheral Blood Pressure, Arterial Stiffness (PWV & AIx), Cardiac fitness and considering Classical Cardiovascular Risk Stratification (Framingham, SCORE), Arteriograph enables detecting the real, individual risk even at the early, reversible stage. Numerous EU references are available for reinforcing the significance of this unique screening device, which is also ideal for evaluating the efficiency of applied cardiovascular therapy and for follow up of diabetic patients, too.

Arterial Stiffness Analysis

There are various methods for cardiovascular examination. The ECG shows signs of oxygen deprivation, when coronaries are blocked for 70% or more. Other invasive procedures such as cardiac catheterization will detect abnormalities at an earlier stage, but such tests are only performed if people have complaints.

The AORTOGRAM is performed with the Arteriograph®. This is a relatively new method that is so sensitive, that abnormalities can be detected in a very early stage .

The Arteriograph measures both the loss of arterial functioning and arterial stiffening.

Loss of function is expressed in the unit AIX: the Augmentation Index. The AIX is a measure of the total resistance of all blood vessels. Against this resistance, the heart pumps every stroke. The higher this resistance is, the higher the work load for the heart. An increased resistance of the blood vessels is caused by loss of function of the endothelium.

Loss of elasticity (stiffness) of the arteries is expressed in the unit of measure PWV: Pulse Wave Velocity, or the speed at which the aortic pulse is going. In case of aortic stiffening the speed of the pulse increases. The higher the PWV, the more stiffening of the aorta has already occurred.

Both loss of function and stiffening are categorized in four groups: