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A region-matching method for pulse transit time estimation: potential for improving the accuracy in determining carotid femoral pulse wave velocity

Journal of Human Hypertension volume 29, pages 675–682 (2015)Cite this article

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Abstract

Carotid femoral pulse wave velocity (cfPWV) is the ‘gold standard’ for assessment of arterial stiffness. The reliability of cfPWV measurement depends on the estimation of pulse transit time (PTT). This study aimed to validate a region-matching method for determining PTT and cfPWV against the existing ‘foot-to-foot’ methods. A cohort of 81 subjects (33 males and 48 females) aged 25–80 (45.1±15.7 years) were studied. PTTs were estimated by the region matching and ‘foot-to-foot’ methods (‘diastole minimum’, ‘maximum first derivative’, ‘maximum second derivative’ and ‘tangent intersection’ methods) with manual identification as the reference method and were subsequently used to calculate cfPWV. In a subgroup of 30 individuals, the measurements were repeated after 1 h. There were excellent correlations between cfPWV obtained by the reference method and all the estimated methods (r>0.9, P<0.001 for all), except the diastole minimum method (r=0.793, P<0.001). The region-matching method yielded cfPWV with a better accuracy (mean difference=−0.161 m s−1, limits of agreement: −0.79 to 0.46 m s−1) and repeatability (mean difference=−0.228 m s−1, intraclass correlation coefficient=0.957) comparing with the ‘foot-to-foot’ methods. These results demonstrate that the proposed region-matching method is more accurate and suitable for PTT estimation and cfPWV measurement.

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References

  1. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27 (21): 2588–2605.

    Article  Google Scholar 

  2. Hansen TW, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006; 113 (5): 664–670.

    Article  Google Scholar 

  3. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37 (5): 1236–1241.

    Article  CAS  Google Scholar 

  4. Webb DR, Khunti K, Silverman R, Gray LJ, Srinivasan B, Lacy PS et al. Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity. Diabetologia 2010; 53 (6): 1190–1198.

    Article  CAS  Google Scholar 

  5. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM . Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999; 99 (18): 2434–2439.

    Article  CAS  Google Scholar 

  6. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ et al. Aortic pulse wave velocity improves cardiovascular event prediction an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014; 63 (7): 636–646.

    Article  Google Scholar 

  7. Vardoulis O, Papaioannou TG, Stergiopulos N . Validation of a novel and existing algorithms for the estimation of pulse transit time: advancing the accuracy in pulse wave velocity measurement. Am J Physiol Heart C 2013; 304 (11): 1558–1567.

    Article  Google Scholar 

  8. Mitchell GF, Pfeffer MA, Finn PV, Pfeffer JM . Comparison of techniques for measuring pulse-wave velocity in the rat. J Appl Physiol 1997; 82 (1): 203–210.

    Article  CAS  Google Scholar 

  9. Chiu YC, Arand PW, Shroff SG, Feldman T, Carroll JD . Determination of pulse-wave velocities with computerized algorithms. Am Heart J 1991; 121 (5): 1460–1470.

    Article  CAS  Google Scholar 

  10. Millasseau SC, Stewart AD, Patel SJ, Redwood SR, Chowienczyk PJ . Evaluation of carotid-femoral pulse wave velocity: influence of timing algorithm and heart rate. Hypertension 2005; 45 (2): 222–226.

    Article  CAS  Google Scholar 

  11. Salvi P, Magnani E, Valbusa F, Agnoletti D, Alecu C, Joly L et al. Comparative study of methodologies for pulse wave velocity estimation. J Hum Hypertens 2008; 22 (10): 669–677.

    Article  CAS  Google Scholar 

  12. Gao MW, Zhang GQ, Olivier NB, Mukkamala R . Improved pulse wave velocity estimation using an arterial tube-load model. IEEE Trans Biomed Eng 2014; 61 (3): 848–858.

    Article  Google Scholar 

  13. McDonald DA . Regional pulse-wave velocity in the arterial tree. J Appl Physiol 1968; 24 (1): 73–78.

    Article  CAS  Google Scholar 

  14. Nichols WW, McDonald DA . Wave-velocity in the proximal aorta. Med Biol Eng 1972; 10 (3): 327–335.

    Article  CAS  Google Scholar 

  15. Khir AW, Zambanini A, Parker KH . Local and regional wave speed in the aorta: effects of arterial occlusion. Med Eng Phy 2004; 26 (1): 23–29.

    Article  CAS  Google Scholar 

  16. Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank J, De Backer T et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012; 30 (3): 445–448.

    Article  CAS  Google Scholar 

  17. Weber T, Ammer M, Rammer M, Adji A, O'Rourke MF, Wassertheurer S et al. Noninvasive determination of carotid-femoral pulse wave velocity depends critically on assessment of travel distance: a comparison with invasive measurement. J Hypertens 2009; 27 (8): 1624–1630.

    Article  CAS  Google Scholar 

  18. Pereira T, Maldonado J . Comparative study of two generations of the Complior device for aortic pulse wave velocity measurements. Blood Press Monit 2010; 15 (6): 316–321.

    Article  Google Scholar 

  19. Huybrechts SA, Devos DG, Vermeersch SJ, Mahieu D, Achten E, de Backer TL et al. Carotid to femoral pulse wave velocity: a comparison of real travelled aortic path lengths determined by MRI and superficial measurements. J Hypertens 2011; 29 (8): 1577–1582.

    Article  CAS  Google Scholar 

  20. Wilkinson IB, McEniery CM, Schillaci G, Boutouyrie P, Segers P, Donald A et al. ARTERY Society guidelines for validation of non-invasive haemodynamic measurement devices: Part 1, arterial pulse wave velocity. Artery Res 2010; 4 (2): 34–40.

    Article  Google Scholar 

  21. Vlachopoulos C, Aznaouridis K, Stefanadis C . Prediction of cardiovascular events and all-cause mortality with arterial stiffness a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55 (13): 1318–1327.

    Article  Google Scholar 

  22. Hwang MH, Yoo JK, Kim HK, Hwang CL, Mackay K, Hemstreet O et al. Validity and reliability of aortic pulse wave velocity and augmentation index determined by the new cuff-based SphygmoCor Xcel. J Hum Hypertens 2014; 28 (8): 475–481.

    Article  CAS  Google Scholar 

  23. Papaioannou TG, Protogerou AD, Nasothimiou EG, Tzamouranis D, Skliros N, Achimastos A et al. Assessment of differences between repeated pulse wave velocity measurements in terms of 'bias' in the extrapolated cardiovascular risk and the classification of aortic stiffness: Is a single PWV measurement enough? J Hum Hypertens 2012; 26 (10): 594–602.

    Article  CAS  Google Scholar 

  24. Segers P, Mahieu D, Kips J, Rietzschel E, De Buyzere M, De Bacquer D et al. Amplification of the pressure pulse in the upper limb in healthy, middle-aged men and women. Hypertension 2009; 54 (2): 414–420.

    Article  CAS  Google Scholar 

  25. Mahieu D, Kips J, Rietzschel ER, De Buyzere ML, Verbeke F, Gillebert TC et al. Noninvasive assessment of central and peripheral arterial pressure (waveforms): implications of calibration methods. J Hypertens 2010; 28 (2): 300–305.

    Article  CAS  Google Scholar 

  26. Agnoletti D, Zhang Y, Salvi P, Borghi C, Topouchian J, Safar ME et al. Pulse pressure amplification, pressure waveform calibration and clinical applications. Atherosclerosis 2012; 224 (1): 108–112.

    Article  CAS  Google Scholar 

  27. Paul B, Hewitson CL, Woodman RJ, Mangoni AA . Analysis of short-term reproducibility of arterial vasoreactivity by pulse-wave analysis after pharmacological challenge. Clin Exp Pharmacol P 2009; 36 (1): 49–54.

    Article  CAS  Google Scholar 

  28. Schillaci G, Bilo G, Pucci G, Laurent S, Macquin-Mavier I, Boutouyrie P et al. Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension findings from 2 large databases. Hypertension 2012; 60 (2): 369–377.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by grant 61301059 from National Natural Science Foundation of China and 2013BAH14F01 from National Science and Technology Pillar Program. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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  1. F S Hu and Y L Zhang: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Automation, University of Science and Technology of China, Hefei, PR China

    F S Hu

  2. Research Center for Information Technology of Sports and Health, Institute of Intelligent Machines, Chinese Academy of Sciences, Hefei, PR China

    F S Hu, Y L Zhang, Z C Ma, Q Q Cao, Y B Xu, Z J He & Y N Sun

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Correspondence to Y N Sun.

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Hu, F., Zhang, Y., Ma, Z. et al. A region-matching method for pulse transit time estimation: potential for improving the accuracy in determining carotid femoral pulse wave velocity. J Hum Hypertens 29, 675–682 (2015). https://doi.org/10.1038/jhh.2015.9

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