Introduction of diverse devices to measure arterial stiffness
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1 Slide 1 Introduction of diverse devices to measure arterial stiffness PARK, Jeong Bae, MD, PhD, Medicine/Cardiology, Samsung Cheil Hospital, Sungkyunkwan University School of Medicine 일혈관연구회부산집담회, 부산롯데호텔
2 Slide 2 Fluctuations in amplitude of flow, pressure, and diameter in a large artery Heart SV C Flow Pressure Diameter
3 Slide 3 mmhg Pressure pulsations Pressure Asc aorta Aorta arch Abd. aorta Fem. artery Sap. artery
4 Slide 4 A Model of the Systematic Circulation.
5 Slide 5 Compliance, D/ P or A/ P Systole Augmentation index AI= Augmentation pr. SBP - DBP vs. pulse wave velocity PWV = D / T
6 Slide 6 Terminology Parameter Definition Formula Distensibility Compliance The relative change in vessel diameter (or area) for a given change in pressure The absolute change in vessel diameter (or area) for a given change in pressure D/( PxD), A/( PxA) D/ P, A/ P Elastic modulus Pulse wave velocity Stiffness index (ß) The pressure change required for (theoretical) 100% stretch from resting diameter (inverse of distensibility) The speed with which the pulse wave travels along a length of artery The ratio of the natural logarithm of SBP/DBP to the relative change in diameter ( PxD)/ D Distance/ t ln(p s /P d ) / [(D s -D d )/D d )] Augmentation index Size of increase or decrease in the pulse height as a result of the reflected wave, or Size of reflected peak (P2/P1) (P2-P1)/(Ps-Pd), (P2/P1)
7 Slide 7 Volume (V) I. Compliance Heart SV Def: The absolute change in vessel diameter (or area) for a given change in pressure. D/ P or A/ P Elastic a. C Muscular a. dv/dp Resistance a. Pressure (P)
8 Slide 8 I-2. Local Arterial (Aortic) Stiffness : Stiffness index = Ln (SBP/DBP) / (Dsys-Ddia/Ddia) Dd Ds
9 Slide 9 II. Pulse wave velocity The speed with which the pulse wave travels along a length of artery (Distance/ t) A a * * distance b B A B t
10 Slide 10 III. Augmentation pressure and augmentation index incisura SBP P2 P = P2 - P1 pp P1 AI= P SBP - DBP DBP ejection duration
11 Slide 11 VP-1000,2000 (COLIN)
12 Slide 12 BaPWV and ABI by Colin
13 Slide 13 Arterial stiffness index (ASI)
14 Slide 14 한별 - 혈관질환진단시스템 (PP-1000) 두동맥부위사이의 PWV (pulse wave velocity) 측정 동맥경화, 혈관노화등의혈관관련질환조기발견 환자들에게거부감없이접근할수있는비침습적혈관관련질환진단시스템 기능 심장에서특정부위혈관까지의펄스전달속도실시간디스플레이 심전도, 심음, 4채널동맥펄스동시측정 혈관관련질환별데이터베이스내장 용도 혈관노화및동맥경화등의혈관관련질환분석 동맥탄력성및혈관질환별위험도분석 환자의치료효과및호전상태추적 동맥경화, 고혈압, 당뇨등의혈관질환조기진단
15 Slide 15 한별 - 혈관질환진단시스템 (PP-1000)
16 Slide 16 Complior, Micro-system, Omron
17 Slide 17 Systemic Arterial stiffness ; Augmentation index (AIx) by Sphygmocor Augmentation index Pressure transfer function (Degree of amplification) Aorta Radial artery Radial pulse applanation tonometry
18 Slide 18 Applanation tonometry (SphygmoCor)
19 Slide 19 주요혈관경직도측정기의특징 VP- 1000,2000 (COLIN) VaSera (FUKUDA) CardioVision Complior SphygmoCor (AtCor) PP- 1000(Hanbyul Meditech) 측정신호 ECG, PCG, Brachial & Ankle PP (lt/rt) Brachial PP ECG, Carotid, Radial & Femoral PP ECG, P ECG, PCG, Carotid, Radial, Femoral, Dorsalis Pedis Pulse waves (lt/rt) 측정원리 Cuff 에자동으로압력을인가했다가감소시키면서 4 부위에서의혈압값 ( 최고, 최저, 평균 ) 을측정하고맥파파형을검출 각동맥부위에서의맥파파형검출 특정동맥부위에서의맥파파형을검출한후다른부위에서맥파검출 각부위에압력센서를위치하고 4 채널로부터동시에맥파파형을검출 측정변수및진단내용 사지혈압, bapwv, ABI hcpwv, hbpwv, fapwv, hfpwv CAVI (cardio-ankle vascular index), TBI (toe-brachial index) 좌우상완혈압 ASI (arterial Stiffnessindex) Framingham 위험도 ASI/CHD 위험도 PWV, 경동맥 - 대퇴동맥경동맥 - 요골동맥경동맥 - 족배동맥 PWV PWA PWV, 경동맥 - 대퇴동맥경동맥 - 요골동맥경동맥 - 족배동맥 PWV; 대동맥, 상하지동맥경화의수준추정혈관나이
20 Slide 20 주요혈관경직도측정기의특징 Pulse Prace (MML) DPA (digital arterial pulsewave analyzer, MERIDIAN) PDL/PVL (Biomedix) & Unetixs(Unextis) 측정신호 Volume Pulse PTG(plethysmogram) PPG, pressure volume, Doppler waveform 측정원리 손가락끝에서지첨용적맥파검출 손가락으로부터맥파 ( 지첨용적맥파 ) 를검출하고이로부터 APG ( 가속도맥파 ) 산출 사지에서부위별로혈압측정, 도플러로 tibial, dorsal 혈류상태파악, 양쪽발가락에서 PPG 측정 측정변수및진단내용 동맥경화도와반사도측정, 손가락끝에서측정된용적맥파의형태를분석하여경화도정도나타냄 가속도맥파파형의모양변화를분석 심박변이도 (HRV) 부위별혈압으로동맥패색이있는곳파악 도플러주로말초동맥질환이발생하는곳을중심으로정확한부위검출가능 발가락 PPG 최단말초부위의혈관상태파악
21 Slide 21 Conclusion To order to estimate arterial stiffness, systemic arterial stiffness (eg. augmentation index), in addition to one-site stiffness (eg. compliance or -index) or one-segment stiffness (eg. pulse wave velocity) would be the best.
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