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Published on: February 7, 2014
Pulse wave analysis is a reproducible technique for measuring central blood pressure during hemodynamic perturbations
David J Holland1, Julian W Sacre, Sarah J McFarlane
1Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia.
Insights
Radial tonometry reliably measures central blood pressure and wave reflection during exercise. This technique is reproducible, making it suitable for studies altering hemodynamics.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Exercise Science
Background:
- Central blood pressure and wave reflection markers, like augmentation index (AIx), offer prognostic information beyond brachial BP.
- Assessing central waveforms during exercise is crucial for understanding altered hemodynamics, but test reliability under these conditions is not well-established.
Purpose of the Study:
- To evaluate the reproducibility of radial tonometry for measuring central hemodynamic indices during exercise-induced hemodynamic perturbations.
Main Methods:
- Radial waveforms were recorded in 28 healthy adults at rest, during submaximal cycling (50-70% HRmax), and post-maximal treadmill exercise.
- Measurements were repeated on two separate occasions, with waveforms calibrated by brachial BP.
- Key metrics included augmentation index (AIx) and pulse pressure amplification (PPAmp).
Main Results:
- Excellent reproducibility was observed for AIx, central pulse pressure, and PPAmp across all exercise intensities between testing days.
- Intraclass correlations for AIx, central pulse pressure, and PPAmp at 50% exercise were 0.93, 0.89, and 0.89, respectively (P < 0.001).
- No significant differences in HR, PPAmp, or AIx were found between visits at rest or during exercise.
Conclusions:
- Radial tonometry demonstrates high reproducibility for assessing central waveform indices during exercise.
- The technique is reliable even under significant hemodynamic changes induced by exercise.
- This supports its utility in intervention studies investigating altered hemodynamics.
Background:
Central blood pressure (BP) and markers of wave reflection (augmentation index; AIx) measured by radial tonometry have prognostic value independent from brachial BP. The measurement of the central waveform is increasingly used during altered hemodynamics, including exercise, but reliability of the test has not been reported under changed loading conditions. This study aimed to test the technique's reproducibility during major hemodynamic perturbations induced by exercise.
Methods:
Radial waveforms were recorded (SphygmoCor) in 28 healthy subjects (aged 53 +/- 11 years) at rest, during submaximal exercise (cycling at 50, 60, and 70% of maximal age-predicted heart rate (HR)) and immediately after maximal treadmill exercise on two occasions separated by 9 +/- 5 days. Data were compared between testing days. Waveforms were calibrated with brachial BP measured using a mercury sphygmomanometer. Pulse pressure amplification (PPAmp) was defined as the ratio of brachial to central pulse pressure.
Results:
There was very good reproducibility between visits at all exercise intensities for all waveform measures, including AIx, central pulse pressure, and PPAmp (intraclass correlations at 50% exercise were 0.93, 0.89, and 0.89, respectively; P < 0.001). The mean difference between tests at this intensity was 0 +/- 4% for AIx, 4 +/- 6 mm Hg for central pulse pressure, and -0.02 +/- 0.09 for PPAmp. There were no significant differences between visits for HR, PPAmp, or AIx at rest or with exercise (P > 0.05 for all).
Conclusions:
Radial tonometry is a reproducible technique for measurement of central waveform indices during perturbations induced by exercise. It should, therefore, be suitable for use in intervention studies in which hemodynamics are altered.
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