Timing and Patient Position During Cuff Blood Pressure Measurement Affect Myocardial Work Parameters Measured by
Samantha Fisicaro1, Alexandra Clement2, Michele Tomaselli1
1Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
Insights
Blood pressure measurement timing and patient position during echocardiography significantly impact myocardial work calculations. Standardizing these factors is crucial for accurate noninvasive assessment of cardiac function.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Cuff blood pressure measurement is vital for noninvasive myocardial work calculation.
- Lack of standardized protocols for blood pressure measurement during echocardiography poses a challenge.
Purpose of the Study:
- To investigate the impact of measurement timing and patient positioning during echocardiography on cuff blood pressure readings.
- To assess how these variations affect myocardial work parameter calculations.
Main Methods:
- Prospective enrollment of 101 patients undergoing echocardiography.
- Cuff blood pressure was measured four times: before, during lateral decubitus positioning, during apical view acquisition, and post-study.
- Measurements were taken using an automated digital monitor on both arms.
Main Results:
- Systolic blood pressure showed significant drops between measurement points (BP1 to BP2, BP2 to BP3, BP1 to BP4).
- Myocardial work parameters, such as the global work index, varied significantly with each blood pressure measurement point.
- Global longitudinal strain averaged -16% ± 3%.
Conclusions:
- Measurement timing and patient position during echocardiography critically influence cuff blood pressure.
- These factors directly affect the calculated values of myocardial work parameters.
- Standardization of blood pressure measurement protocols is recommended for reliable myocardial work assessment.
Background:
Although cuff blood pressure measurement is a critical parameter to calculate myocardial work noninvasively, there is no recommendation about when and how to measure it. Accordingly, we sought to evaluate the effects of the timing during the echo study and the patient's position on the scanning bed during the cuff blood pressure measurement on myocardial work parameter calculations.
Methods:
One hundred one consecutive patients (44 women, 66 ± 14 years) undergoing clinically indicated echocardiography were prospectively enrolled. During the echocardiographic study, we measured the cuff blood pressure 4 times, using a fully automatic digital blood pressure monitor applied to the right and left arm in the same position throughout the study: BP1, before the start of the echo study, with the patient lying in the supine position; BP2, after positioning the patients on their left side to start the echo study; BP3, at the time of the acquisition of the 3 apical views (4- and 2-chamber and long-axis) used to measured left ventricular global longitudinal strain; and BP4, at the end of the echo study with the patient again in the supine position.
Results:
Systolic blood pressureat BP1 was 147 ± 21 mm Hg. Between BP1 and BP2, it dropped by 17 ± 9 mm Hg (P < .05). Systolic blood pressure at BP3 was significantly lower than BP2 (130 ± 20 mm Hg vs 122 ± 18 mm Hg, P < .05), and at BP4 was significantly lower than at BP1 (-9 ± 13 mm Hg, P < .05). The average global longitudinal strain was -16% ± 3%. Accordingly, the global work index was 1,929 ± 441 mm Hg% at BP1, dropped to 1,717 ± 421 at BP2, decreased to 1,602 ± 351 mm Hg% at BP3, and increased to 1,815 ± 386 mm Hg% at BP4 (P < .001).
Conclusions:
The timing during the echocardiography study and the patient's position on the scanning bed are critical determinants of the measured cuff systolic blood pressure and the resulting values of myocardial work parameters.
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