Use of arterial transfer functions for the derivation of central aortic waveform characteristics in subjects with type 2 diabetes and cardiovascular disease.

OBJECTIVE Optimal blood pressure control in subjects with diabetes reduces cardiovascular complications. There is theoretical benefit in the assessment of central aortic waveforms including the augmentation index, which is taken as a putative index of stiffness. Transfer functions may be used to reconstruct aortic from radial pressure waveforms; however, a single generalized transfer function may not be appropriate for all patients. We aimed to evaluate the technique in subjects with diabetes. RESEARCH DESIGN AND METHODS Simultaneous invasive central aortic and noninvasive radial waveforms were acquired in 19 subjects with type 2 diabetes, and a diabetes-specific transfer function was derived. Similar data were acquired from 38 age- and sex-matched subjects without diabetes. Central waveforms were reconstructed using a generalized transfer function in all patients and the diabetes-specific transfer function in individuals with diabetes. RESULTS There was no difference between groups in measured central pressures. The error in generalized transfer function-derived systolic pressure was greater in individuals with diabetes (6 +/- 7 mmHg) (mean +/- SD) than without diabetes (2 +/- 8 mmHg) (P<0.05). Errors in other parameters were no different. The diabetes-specific transfer function reduced the error in derived systolic pressure to 0 +/- 7 mmHg in individuals with diabetes--no different than that with the generalized transfer function in individuals without diabetes. The central augmentation index reconstructed by either transfer function was unrelated to that directly measured. CONCLUSIONS A generalized transfer function is inappropriate for the derivation of central waveforms in subjects with type 2 diabetes. Errors in subjects with diabetes might be reduced with a diabetes-specific transfer function.

[1]  Cited "validation" references for the SphygmoCor device. , 2001, Kidney international.

[2]  R. Holman,et al.  Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. , 1998 .

[3]  J. Cockcroft,et al.  Pressure Amplification Explains Why Pulse Pressure Is Unrelated to Risk in Young Subjects , 2001, Hypertension.

[4]  Veikko Salomaa,et al.  Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC Study. Atherosclerosis Risk in Communities Study. , 1995, Circulation.

[5]  D. Kass,et al.  Parametric model derivation of transfer function for noninvasive estimation of aortic pressure by radial tonometry , 1999, IEEE Transactions on Biomedical Engineering.

[6]  M. O'Rourke,et al.  Arterial stiffness, systolic blood pressure, and logical treatment of arterial hypertension. , 1990, Hypertension.

[7]  A S Berson,et al.  National Standard for Measurement of Resting and Ambulatory Blood Pressures With Automated Sphygmomanometers , 1993, Hypertension.

[8]  K. L. Berry,et al.  Systemic arterial compliance is reduced in young patients with IDDM. , 1999, American journal of physiology. Heart and circulatory physiology.

[9]  M. O'Rourke.  Arterial haemodynamics and ventricular-vascular interaction in hypertension. , 1994, Blood pressure.

[10]  D. Webb,et al.  Heart rate dependency of pulse pressure amplification and arterial stiffness. , 2002, American journal of hypertension.

[11]  C. Vlachopoulos,et al.  Effect of caffeine on aortic elastic properties and wave reflection , 2003, Journal of hypertension.

[12]  D. Webb,et al.  Changes in the derived central pressure waveform and pulse pressure in response to angiotensin II and noradrenaline in man , 2001, The Journal of physiology.

[13]  Jaspal S. Kooner,et al.  Estimation of central aortic pressure by SphygmoCor requires intra-arterial peripheral pressures. , 2003 .

[14]  Thomas Weber,et al.  Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease , 2004, Circulation.

[15]  K. Takazawa,et al.  Estimation of ascending aortic pressure from radial arterial pressure using a generalised transfer function. , 1996, Zeitschrift fur Kardiologie.

[16]  Christodoulos Stefanadis,et al.  Cigar smoking has an acute detrimental effect on arterial stiffness. , 2004, American journal of hypertension.

[17]  M. Karamanoglu,et al.  An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. , 1993, European heart journal.

[18]  Estimation of arterial mechanical properties from aortic and tonometric arterial pressure waveforms. , 1997, Methods of information in medicine.

[19]  I. Meredith,et al.  Use of arterial transfer functions for the derivation of aortic waveform characteristics , 2003, Journal of hypertension.

[20]  B. Fetics,et al.  Estimation of Central Aortic Pressure Waveform by Mathematical Transformation of Radial Tonometry Pressure Data , 1998 .

[21]  D. Yue,et al.  Augmentation of central arterial pressure in type 1 diabetes. , 1999, Diabetes care.

[22]  I. Meredith,et al.  Reliability of transfer functions in determining central pulse pressure and augmentation index. , 2002, Journal of the American College of Cardiology.

[23]  C. Reid,et al.  Heart, stroke and vascular diseases, Australian facts: Australian Institute of Health and Welfare and the National Heart Foundation, May 1999. AIHW Cat no. CVD7. ISSN 1323 9236; ISBN 0 642 39578 0. , 2001 .

[24]  C. Hayward,et al.  Gender-related differences in the central arterial pressure waveform. , 1997, Journal of the American College of Cardiology.

[25]  D K Yue,et al.  Augmentation of central arterial pressure in Type 2 diabetes , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[26]  J. Cockcroft,et al.  Use of arterial transfer functions for the derivation of central aortic waveform characteristics in subjects with type 2 diabetes and cardiovascular disease. , 2004, Diabetes care.

[27]  D. Webb,et al.  The influence of heart rate on augmentation index and central arterial pressure in humans , 2000, The Journal of physiology.

[28]  P Segers,et al.  Peripheral “Oscillatory” Compliance Is Associated With Aortic Augmentation Index , 2001, Hypertension.

[29]  E. Lehmann.  Where is the evidence that radial artery tonometry can be used to accurately and noninvasively predict central aortic blood pressure in patients with diabetes? , 2000, Diabetes care.

[30]  E. Lehmann.  Regarding the accuracy of generalized transfer functions for estimating central aortic blood pressure when calibrated non-invasively. , 2000, Journal of hypertension.

[31]  D. Webb,et al.  Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis , 1998, Journal of hypertension.

[32]  D. Webb,et al.  Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. , 2002, Journal of the American College of Cardiology.

[33]  M. O'Rourke,et al.  Generation of ascending aortic from radial artery pressure waveform , 2003 .

[34]  V. Salomaa,et al.  Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC Study. Atherosclerosis Risk in Communities Study. , 1995, Circulation.

[35]  D. Webb,et al.  Increased augmentation index and systolic stress in type 1 diabetes mellitus. , 2000, QJM : monthly journal of the Association of Physicians.

[36]  C. H. Chen,et al.  Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. , 1997, Circulation.

[37]  Philip D. Harvey,et al.  Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 , 1998, BMJ.

[38]  I. Meredith,et al.  Comparison of generalized and gender-specific transfer functions for the derivation of aortic waveforms. , 2002, American journal of physiology. Heart and circulatory physiology.

[39]  David J. Webb,et al.  Pulse‐Wave Analysis: Clinical Evaluation of a Noninvasive, Widely Applicable Method for Assessing Endothelial Function , 2002, Arteriosclerosis, thrombosis, and vascular biology.