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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
2005 5 27일 혈관연구회 부산 집담회, 부산 롯데 호텔
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Slide 2
Flow Pressure Diameter
Fluctuations in amplitude of flow,
pressure, and diameter in a large artery
HeartSV
C
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Slide 3
Pressure pulsations
Asc
aorta
Aorta
arch
Abd.
aorta
Fem.
artery
Sap.
artery
Pressure
100
80
60mm
Hg
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Slide 4
A Model of the Systematic Circulation.
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Slide 5
Systole
Compliance, D/P or A/P
vs. pulse wave velocity
PWV = D / T
Augmentation index
AI=Augmentation pr.
SBP - DBP
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Slide 6
Parameter Definition Formula
Distensibility The relative change in vessel diameter (or area) for a given change in pressure
D/(PxD), A/(PxA)
Compliance The absolute change in vessel diameter (or area) for a given change in pressure
D/P, A/P
Elastic modulus The pressure change required for (theoretical) 100% stretch from resting diameter (inverse of distensibility)
(PxD)/D
Pulse wave velocity The speed with which the pulse wave travels along a length of artery
Distance/t
Stiffness index (ß ) The ratio of the natural logarithm of SBP/DBP to the relative change in diameter
ln(Ps/Pd)/ [(Ds-Dd)/Dd)]
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)
Terminology
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Slide 7
Elastic a.
Muscular a.
Heart SV
C
Resistance a.
Def: The absolute change in vessel
diameter (or area) for a given
change in pressure. D/P or A/P
I. Compliance
dV/dPVo
lum
e (
V)
Pressure (P)
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Slide 8
I-2. Local Arterial (Aortic) Stiffness: Stiffness index
= Ln (SBP/DBP) / (Dsys-Ddia/Ddia)
DsDd
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Slide 9
II. Pulse wave velocity
The speed with which the pulse wave travels along a length of artery
(Distance/t)
* *a b
distance
A B
A
B
t
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Slide 10
P2
P1
SBP
DBP
AI=P
SBP - DBP
P = P2 - P1
III. Augmentation pressure and
augmentation index
incisura
ejection duration
pp
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Slide 11
VP-1000,2000 (COLIN)
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Slide 12
BaPWV and ABI by Colin
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Slide 13
Arterial stiffness index (ASI)
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Slide 14
• 두 동맥부위 사이의 PWV (pulse wave velocity) 측정
• 동맥경화, 혈관노화 등의 혈관관련질환 조기 발견
• 환자들에게 거부감 없이 접근할 수 있는 비침습적 혈관관련질환 진단 시스템
• 기 능
• 심장에서 특정부위 혈관까지의 펄스전달속도 실시간 디스플레이
• 심전도, 심음, 4채널 동맥펄스 동시 측정
• 혈관관련 질환별 데이터베이스 내장
• 용 도
• 혈관노화 및 동맥경화 등의 혈관 관련 질환 분석
• 동맥탄력성 및 혈관 질환별 위험도 분석
• 환자의 치료효과 및 호전상태 추적
• 동맥경화, 고혈압, 당뇨 등의 혈관 질환 조기진단
한별-혈관질환 진단시스템 (PP-1000)
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Slide 15
한별-혈관질환 진단시스템 (PP-1000)
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Slide 16
Complior, Micro-system, Omron
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Slide 17
Radial artery
Systemic Arterial stiffness; Augmentation index (AIx) by Sphygmocor
Aorta
Pressure transfer function(Degree of amplification)
Radial pulse
applanation tonometry
Augmentation index
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Slide 18
Applanation tonometry (SphygmoCor)
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Slide 19
주요 혈관경직도 측정기의 특징
VP-1000,2000 (COLIN)
VaSera-1000
(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 Cuff에 자동으로 압력을 인가했다가 감소시키면서4 부위에서의 혈압 값(최고, 최저, 평균)을측정하고 맥파 파형을 검출
각 동맥부위에서의 맥파파형 검출
특정 동맥부위에서의 맥파파형을 검출한후 다른 부위
에서 맥파 검출
각 부위에압력센서를위치하고 4 채널로부터 동시에맥파 파형을 검출
측정변수및진단내용
사지혈압, baPWV, ABI 좌우 상완 혈압ASI (arterial
Stiffnessindex)
Framingham
위험도
ASI/CHD위험도
PWV,
경동맥-대퇴동맥경동맥-요골동맥
경동맥-족배동맥
PWV
PWA
PWV,
경동맥-대퇴동맥경동맥-요골동맥
경동맥-족배동맥hcPWV, hbPWV, faPWV, hfPWV
CAVI
(cardio-ankle vascular index),
TBI
(toe-brachial index)
PWV;대동맥,상하지
동맥경화의 수준
추정 혈관 나이
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Slide 20
주요 혈관경직도 측정기의 특징
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 손가락끝에서지첨용적맥파 검출
손가락으로부터 맥파(지첨용적맥파) 를검출하고 이로부터 APG (가속도 맥파) 산출
사지에서 부위별로 혈압측정, 도플러로 tibial, dorsal 혈류상태 파악, 양쪽발가락에서 PPG 측정
측정변수 및진단내용
동맥 경화도와 반사도 측정,손 가 락 끝 에 서 측 정 된용 적 맥 파 의 형 태 를분 석 하 여 경 화 도 정 도나타냄
가속도 맥파 파형의 모양변화를 분석
심박변이도(HRV)
부위별 혈압으로 동맥패색이있는 곳 파악
도플러 주로 말초동맥질환이발생하는 곳을 중심으로 정확한부위 검출 가능
발가락PPG 최단말초부위의혈관상태 파악
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Slide 21
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.
Conclusion