Key result
SphygmoCor XCEL and Mobil-O-Graph devices overestimated central aortic SBP by 5.7 to 19.1 mmHg in children and adolescents, whereas the radial tonometry/transfer function method was accurate.
Why the study?
Central aortic SBP may carry superior prognostic value compared with peripheral SBP, but noninvasive measurement techniques had not been formally validated in children and adolescents.
Do noninvasive automated devices and radial tonometry accurately estimate central aortic blood pressure compared to invasive measurement in children and adolescents?
Cross-Sectional (n=69)
Do noninvasive automated devices and radial tonometry accurately estimate central aortic blood pressure compared to invasive measurement in children and adolescents?
Effect estimate: Mean difference 7.9 ± 6.8 mmHg (XCEL), 5.7 ± 10.3 mmHg (MoG-C1), 19.1 ± 14.9 mmHg (MoG-C2)
Automated devices like XCEL and Mobil-O-Graph overestimate central aortic systolic blood pressure in children and adolescents, whereas radial tonometry with accurate pressure pulse calibration provides acceptable accuracy.
Cautions against relying on automated devices for pediatric central blood pressure assessment; leaves.
BACKGROUND: Central aortic SBP (cSBP) may have superior prognostic value compared with peripheral SBP (pSBP), but noninvasive cSBP measurement techniques have not been formally validated in children and adolescents. METHOD: This study assessed the accuracy of two automated devices and the radial tonometry/transfer function method (RT-TF) for estimating central pressures and pulse pressure amplification (PPA) in this population, with adherence to validation guidelines for central pressure devices. In 69 children/adolescents aged 3-18 years undergoing clinically indicated aortic catheterization, high fidelity ascending aortic cSBP was measured with a micromanometer-tipped wire and compared with values from SphygmoCor XCEL, Mobil-O-Graph (systolic/diastolic calibration, MoG-C1, or mean/diastolic calibration, MoG-C2) and RT-TF. Reference intra-arterial pSBP was derived from the tonometry pulse calibrated to central mean/diastolic pressures. RESULTS: XCEL, MoG-C1 and MoG-C2 overestimated cSBP by 7.9 ± 6.8 mmHg (mean ± SD), 5.7 ± 10.3 mmHg, and 19.1 ± 14.9 mmHg, exceeding the validation cut-off (5 ± 8 mmHg). Brachial pSBP was also overestimated by XCEL (10.9 ± 8.4 mmHg) and Mobil-O-Graph (11.5 ± 12.3 mmHg). By contrast, central and brachial diastolic pressures were underestimated by the automated devices, albeit mostly within acceptable limits; pulse pressures were, therefore, substantially overestimated. Central-brachial PPA (4.5 ± 4.4 mmHg) was overestimated by XCEL (8.7 ± 3.2 mmHg) and MoG-C1 (11.1 ± 6.4 mmHg), but underestimated by MoG-C2 (-3.0 ± 6.6 mmHg). Given accurate pulse calibration, RT-TF achieved acceptable accuracy for cSBP (-0.2 ± 4.6 mmHg) and central-radial PPA (1.9 ± 5.1 mmHg). CONCLUSION: In conclusion, XCEL and Mobil-O-Graph overestimated pSBP and cSBP in children and adolescents. cSBP can be obtained via the same transfer function used in adults, but accurate pressure pulse calibration is critical.Video Abstracts: http://links.lww.com/HJH/B222.
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Goldsmith et al. (2019) conducted a cross-sectional in Clinically indicated aortic catheterization (n=69). Automated blood pressure devices (SphygmoCor XCEL, Mobil-O-Graph) and radial tonometry/transfer function (RT-TF) vs. Invasive aortic catheterization (micromanometer-tipped wire) was evaluated on Accuracy of central aortic SBP (cSBP) estimation compared to invasive measurement (Mean difference 7.9 ± 6.8 mmHg (XCEL), 5.7 ± 10.3 mmHg (MoG-C1), 19.1 ± 14.9 mmHg (MoG-C2)). SphygmoCor XCEL and Mobil-O-Graph devices overestimated central aortic SBP by 5.7 to 19.1 mmHg in children and adolescents, whereas the radial tonometry/transfer function method was accurate.
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