超声与动脉硬化仪检测肱-踝动脉脉搏波传导速度的相关性研究

目的通过联合运用多普勒超声探头及脉搏波传感器检测肱-踝动脉段血管的脉搏波传导速度(pulse wave velocity,PWV),并将检测结果与动脉硬化仪检测该动脉段的结果进行相关性分析,探讨联合运用超声多普勒探头与脉搏波传感器检测肱-踝动脉段脉搏波传导速度(brachial ankle pulse wave velocity,baPWV)方法的可行性。方法纳入30例正常人,分别将超声多普勒探头与脉搏波传感器放置于受试者左侧肘部肱动脉及左侧踝部胫后动脉,将受试者左侧肘部肱动脉及左侧踝部胫后动脉间的距离与动脉多普勒血流流速曲线的起点与动脉脉搏波起点间的传播时间相比,得出的比值作为肱-踝动脉段的PWV。并将检测结果与动脉硬化仪检测同组受试者该段动脉脉搏波传导速度的检测结果进行相关性分析。结果将脉搏波传感器放置于肱动脉,多普勒探头放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.584,P<0.01)。将多普勒探头放置于肱动脉,脉搏波传感器放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.703,P<0.01)。结论联合运用超声多普勒探头与脉搏波传感器检测肱-踝动脉段脉搏波传导速度为脉搏波传导速度的检测提供了一种新的检测方法,具有一定的临床实用价值,值得进一步推广。     

正常人颈总动脉、肱动脉、胫后动脉血流动力学参数分析

目的 通过运用超声检测方法采集正常人颈总动脉、肱动脉、胫后动脉的血流动力学参数进行分析,探讨监测人体多处动脉血流动力学变化的意义.方法 在30例正常人中,将超声多普勒探头置于受试者左侧颈总动脉起始段、左侧肱动脉、左侧胫后动脉测量以上动脉的血管内径、动脉血流流速波传导时间、血流加速度及收缩期射血面积,对获得的多处、多种血...     

脉搏波传导速度对冠心病的诊断价值

目的:探讨冠状动脉粥样硬化性心脏病(冠心病)患者各动脉段脉搏波传导速度的改变及其对冠心病的诊断价值。方法:根据冠状动脉造影结果将218例患者分为冠心病组(121例)和非冠心病组(97例),分别进行右侧颈-桡(RC-R)、右侧颈-股(RC-F)、右侧股-踝(RF-A)动脉段和相应左侧动脉段(LC-R、LC-F、LF-A)的脉搏波传导速度(pulsewavevelocity,PWV)检查,分析冠心病患者的PWV变化特征;以冠状动脉造影为金标准,应用受试者工作特征(ROC)曲线评价不同动脉段PWV诊断冠心病的敏感度和特异度。结果:非冠心病组及冠心病组的RC-FPWV(7.60±1.59和9.31±1.75P<0.01)、LC-FPWV(7.52±1.50和9.02±1.71P<0.01)、RC-RPWV(8.00±1.27和8.69±1.37P<0.01)和LC-RPWV(8.03±1.2和8.52±1.03P     

原发性高血压患者血压分级及危险因素分层与脉搏波速度关系的研究

目的 探讨原发性高血压患者血压分级以及危险因素分层与动脉脉搏波速度(PWV)的关系.方法 应用动脉脉搏速度自动测量系统测定入选的660例原发性高血压患者的PWV(330例测定颈-股动脉PWV值,330例测定肱动脉-踝动脉PWV值),并对患者进行危险因素分层,比较不同血压水平及危险程度患者的脉搏波速度.结果 1级与2级高血压患者的cfPWV与baPWV间差异无统计学意义[颈-股动脉PWV(10.24±1.9)m/s比(10.78±0.9)m/s,P=0.324;baPWV(1 638±160)cm/s比(1 720±170)cm/s,P=0.288];伴有一种以上心血管危险因素患者的PWV显著高于单纯高血压患者[颈-股动脉PWV(10.28±1.6)m/s比(12.16±1.4)m/s,P=0.001;baPWV(1 735±138)cm、s比(1 584±160)cm/s,P=0.001].结论 存在一种或一种以上心血管危险因素的高血压患者PWV值明显高于无危险因素的高血压患者,心血管危险因素对脉搏波速度的影响可能较大.     

超声多普勒脉搏波传播速度评价在大动脉炎中的应用

目的 建立超声多普勒测量颈-股脉搏波传播速度(PWV)的方法,明确大动脉炎(TA)患者大动脉僵硬度的变化情况,探讨基于超声多普勒的PWV评价在TA中的价值。方法 纳入首次诊治的TA女性患者23例,并招募同期健康对照组女性志愿者23例,年龄、身高、体质量与病例组匹配。所有受试者颈-股PWV的测量采用超声多普勒法。结果 TA患者的颈-股PWV与健康对照组相比显著增加[(8.66±2.12)m/s vs(6.51±1.11)m/s,P0.001]。结论 TA患者超声多普勒法测量的中心动脉僵硬度较正常人群显著增高,表明TA患者存在显著的大血管病变。基于超声多普勒的颈-股PWV评价为临床监测和评价中心动脉僵硬度和心血管风险提供了一项重要的方法和指标。     

脉搏波传导速度对2型糖尿病大血管病变的诊断价值

目的 评价2型糖尿病的大血管病变与脉搏波传导速度的相关性,探讨脉搏波传导速度对糖尿病大血管病变的诊断价值.方法 选取80例2型糖尿病患者,全部应用全自动动脉硬化测定仪VP-2000/1000 Type 230 BP-203RPE Ⅱ测定四肢的脉搏波传导速度(baPWV),同时应用HITACHI EUB-6500 B型超声诊断仪测量颈动脉内膜中层厚度(IMT),分析二者的相关性.结果 2型糖尿病颈动脉硬化组脉搏波传导速度(baPWV值)明显升高,能够良好的反映动脉血管壁的弹性,与IMT呈正相关.结论 脉搏波传导速度可以作为诊断动脉粥样硬化的新指标.     

波强法测定脉搏波传导速度的临床应用价值

目的 探讨波强法(WI)所测脉搏波传导速度(PWV)的可重复性,并与传统平面压力波法进行比较,探讨其临床应用价值.方法 应用多普勒超声仪的波强分析系统,测量110例门诊志愿者右侧肱动脉和胫后动脉R-W1时间,由此计算右侧臂踝脉搏波传导速度(baPWV),同时用压力波法(VP-1000)测量该值;然后再随机选取其中30例受检者重复上述检查.采用配对t检验比较两种方法测值的差异,并分析其直线相关性;最后应用Bland-Altman法分析这两种方法的一致性及各自观察者内部的可重复性.结果 baPWV的均值分别为波强法中R-W1段(13.03±1.93) m/s,压力波法(12.05±2.02)m/s,两种方法的测值差异有统计学意义(P＜0.001),两者差值平均为(0.98±1.1)m/s,其95％一致性界限为(- 1.18 m/s,3.14 m/s).波强法中R-W1段和压力波法具有较高的直线相关性(r=0.85,P＜0.001);其各自观察者内部的重复测量变异率分别为8.2％和7.0％.结论 瞬时波强法可为临床测量PWV提供一种简便无创的新方法,并与标准压力波法有很好的相关性和一致性.     

类风湿性关节炎患者外周动脉僵硬度评估

目的 采用动脉硬化检测技术和超声回波跟踪(echo-tracking,ET)技术评估类风湿性关节炎(rheumatoid arthritis,RA)患者外周动脉僵硬度.方法 连续纳入25例RA患者,同时选取48例健康自愿者作为对照组.采用全自动动脉硬化检测仪对所有受试者行肱-踝动脉脉搏波传导速度(branchial ankle pulse wave velocity,baPWV)检测,此指标是评估动脉僵硬度的经典指标之一.同时应用超声回波跟踪技术对所有受试者行动脉僵硬度及形态学检测.结果 与对照组比较,RA组baPWV显著增高,分别为[14.70(9.17～21.39)m/s,12.86(10.00～15.24)m/s,P=0.025 1].回波跟踪技术所测得的RA组的动脉僵硬度指标,即压力应变弹性系数(pressure elastic coefficient,Eρ)和硬度系数(stiffness parameter,β)在肱动脉和胫后动脉较对照组增高,在胫后动脉与baPWV正相关(r=0.600 0,P＜0.000 1;r=0.524 0,P＜0.0001)结论 RA患者的动脉僵硬度较对照组显著增高,动脉硬化检测技术和超声回波跟踪技术相结合,能为临床提供早期、简捷、无创检测血管病变的方法.     

嘉兴市南湖区1286例臂踝脉搏波传导速度调查分析

血管壁病变是各种心血管事件发生的基础,早期发现和干预亚临床期血管病变的进展是延缓和控制心血管事件的根本措施.脉搏波传导速度(以下简称PWV)是动脉弹性功能检测的主要方法,反映动脉僵硬度的早期敏感指标[1],及时检出人体动脉弹性功能减退,寻找出危险因子为干预血管壁病变的进展提供依据.嘉兴市南湖区国民体质监测中心1年来免费为区内职工精确安全地监测臂踝脉搏波传导速度(baPWV)1286例,检测结果显示高血压、年龄等因素是影响PWV的重要因素,分析如下.     

糖耐量异常者颈动脉内膜中层厚度与臂踝脉搏波传导速度的关系

【目的】了解糖耐量异常（IGT）者颈动脉内膜中层厚度（IMT）与臂踝脉搏波传导速度（baPWV）的变化,并探讨两者的关系。【方法】收集健康体检者中糖耐量异常者81例、2型糖尿病患者78例、糖耐量正常者89例,每例均采用超声检测颈动脉IMT及全自动动脉硬化仪测定baPWV。【结果】随着糖代谢异常的加重,颈动脉IMT逐渐增厚,baPwV逐渐升高（P〈0．05）;单因素相关分析提示IMT、baPWV与年龄、总胆固醇（TC）、甘油三酯（TG）呈正相关;多元回归分析显示年龄是IMT、baPWV的独立危险因素。【结论】早期动脉粥样硬化在IGT阶段就已开始,对糖尿病高危人群应尽早筛查,并应及时采取相应的干预措施。     

正常人颈总动脉、肱动脉、胫后动脉牛顿射血力分析

目的 运用多普勒超声技术检测正常人颈总动脉、肱动脉、胫后动脉的牛顿射血力,探讨正常人体多处外周动脉牛顿射血力变化的意义.方法 纳入30例正常人,将多普勒超声探头分别置于受试者左侧颈总动脉起始段、左侧肱动脉、左侧胫后动脉,测量以上动脉的血管内径、血流加速度及加速期流速积分,根据牛顿第二定律F=ma计算出牛顿射血力.结果 30例正常人左侧颈总动脉的血管内径为(0.59±0.05)cm,血管截面积为(0.28±0.05)cm2,血流加速度为(1 681.53±1 590.88)cm/s2,加速期流速积分为(4.31±1.01)cm,牛顿射血力为(1 941.73±958.68)dynes.左侧肱动脉的血管内径为(0.32±0.04)cm,血管截面积为(0.08±0.02)cm2,血流加速度为(1018.40±287.28)cm/s2,加速期流速积分为(3.21±1.17)cm,牛顿射血力为(319.57±228.93)dynes.左侧胫后动脉的血管内径为(0.21±0.03)mm,血管截面积为(0.03±0.01)cm2,血流加速度为(658.13±173.94)cm/s2,加速期流速积分为(2.28±1.15)cm,牛顿射血力为(68.11±69.34)dynes.结论 通过检测人体多处外周动脉牛顿射血力可以分析从心脏到外周血管轴向力的分布,分析人体动脉长度、血管内径、血管弹性变化及动能势能转换对牛顿射血力传导的影响,为该参数的临床应用提供科学依据.     

Quantitative transcutaneous measurements of blood flow in carotid artery by means of pulse and continuous wave Doppler methods.

The authors present results of quantitative measurements of blood in vivo in the carotid artery of man. The Doppler pulse technique was used after being previously verified for steady state flows in tubes and for pulsating flows in a canine aorta where the electromagnetic method was also used for comparison.An ultrasonic probe with two transducers was adapted for determination of the angle of the ultrasonic beam in relation to the vessel allowing the measurement of the vessel diameter which was also determined by means of the ultrasonographic B-mode technique.By means of the Doppler pulse method profiles of the blood velocity in the carotid artery were determined as a function of time.The continous wave Doppler technique together with the zero-crossing system and spectral analysis were also used for making measurements.The flow velocity and the shape of the flow curve with time obtained with the above techniques showed good agreement. The measured flow rate in the carotid artery amounted to Q_M = 1.61/min (maximum instantaneous value) and Q₀ - 0.531/min (mean time value).     

On-chip laser Doppler vibrometer for arterial pulse wave velocity measurement

Pulse wave velocity (PWV) is an important marker for cardiovascular risk. The Laser Doppler vibrometry has been suggested as a potential technique to measure the local carotid PWV by measuring the transit time of the pulse wave between two locations along the common carotid artery (CCA) from skin surface vibrations. However, the present LDV setups are still bulky and difficult to handle. We present in this paper a more compact LDV system integrated on a CMOS-compatible silicon-on-insulator substrate. In this system, a chip with two homodyne LDVs is utilized to simultaneously measure the pulse wave at two different locations along the CCA. Measurement results show that the dual-LDV chip can successfully conduct the PWV measurement.OCIS codes: (280.3340) Laser Doppler velocimetry, (130.6750) Systems     

Arterial pulse wave velocity with tissue Doppler imaging

This paper describes a new noninvasive ultrasonic method for estimating pulse wave velocity (PWV), an important physical parameter for characterizing the elastic properties of the arterial walls. The method utilizes a relatively new color Doppler modality for measuring tissue motion (tissue Doppler imaging or TDI). In contrast to previously proposed methods, the TDI modality offers multiple recording sites along the artery that improve the PWV estimation considerably. The new PWV estimation method was evaluated through an in vitro setup consisting of an elastic vessel supplied with a pulsatile pump. The study concentrated on the effect of different system parameters controlling resolution, sensitivity and the amount of acquired data. It was shown that the system parameters have a significant effect on the PWV variance, whereas the PWV mean remains unchanged. It was also established that high temporal resolution is the most vital parameter for minimizing PWV variance. Finally, the new PWV estimation method was applied to a limited set of human carotid artery data sets, with good results.     

Brachio-ankle pulse wave velocity and cardio-ankle vascular index (CAVI)

In order to diagnose arteriosclerosis in any part of the body, pulse wave velocity (PWV) measurement is a useful approach. However, it is considered that the technique of PWV measurement should be simplified. A new method for measuring PWV has therefore been proposed in Japan. The PWV of the brachial artery (ba) and the ankle was measured by applying air pressure with the aid of a volume plethysmograph. Comparisons between the baPWV measurement method and the conventional method are currently being performed. Since satisfactory results have been obtained to date, baPWV has gained popularity throughout Japan. Since this method measures PWV in the arm and foot, it may be said that aortic PWV is not reflected though a large amount of past PWV measurements. BaPWV is influenced by blood pressure. With the baPWV technique, blood pressure compensation is not carried out. Furthermore, the pulse pressure is measured by air pressure; therefore any stimulus that exerts pressure on an artery may influence these results. Due to these reasons, a cardio-ankle vascular index (CAVI) has been proposed in which the pressure wave form indicating the closing of the aortic valve appears in the form of an arterial pressure wave after a fixed delay time. This delay is the time difference between the actual closing of the aortic valve and the measuring point. Prior to the introduction of baPWV, PWV was measured in the carotid artery and foot. As in traditional PWV, baPWV uses the delay time, but between the brachial artery and the ankle artery. However, the carotid artery differs from the brachial artery, and the measured value differs depending on whether the arteriosclerosis is present in the carotid artery or the brachial artery. CAVI is calculated from the ECG, PCG, brachial artery waveform and ankle artery waveform using a special algorithm. This new method represents a breakthrough in the diagnosis of atherosclerosis.     

Measurement of regional pulse wave velocity using very high frame rate ultrasound

Purpose

Pulse wave velocity (PWV) is the propagation velocity of the pressure wave along the artery due to the heartbeat. The PWV becomes faster with progression of arteriosclerosis and, thus, can be used as a diagnostic index of arteriosclerosis. Measurement of PWV is known as a noninvasive approach for diagnosis of arteriosclerosis and is widely used in clinical situations. In the traditional PWV method, the average PWV is calculated between two points, the carotid and femoral arteries, at an interval of several tens of centimeters. However, PWV depends on part of the arterial tree, i.e., PWVs in the distal arteries are faster than those in the proximal arteries. Therefore, measurement of regional PWV is preferable.

Methods

To evaluate regional PWV in the present study, the minute vibration velocity of the human carotid arterial wall was measured at intervals of 0.2 mm at 72 points in the arterial longitudinal direction by the phased-tracking method at a high temporal resolution of 3472 Hz, and PWV was estimated by applying the Hilbert transform to those waveforms.

Results

In the present study, carotid arteries of three healthy subjects were measured in vivo. The PWVs in short segments of 14.4 mm in the arterial longitudinal direction were estimated to be 5.6, 6.4, and 6.7 m/s, which were in good agreement with those reported in the literature. Furthermore, for one of the subjects, a component was clearly found propagating from the periphery to the direction of the heart, i.e., a well known component reflected by the peripheral arteries. By using the proposed method, the propagation speed of the reflection component was also separately estimated to be ?8.4 m/s. The higher magnitude of PWV for the reflection component was considered to be the difference in blood pressure at the arrivals of the forward and reflection components.

Conclusion

Such a method would be useful for more sensitive evaluation of the change in elasticity due to progression of arteriosclerosis by measuring the regional PWV in a specific artery of interest (not the average PWV including other arteries).     

Gait performance in relation to aortic pulse wave velocity,carotid artery elasticity and peripheral perfusion in healthy older adults

Arterial stiffening is a widely known physiological change that occurs with ageing, but the functional consequences of vascular ageing are unclear. The purpose of this study was to determine whether carotid–femoral pulse wave velocity (PWV), mechanical properties of the carotid and femoral arteries and/or peripheral perfusion was associated with gait performance measured using a 400‐m walk test. Twenty‐one healthy older (68 ± 5 years) adults without cardiovascular disease participated in this study. Applanation tonometry was used to measure PWV, and Doppler ultrasound was used to measure arterial wall properties of the left common carotid and common femoral artery along with femoral blood flow. The median walk distance in the first 2 min of the test was 585 ft, and the overall gait speed was 1·5 m s^?1. Gait performance was inversely correlated with PWV (distance: r = ‐0·51; speed: r = ?0·48; P<0·05) and carotid artery stiffness index β (distance: r = ?0·56; speed: r =  ? 0·51; P<0·05) after adjustment for age, body mass index, waist circumference and systolic blood pressure. No significant correlations were found between gait performance and femoral artery stiffness index β or femoral artery blood flow. These results found higher central arterial stiffness, as assessed by segmental arterial stiffness or local arterial wall properties, is associated with lower gait performance in older adults independent of other confounders.     

Measurement of pulse wave velocity using pulse wave Doppler ultrasound: comparison with arterial tonometry

Pulse wave velocity (PWV), the speed of propagation of arterial pressure waves through the arterial tree, is related to arterial stiffness and is an important prognostic marker for cardiovascular events. In clinical practice PWV is commonly determined by arterial tonometry, with a noninvasive pressure sensor applied sequentially over carotid and femoral arteries. The electrocardiogram (ECG) is used as a timing reference to determine the time delay or "transit time" between the upstroke of carotid and femoral pulse waveforms. Commercially available vascular ultrasound scanners provide a pulsed wave (PW) Doppler velocity signal, which should allow determination of carotid-femoral transit time and hence PWV. We compared carotid-femoral PWV measured by tonometry and by PW Doppler ultrasound (Seimens, Apsen scanner with 7 MHz linear transducer) in asymptomatic subjects (n = 62, 26 male, aged 21 to 72 y). To test for intra-subject and inter-observer variation, ten subjects were scanned by one observer on two occasions 2 wk apart and by two observers on same day. PWV by tonometry ranged from 5.3 to 15.0 m/s. There was no significant difference between mean values of PWV obtained by the two techniques (mean difference: 0.3 m/s, standard deviation of difference: 1.5 m/s), which were closely correlated (r = 0.83). The coefficient of variation for repeated measures on the same subject by the same observer was 10.1% and the inter-observer coefficient of variation was 5.8%. These results suggest a commercial ultrasound scanner can be used to measure PWV, giving results that are reproducible and closely correlated with those obtained by arterial tonometry. (E-mail: ben_yu.jiang@kcl.ac.uk).