Esta obra está bajo el apoyo financiero del programa clave nacional de investigación y desarrollo de China (Grant No. 2017YFC0111800) y el gobierno municipal de Shanghai (Grant ID. 2013ZYJB0902 y 15GWZK1002). El Dr. Yi Zhang fue apoyado por la nacional naturaleza ciencia Fundación de China (Grant ID. 81300239 y 81670377).

Este protocolo fue aprobado por el Hospital de ética Comité de Shanghai décima parte de la gente.
1. reclutamiento de los participantes
<ol><li>Son adultos con un ritmo moderado (40 < HR < 160).</li>
	<li>Utilice los siguientes criterios de exclusión.<ol>
<li>Excluir aquellos sin interna fístula arteriovenosa para diálisis renal o cualquier otra fístula arteriovenosa periférica como eso.</li>
		<li>Excluir aquellos sin espasmo arterial periférico, por ejemplo la enfermedad de Raynaud.</li>
		<li>Excluir aquellos sin estenosis valvular aórtica (transprosthetic presión gradiente > 60 mmHg).</li>
		<li>Excluir aquellos sin bloque de (AV) auriculoventricular de segundo o tercer grado.</li>
		<li>Excluir aquellos sin fibrilación auricular o aleteo auricular.</li>
		<li>Excluirlos que no tienen las placas ateroscleróticas carótidas inestables que pueden romperse después de amasar. 9) sin deterioro cognitivo o incapaces de cooperar.</li>
	</ol>
</li>
	<li>Asegúrese de que la vejiga de los participantes está vacía.</li>
	<li>Que los participantes se abstengan de fumar, uso de tabaco o cafeína por al menos 3 horas antes de la medición. Abstenerse del alcohol durante al menos 12 horas antes de la medición. Rápido para por lo menos 3 horas antes de la medición.</li>
</ol>2. mediciones de TOD Vascular
Nota: cf-PWV y PWA medidas, como medidas de presión convencional de cuatro extremidades, se realizan a través de un método de evaluación no invasivo. Un protocolo estándar es crucial para obtener un valor exacto, especialmente cuando hay varios operadores. Asegúrese de practicar el método antes de la operación real. La cooperación del participante es clave para la medición de cf-PWV.
<ol><li>Explicar el procedimiento al participante y obtener el permiso.</li>
	<li>Medir la estatura y el peso antes del inicio de las mediciones.</li>
	<li>Explicar que el proceso puede tomar 5-10 minutos y consiste en dejar que la mentira participante en la cama.<ol>
<li>Mantener la piel del paciente limpia y seca cuando cambio de posición supina. Si la piel del paciente está húmeda debido a la sudoración, luego seque la piel.</li>
		<li>Realizar las mediciones en una habitación tranquila con una temperatura estable.</li>
	</ol>
</li>
	<li>Poner las manos del participante junto a su cuerpo para asegurarse de que hay un suave, señal de ECG. Conecte hasta monitores de ECG de 3 derivaciones, posicionamiento tres electrodos (RA, LL, LA) según el siguiente diagrama (figura 2). Nota: Se recomienda el uso de electrodos desechables. Los cables y cables de ECG no pueden utilizarse en otro ECG equipo de dibujo.</li>
	<li>Tienen el resto de pacientes para al menos 5 minutos en la posición supina. Luego se mide la presión arterial del paciente con un dispositivo semiautomático oscilométrico. Nota: La presión arterial se mide según las recomendaciones de la sociedad europea de hipertensión arterial17.</li>
	<li>Tienen el resto paciente por al menos 2 minutos. Nota: La dilatación vascular periférica causada por oclusión de la arteria al medir la presión arterial arteria braquial va a cambiar la transmisión del pulso de arteria braquial. Descanso es esencial para evitar la desviación excesiva.</li>
	<li>Mientras el participante se apoya, ingrese toda la información del participante, incluyendo la presión arterial supina, estatura, peso y nombre del operador, en el dispositivo de medición (figura 3).</li>
	<li>Después de introducir toda la información, mantener a los participantes en una posición supina.</li>
	<li>Medir manualmente los siguientes parámetros (mm) (figura 3).<ol>
<li>Mida la distancia de la muesca del suprasternal (SSN) hasta el punto de detección remota (arteria femoral).</li>
		<li>Mida la distancia desde la ranura esternal hasta el punto de detección proximal (arteria carótida).</li>
		<li>Mida la distancia desde el punto de detección remota (arteria femoral) hasta el punto de detección proximal (arteria carótida) (cf-distancia).</li>
	</ol>
</li>
	<li>Seleccione el modo de PWA. Ingrese '0' como distancia de SSN-carótida e ingrese 0.8 * cf-distancia distancia SSN-femoral. Si el dispositivo no acepta el '0', poner otro valor como la distancia de SSN-carótida y añadir valor a la distancia cf 80% SSN-femoral distancia5. Nota: El operador debe sentarse en una posición más cómoda.</li>
	<li>Presione el botón para captura de datos. Coloque el tonómetro en el punto de fluctuación de la arteria radial (1-2 cm por encima de la apófisis estiloides radial en un punto donde la fluctuación es fuerte y estable) para medir la presión arterial central.<ol>
<li>Mantener la posición de lo tonometer para obtener una constante forma de onda en el equipo. Una vez que la calidad y reproducibilidad de las mediciones de la tonometría alcanzan el estándar, la grabación de la señal es terminada automáticamente por la computadora.</li>
		<li>Mantenga el tonometer en 90°.</li>
		<li>Para evitar el movimiento del parásito, inmovilizar el tonómetro cerca de la base con los dedos, fije firmemente el tonometer en la piel. Nota: El software graba automáticamente los datos tan pronto como el tonómetro se coloca en contacto con el sitio de medición. La calidad y reproducibilidad de las mediciones de la tonometría se prueban automáticamente. Un índice de operador mayor de 80% se considera como una medición confiable. Amplificación de la presión de pulso (PPA) se define como el cociente de la presión de pulso periférico al central y se calcula con la fórmula, PPA = (braquial SBP - braquial DBP) / (central central PAS Pad) -1. PWA puede observarse en el dispositivo18 (figura 4).</li>
	</ol>
</li>
	<li>Seleccione el modo PWV. Coloque el tonómetro en el punto de fluctuación de la arteria carótida. Mantener la posición de lo tonometer para obtener una constante forma de onda en el equipo. Después de grabar una forma de onda estable durante 15-20 segundos. Una vez la calidad y reproducibilidad de las mediciones de la tonometría alcanzan el acabado estándar, grabación manualmente (figura 5).</li>
	<li>Coloque el tonómetro en el punto de fluctuación de la arteria femoral (1-2 cm por debajo del punto medio del ligamento inguinal en un punto donde la fluctuación es estable). Mantener la posición del tonometer para grabar de una forma de onda constante. Después de registrar una forma de onda estable durante 15-20 segundos, termine de grabar manualmente una vez que la calidad y reproducibilidad de las mediciones de la tonometría alcanzan el estándar. El valor PWV puede observarse en el dispositivo cf-PWV ≥ 10 m/s se considera como arterial rigidez (figura 5)1.</li>
</ol>

<ol>
	<li>Laurent, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expert+consensus+document+on+arterial+stiffness:+methodological+issues+and+clinical+applications.">Expert consensus document on arterial stiffness: methodological issues and clinical applications.</a> Eur Heart J. 27 (21), 2588-2605 (2006).</li><li>Townsend, R. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recommendations+for+Improving+and+Standardizing+Vascular+Research+on+Arterial+Stiffness:+A+Scientific+Statement+From+the+American+Heart+Association.">Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association.</a> Hypertension. 66 (3), 698-722 (2015).</li><li>Niiranen, T. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence,+Correlates,+and+Prognosis+of+Healthy+Vascular+Aging+in+a+Western+Community-Dwelling+Cohort:+The+Framingham+Heart+Study.">Prevalence, Correlates, and Prognosis of Healthy Vascular Aging in a Western Community-Dwelling Cohort: The Framingham Heart Study.</a> Hypertension. 70 (2), 267-274 (2017).</li><li>Reference Values for Arterial Stiffness, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determinants+of+pulse+wave+velocity+in+healthy+people+and+in+the+presence+of+cardiovascular+risk+factors:+'establishing+normal+and+reference+values.">Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values.</a> Eur Heart J. 31 (19), 2338-2350 (2010).</li><li>Van Bortel, L. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expert+consensus+document+on+the+measurement+of+aortic+stiffness+in+daily+practice+using+carotid-femoral+pulse+wave+velocity.">Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity.</a> J Hypertens. 30 (3), 445-448 (2012).</li><li>Salvi, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Pulse waves: how vascular hemodynamics affect blood pressure. , (2011).</li><li>Mancia, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2013+ESH/ESC+Guidelines+for+the+management+of+arterial+hypertension:+the+Task+Force+for+the+management+of+arterial+hypertension+of+the+European+Society+of+Hypertension+(ESH)+and+of+the+European+Society+of+Cardiology+(ESC).">2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).</a> J Hypertens. 31 (7), 1281-1357 (2013).</li><li>Yamashina, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity,+reproducibility,+and+clinical+significance+of+noninvasive+brachial-ankle+pulse+wave+velocity+measurement.">Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement.</a> Hypertens Res. 25 (3), 359-364 (2002).</li><li>Tanaka, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+between+carotid-femoral+and+brachial-ankle+pulse+wave+velocity+as+measures+of+arterial+stiffness.">Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness.</a> J Hypertens. 27 (10), 2022-2027 (2009).</li><li>Lu, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Carotid-Femoral+and+Brachial-Ankle+Pulse-Wave+Velocity+in+Association+With+Target+Organ+Damage+in+the+Community-Dwelling+Elderly+Chinese:+The+Northern+Shanghai+Study.">Comparison of Carotid-Femoral and Brachial-Ankle Pulse-Wave Velocity in Association With Target Organ Damage in the Community-Dwelling Elderly Chinese: The Northern Shanghai Study.</a> J Am Heart Assoc. 6 (2), (2017).</li><li>D'Agostino, R. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=General+cardiovascular+risk+profile+for+use+in+primary+care:+the+Framingham+Heart+Study.">General cardiovascular risk profile for use in primary care: the Framingham Heart Study.</a> Circulation. 117 (6), 743-753 (2008).</li><li>Conroy, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimation+of+ten-year+risk+of+fatal+cardiovascular+disease+in+Europe:+the+SCORE+project.">Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.</a> Eur Heart J. 24 (11), 987-1003 (2003).</li><li>Zethelius, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+multiple+biomarkers+to+improve+the+prediction+of+death+from+cardiovascular+causes.">Use of multiple biomarkers to improve the prediction of death from cardiovascular causes.</a> N Engl J Med. 358 (20), 2107-2116 (2008).</li><li>Vernooij, J. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hypertensive+target+organ+damage+and+the+risk+for+vascular+events+and+all-cause+mortality+in+patients+with+vascular+disease.">Hypertensive target organ damage and the risk for vascular events and all-cause mortality in patients with vascular disease.</a> J Hypertens. 31 (3), 492-499 (2013).</li><li>van der Veen, P. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hypertensive+Target+Organ+Damage+and+Longitudinal+Changes+in+Brain+Structure+and+Function:+The+Second+Manifestations+of+Arterial+Disease-Magnetic+Resonance+Study.">Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function: The Second Manifestations of Arterial Disease-Magnetic Resonance Study.</a> Hypertension. 66 (6), 1152-1158 (2015).</li><li>Ji, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shanghai+Study:+cardiovascular+risk+and+its+associated+factors+in+the+Chinese+elderly-a+study+protocol+of+a+prospective+study+design.">Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design.</a> BMJ Open. 7 (3), (2017).</li><li>O'Brien, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+guidelines+of+the+European+Society+of+Hypertension+for+clinic,+ambulatory+and+self+blood+pressure+measurement.">Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement.</a> J Hypertens. 23 (4), 697-701 (2005).</li><li>Agnoletti, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulse+wave+analysis+with+two+tonometric+devices:+a+comparison+study.">Pulse wave analysis with two tonometric devices: a comparison study.</a> Physiol Meas. 35 (9), 1837-1848 (2014).</li><li>Ji, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shanghai+Study:+cardiovascular+risk+and+its+associated+factors+in+the+Chinese+elderly-a+study+protocol+of+a+prospective+study+design.">Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design.</a> BMJ Open. 7 (3), e013880 (2017).</li><li>Zhang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+study+of+central+blood+pressure+and+wave+reflection+obtained+from+tonometry-based+devices.">Comparison study of central blood pressure and wave reflection obtained from tonometry-based devices.</a> Am J Hypertens. 26 (1), 34-41 (2013).</li><li>Sharman, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+non-invasive+central+blood+pressure+devices:+ARTERY+Society+task+force+consensus+statement+on+protocol+standardization.">Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization.</a> Eur Heart J. 38 (37), 2805-2812 (2017).</li><li>Millasseau, S., Agnoletti, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+estimation+of+aortic+blood+pressures:+a+close+look+at+current+devices+and+methods.">Non-invasive estimation of aortic blood pressures: a close look at current devices and methods.</a> Curr Pharm Des. 21 (6), 709-718 (2015).</li><li>Olsen, M. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+call+to+action+and+a+lifecourse+strategy+to+address+the+global+burden+of+raised+blood+pressure+on+current+and+future+generations:+the+Lancet+Commission+on+hypertension.">A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension.</a> Lancet. 388 (10060), 2665-2712 (2016).</li></ol>

Los autores no tienen nada que revelar.

Aquí, demostramos una metodología ampliamente accesible para evaluar novela preclínicos vascular TOD los participantes, rigidez arterial, evaluado por cf-PWV. Para comparar PWs con diferencias hemodinámicas mínimas entre las mediciones que se realiza antes de los dispositivos, sólo acepta datos cuando la PA sistólica y diastólica braquial variados por menos de 3 mmHg. Esto reduce la desviación causada por la manipulación humana. En el presente Protocolo, los pasos críticos son se estandarizaron las condiciones...

Rigidez arterial es un buen marcador de envejecimiento vascular evaluación1,2. La medición de la rigidez arterial es tradicionalmente llevado a cabo utilizando una metodología de velocidad (PWV) de la onda de pulso que es una medida importante y confiable de la rigidez arterial1,3,4,5. Específicamente, PWV representa la rigidez de un segmento arterial específico. La onda del pulso se transmite a través de los vasos en un segmento específico, y su velocidad es inversamente relacionado a las propiedades viscoelásticas de la pared sí mismo6. Valor PWV aumenta con la rigidez arterial.
PWV carótida-femoral (cf-PWV) y braquial-tobillo PWV (ba-PWV) son las medidas más frecuentemente aplicadas 2 de PWV. Son ampliamente utilizados en la práctica clínica, donde cf-PWV es popular en los países occidentales y ba-PWV es popular en países asiáticos. 7 , 8. de hecho, cf-VOP ha sido considerado como el 'patrón oro' medición de la rigidez arterial1. Para cf-VOP, se toma como representativo de la VOP para la aorta entera. Además, para ba-VOP, hay no hay vías arteriales enlazan a los sitios de medición (braquiales de tobillo). El estimado ba-PWV representa el PWV para la totalidad del sistema arterial central y periférica9. Un estudio ha divulgado que cf-PWV es superior a la ba-VOP en asociaciones con hipertensos asintomáticos objetivo órgano daño (TOD)10 (figura 1).
Dispositivos no invasivos para rigidez regional equipado con un tonómetro específico cada vez más se utilizan para medir la rigidez de la carótida a segmento femoral1. En medidas de cf-VOP, este dispositivo y un tonómetro de mano crean una forma de onda constante en el equipo que puede grabar imágenes de forma de onda digital de alta resolución y los valores PWV específicos (figura 2). Todas estas medidas tienen que estar estandarizados. Aquí, mostramos cómo grabar un cf-PWV de buena calidad con este dispositivo no invasivo basado en la tonometría en un entorno del mundo real.
Algunos establecieron modelos de predicción de riesgo cardiovascular como el score de Framingham o las tablas de riesgo SCORE principalmente son calculados y ordenados por factores de riesgo convencionales11,12. Sin embargo, hay que añadir algunos nuevos biomarcadores en el modelo de evaluación de riesgos para mejorar la estratificación de riesgo13. En literatura, rigidez arterial se considera como un estado intermedio entre los factores de riesgo convencionales y eventos cardiovasculares clínicos14. Así, adición de PWV cf en el modelo de evaluación de riesgos puede ser una herramienta para la estratificación de riesgo15,16.
Aquí, se genera un plan de metodología para evaluar cf-VOP los participantes, junto con PWA, establecer un protocolo estándar para la evaluación de rigidez arterial.

<table><tbody><tr><td>SphygmoCor tonometry-based device</td><td>AtCor Medical, Australia</td><td></td><td>For central blood pressures and cf-PWV</td></tr><tr><td>Electrodes</td><td>AtCor Medical, Australia</td><td></td><td>To record the ECG</td></tr><tr><td>Semiautomatic Oscillometric device</td><td>OMRON Healthcare, kyoto, Japan</td><td></td><td>To measure brachial BP</td></tr></tbody></table>

measuring the carotid to femoral pulse wave velocity (cf-pwv) to evaluate arterial stiffness

Para los ancianos, la rigidez arterial es un buen marcador para la evaluación del envejecimiento y se recomienda determinar la rigidez arterial invasiva por la medida de carótida a la velocidad de la onda de pulso femoral (cf-PWV) (clase I; Nivel de evidencia A). En literatura, han reportado numerosos estudios comunitarios o específicos de la enfermedad que mayor cf-VOP se asocia con mayor riesgo cardiovascular. Aquí, discutimos estrategias para evaluar la rigidez arterial con cf-PWV. Siguiendo la bien definidos pasos detallados aquí, por ejemplo, operador de la posición correcta, medida de la distancia y tonómetro posición, obtenemos un valor de cf-PWV estándar para evaluar la rigidez arterial. En este trabajo, un método paso a paso detallado para registrar un buena calidad PWV y pulso onda del análisis (PWA) usando un dispositivo no invasivo por tonometría se discutirá.

CF-PWV (con este método) y ba-PWV (con otro método10) se llevaron a cabo en todos los participantes de 2098 del norte estudio de Shanghai19. Cf-PWV y ba-PWV fueron utilizados en el mismo modelo de regresión logística. En este modelo, la edad y el sexo fueron ajustados. Los resultados mostraron que sólo cf-VOP pero no ba-VOP, se asoció significativamente con mayor IMT y placa arterial, lo que indica la superioridad de cf-PWV sobre ba-VO...

Watch this Scientific Journal Video about Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness at JoVE.com

Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness

Este protocolo describe un método para estandarizar las mediciones de la velocidad de onda de pulso carótida-femoral para evaluar la rigidez arterial.

Medición de la carótida a la velocidad de la onda de pulso Femoral (Cf-PWV) para evaluar la rigidez Arterial

For the elderly, arterial stiffening is a good marker for aging evaluation and it is recommended that the arterial stiffness be determined noninvasively ...

measuring-carotid-to-femoral-pulse-wave-velocity-cf-pwv-to-evaluate

Research

Education

JoVE Core

JoVE Journal

Nursing

Medicine

Unit 1

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness

Vital Signs: Pulse

SCIENTISTS IN ACTION

17.3K vistas.  Tongji University School of Medicine. Este protocolo describe un método para estandarizar las mediciones de la velocidad de onda de pulso carótida-femoral para evaluar la rigidez arterial.

Video: Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

La medición y tratamiento de la represión en la ambliopía

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

Investigación

Medicina

Pulse Wave Velocity Testing in the Baltimore Longitudinal Study of Aging

Carotid-femoral pulse wave velocity is considered the gold standard for measurements of central arterial stiffness obtained through noninvasive methods1.&#160;Subjects are placed in the supine position and allowed to rest quietly for at least 10 min prior to the start of the exam. The proper cuff size is selected and a blood pressure is obtained using an oscillometric device. Once a resting blood pressure has been obtained, pressure waveforms are acquired from the right femoral and right common carotid arteries. The system then automatically calculates the pulse transit time between these two sites (using the carotid artery as a surrogate for the descending aorta). Body surface measurements are used to determine the distance traveled by the pulse wave between the two sampling sites. This distance is then divided by the pulse transit time resulting in the pulse wave velocity. The measurements are performed in triplicate and the average is used for analysis.

Pulse wave velocity (PWV) measurement assesses arterial stiffness by a tonometry-based system that measures the speed with which arterial pressure wave travels along the arterial tree, typically approximating the time that it takes this wave to travel from the descending aorta (using the carotid artery as a surrogate) to the femoral artery. Carotid-femoral PWV increases two- to threefold across the adult lifespan.

Onda de pulso Pruebas de velocidad en el Baltimore Longitudinal Study of Aging

Carotid-femoral pulse wave velocity is considered the gold standard for measurements of central arterial stiffness obtained through noninvasive ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

Evaluación de la función vascular en pacientes con enfermedad renal crónica

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Measuring Ascending Aortic Stiffness In Vivo in Mice Using Ultrasound

We present a protocol for measuring in vivo aortic stiffness in mice using high-resolution ultrasound imaging. Aortic diameter is measured by ultrasound and aortic blood pressure is measured invasively with a solid-state pressure catheter. Blood pressure is raised then lowered incrementally by intravenous infusion of vasoactive drugs phenylephrine and sodium nitroprusside. Aortic diameter is measured for each pressure step to characterize the pressure-diameter relationship of the ascending aorta. Stiffness indices derived from the pressure-diameter relationship can be calculated from the data collected. Calculation of arterial compliance is described in this protocol.
This technique can be used to investigate mechanisms underlying increased aortic stiffness associated with cardiovascular disease and aging. The technique produces a physiologically relevant measure of stiffness compared to ex vivo approaches because physiological influences on aortic stiffness are incorporated in the measurement. The primary limitation of this technique is the measurement error introduced from the movement of the aorta during the cardiac cycle. This motion can be compensated by adjusting the location of the probe with the aortic movement as well as making multiple measurements of the aortic pressure-diameter relationship and expanding the experimental group size.

Measuring Ascending Aortic Stiffness In Vivo in Mice Using Ultrasound

We describe a technique for measuring aortic stiffness from its pressure-diameter relationship in vivo in mice. Aortic diameter is recorded by ultrasound and aortic pressure is measured invasively with a solid-state pressure catheter. Blood pressure is changed incrementally and the resulting diameter is measured.

Medición ascendente aórtica Rigidez<em&gt; En Vivo</em&gt; En ratones usando ultrasonido

We present a protocol for measuring in vivo aortic stiffness in mice using high-resolution ultrasound imaging. Aortic diameter is measured by ultrasound ...

A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis. Damage to the endothelium may predispose the vessel to atherosclerosis and increase the risk for cardiovascular disease. Assessments of peripheral endothelial function are good indicators of early abnormalities in the vascular wall and correlate well with assessments of coronary endothelial function. The present manuscript details the important methodological steps necessary for the assessment of microvascular endothelial function using laser Doppler imaging with iontophoresis, large vessel endothelial function using flow-mediated dilatation, and carotid atherosclerosis using carotid artery ultrasound. A discussion on the methodological considerations for each of the techniques is also presented, and recommendations are made for future research.

The present article describes the methodological considerations for several non-invasive assessments of vascular function and morphology that are commonly used in medical research to assess different stages of atherosclerosis.

Un enfoque metodológico para las evaluaciones no invasivas de la función vascular y Morfología

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis.  Damage to the endothelium may ...

A Murine Model of Arterial Restenosis: Technical Aspects of Femoral Wire Injury

Cardiovascular disease caused by atherosclerosis is the leading cause of death in the developed world. Narrowing of the vessel lumen, due to atherosclerotic plaque development or the rupturing of established plaques, interrupts normal blood flow leading to various morbidities such as myocardial infarction and stroke. In the clinic endovascular procedures such as angioplasty are commonly performed to reopen the lumen. However, these treatments inevitably damage the vessel wall as well as the vascular endothelium, triggering an excessive healing response and the development of a neointimal plaque that extends into the lumen causing vessel restenosis (re-narrowing). Restenosis remains a major cause of failure of endovascular treatments for atherosclerosis. Thus, preclinical animal models of restenosis are vitally important for investigating the pathophysiological mechanisms as well as translational approaches to vascular interventions. Among several murine experimental models, femoral artery wire injury is widely accepted as the most suitable for studies of post-angioplasty restenosis because it closely resembles the angioplasty procedure that injures both endothelium and vessel wall. However, many researchers have difficulty utilizing this model due to its high degree of technical difficulty. This is primarily because a metal wire needs to be inserted into the femoral artery, which is approximately three times thinner than the wire, to generate sufficient injury to induce prominent neointima. Here, we describe the essential surgical details to effectively overcome the major technical difficulties of this model. By following the presented procedures, performing the mouse femoral artery wire injury becomes easier. Once familiarized, the whole procedure can be completed within 20 min.

The mouse femoral artery wire injury model of restenosis is technically challenging. In this protocol we show the key technical details essential for successfully performing wire injury to induce consistent&#160;neointima for studies of restenosis.

Un modelo murino de restenosis arterial: Aspectos Técnicos del femoral Lesiones alambre

Cardiovascular disease caused by atherosclerosis is the leading cause of death in the developed world. Narrowing of the vessel lumen, due to ...

Ultrasound-based Pulse Wave Velocity Evaluation in Mice

Arterial stiffness can be evaluated by calculating pulse wave velocity (PWV), i.e., the speed with which the pulse wave travels in a conduit vessel. This parameter is being increasingly investigated in small rodent models in which it is used for assessing alterations in vascular function related to particular genotypes/treatments or for characterizing cardiovascular disease progression. This protocol describes an image processing algorithm which leads to non-invasive arterial PWV measurement in mice using ultrasound (US) images only. The proposed technique has been used to assess abdominal aorta PWV in mice and evaluate its age-associated changes.
Abdominal aorta US scans are obtained from mice under gaseous anesthesia using a specific US device equipped with high-frequency US probes. B-mode and Pulse-Wave Doppler (PW-Doppler) images are analyzed in order to obtain diameter and mean velocity instantaneous values, respectively. For this purpose, edge detection and contour tracking techniques are employed. The single-beat mean diameter and velocity waveforms are time aligned and combined in order to achieve the diameter-velocity (lnD-V) loop. PWV values are obtained from the slope of the linear part of the loop, which corresponds to the early systolic phase.
With the present approach, anatomical and functional information about the mouse abdominal aorta can be non-invasively achieved. Requiring the processing of US images only, it may represent a useful tool for the non-invasive characterization of different arterial sites in the mouse in terms of elastic properties. The application of the present technique can be easily extended to other vascular districts, such as the carotid artery, thus providing the possibility to obtain a multi-site arterial stiffness assessment.

Arterial stiffness represents a key factor in cardiovascular disease and pulse wave velocity (PWV) can be considered as a surrogate index for arterial stiffness. This protocol describes an image processing algorithm for calculating PWV in mice based on ultrasound image processing that is applicable at different arterial sites.

El ultrasonido basados ​​en la onda de pulso Evaluación de velocidad en ratones

Arterial stiffness can be evaluated by calculating pulse wave velocity (PWV), i.e., the speed with which the pulse wave travels in a conduit vessel. This ...

Measuring the Stiffness of Ex Vivo Mouse Aortas Using Atomic Force Microscopy

Arterial stiffening is a significant risk factor and biomarker for cardiovascular disease and a hallmark of aging. Atomic force microscopy (AFM) is a versatile analytical tool for characterizing viscoelastic mechanical properties for a variety of materials ranging from hard (plastic, glass, metal, etc.) surfaces to cells on any substrate. It has been widely used to measure the stiffness of cells, but less frequently used to measure the stiffness of aortas. In this paper, we will describe the procedures for using AFM in contact mode to measure the ex vivo elastic modulus of unloaded mouse arteries. We describe our procedure for isolation of mouse aortas, and then provide detailed information for the AFM analysis. This includes step-by-step instructions for alignment of the laser beam, calibration of the spring constant and deflection sensitivity of the AFM probe, and acquisition of force curves. We also provide a detailed protocol for data analysis of the force curves.

Measuring the Stiffness of Ex Vivo Mouse Aortas Using Atomic Force Microscopy

We present detailed protocols for isolation of aortas from mouse and measurement of their elastic modulus using atomic force microscopy.

La medición de la rigidez de<em&gt; Ex Vivo</em&gt; Ratón aortas Usando microscopía de fuerza atómica

Arterial stiffening is a significant risk factor and biomarker for cardiovascular disease and a hallmark of aging. Atomic force microscopy (AFM) is a ...

Biología

<meta charset="utf8"></head><body>Uso de la rigidez arterial y la función endotelial para la evaluación cardiovascular

Pulse-Wave Velocity, Flow-Mediated Dilation, and Carotid Intima-Media Thickness to Assess Cardiovascular Risk in Population with Metabolic Syndrome

Pulse-wave velocity (PWV), flow-mediated dilation (FMD), and carotid intima-media thickness (CIMT) are established methods used in research and clinical settings to assess arterial stiffness, endothelial function, and subclinical atherogenesis. These measurements may reflect vascular disease and atherosclerotic progression, which are major causes of adverse cardiovascular events. These methods are particularly valuable in determining cardiovascular dysfunction among populations with different risk factors, such as diabetes mellitus, hypertension, and other metabolic dysfunction-related conditions. They provide a non-invasive and reliable source of information that complements clinical practice. Early detection, risk assessment, and therapeutic decisions regarding cardiovascular disease can be achieved, ultimately contributing to improved patient outcomes. Traditional tools for evaluating cardiovascular disease do not reveal whether metabolic syndrome affects early subclinical cardiovascular disease in patients with obesity. Recent research has highlighted the importance of including arterial stiffness and endothelial function in a comprehensive cardiovascular assessment. Therefore, the aim of the present study is to describe methods that provide information on early subclinical vascular aging, endothelial dysfunction, and atherogenic disease, enabling vascular-targeted risk stratification among populations with obesity and different metabolic profiles.

<meta charset="utf8"></head><body>Autor destacado: Evaluación del perfil cardiovascular de pacientes con síndrome metabólico

Endothelial/vascular aging and atherogenesis are key mechanisms that promote the development of cardiovascular diseases. The present protocol describes methods to evaluate arterial stiffness, endothelial dysfunction, and atherogenesis in patients with related risk factors, which are highly valuable in the cardiovascular research field.

Velocidad de la onda de pulso, dilatación mediada por flujo y grosor íntima-media carotídeo para evaluar el riesgo cardiovascular en población con síndrome metabólico

Pulse-wave velocity (PWV), flow-mediated dilation (FMD), and carotid intima-media thickness (CIMT) are established methods used in research and clinical ...

Medición de la carótida a la velocidad de la onda de pulso Femoral (Cf-PWV) para evaluar la rigidez Arterial

Resumen

Explorar más videos

Capítulos en este video

La medición y tratamiento de la represión en la ambliopía

Onda de pulso Pruebas de velocidad en el Baltimore Longitudinal Study of Aging

Evaluación de la función vascular en pacientes con enfermedad renal crónica

Medición ascendente aórtica Rigidez

Un enfoque metodológico para las evaluaciones no invasivas de la función vascular y Morfología

Un modelo murino de restenosis arterial: Aspectos Técnicos del femoral Lesiones alambre

El ultrasonido basados en la onda de pulso Evaluación de velocidad en ratones

La medición de la rigidez de

Velocidad de la onda de pulso, dilatación mediada por flujo y grosor íntima-media carotídeo para evaluar el riesgo cardiovascular en población con síndrome metabólico

Velocidad de la onda de pulso, dilatación mediada por flujo y grosor íntima-media carotídeo para evaluar el riesgo cardiovascular en población con síndrome metabólico

Medición de la carótida a la velocidad de la onda de pulso Femoral (Cf-PWV) para evaluar la rigidez Arterial

Resumen

Explorar más videos

Capítulos en este video

La medición y tratamiento de la represión en la ambliopía

Onda de pulso Pruebas de velocidad en el Baltimore Longitudinal Study of Aging

Evaluación de la función vascular en pacientes con enfermedad renal crónica

Medición ascendente aórtica Rigidez

Un enfoque metodológico para las evaluaciones no invasivas de la función vascular y Morfología

Un modelo murino de restenosis arterial: Aspectos Técnicos del femoral Lesiones alambre

El ultrasonido basados ​​en la onda de pulso Evaluación de velocidad en ratones

La medición de la rigidez de

Velocidad de la onda de pulso, dilatación mediada por flujo y grosor íntima-media carotídeo para evaluar el riesgo cardiovascular en población con síndrome metabólico

Velocidad de la onda de pulso, dilatación mediada por flujo y grosor íntima-media carotídeo para evaluar el riesgo cardiovascular en población con síndrome metabólico

El ultrasonido basados en la onda de pulso Evaluación de velocidad en ratones