Arterial audiophotoplethysmography

Summary

Background: Digital blood pressure is an important prognostic parameter in peripheral arterial disease. However, it is rarely determined in clinical routine because the methods available are too cumbersome. Patients and methods: Arterial audiophotoplethysmography (APPG) uses an in-built audio output. The systolic pressure corresponds to the reappearance of a pulssynchrone beep during deflation of the pressure cuff (25 mm wide on fingers and toes) after suprasystolic inflation. Measurements can be performed either in transmission or reflection mode. 50 healthy volunteers (age: 23-75 years) were examined in supine position. Blood pressure was taken at the A. brachialis, A. ulnaris, A. radialis, A. poplitea, A. tibialis anterior and posterior using ultrasound Doppler (USD), at the A. brachialis, fingers 1-5, A. poplitea and toes 1-3 using APPG. Results: Regarding the A. brachialis and poplitea, we found an excellent correlation between values obtained by USD and APPG in transmission mode (r: 0.92-0.99), the correlation with the reflection mode-values was slightly lower (r: 0.81- 0.93). The values obtained in reflection mode were significantly lower than in transmission mode (average 5.2 mmHg on the arms, 12.9 mmHg on the legs). Finger pressure was identical with A. brachialis-pressure. Toe/- brachial index was 0.81-0.86 (transmission) and 0.72- 0.78 (reflection). No significant difference was found between any of the fingers, respectively the toes. Conclusions: APPG is a reliable method for determination of digital blood pressure, which can be easily performed. Measurements in transmission mode should be preferred.

Zusammenfassung

Hintergrund: Der akrale Blutdruck, ein wichtiger prognostischer Parameter bei der pAVK, wird bei klinischen Routineuntersuchungen nur selten erfasst, weil die verfügbaren Messmethoden zu umständlich sind. Patienten und Methoden: Die arterielle Audiophotoplethysmographie (APPG) liefert akustische Signale. Der systolische Druck entspricht dem Wert, bei dem beim Ablassen der Luft aus der suprasystolisch aufgepumpten, 25 mm weiten Finger- bzw. Zehenmanschette ein pulssynchroner Ton auftritt. Die Messungen können entweder im Transmissions- oder im Reflexionsmodus durchgeführt werden. 50 Gesunde (Alter 23-75 Jahre) wurden liegend untersucht. Mittels Ultraschall-Doppler (USD) wurde der Blutdruck der A. brachialis, A. ulnaris, A. radialis, A. poplitea, A. tibialis anterior und posterior gemessen, mittels APPG derjenige der A. brachialis, der Finger 1-5, der A. poplitea und der Zehen 1-3. Ergebnisse: Was die A. brachialis und poplitea betrifft, fanden wir eine ausgezeichnete Korrelation zwischen den USD- und den APPG-Werten im Transmissionsmodus (r: 0,92-0,99), die Korrelation mit den Werten im Reflexionsmodus war etwas niedriger (r: 0,81-0,93). Die im Reflexionsmodus ermittelten Werte waren signifikant niedriger als die im Transmissionsmodus gemessenen (im Mittel 5,2 mmHg an den Armen, 12,9 mmHg an den Beinen). Der Fingerblutdruck entsprach dem Blutdruck in der A. brachialis. Der Zehen/Arm-Index betrug 0,81-0,86 (Transmission), 0,72-0,78 (Reflexion). Zwischen dem Blutdruck in einzelnen Fingern oder Zehen fanden wir keinen signifikanten Unterschied. Schlussfolgerungen: Die APPG ist eine zuverlässige Methode für die Messung des akralen Blutdrucks. Die Messungen sollten im Transmissionsmodus durchgeführt werden.

Sommaire

Objectif: La tension artérielle des doigts est un paramètre prognostique important pour les maladies artérielles périphériques. Par contre, elle est rarement constatée par les médecins, car les méthodes actuellement à disposition sont trop compliquées. Patients and méthodes: L’audiophotoplethysmographie arterielle (APPG) produit un «bip» sonore. La pression systolique correspond à la réapparition de ce dernier (correspondant à la pulsation artérielle), lors du dégonflage de la manchette (qui est de 25 mm pour les doigts et les orteils) après un gonflage suprasystolique. Les mesures peuvent être faites en ultilisant des sondes optiques en mode transmission ou réflection. 50 volontaires en bonne santé (agés de 23 à 75 ans) ont été examinés en position allongé. La tension de l’A. brachialis, l’A. ulnaris, l’A. radialis, l’A. poplitea, l’A. tibialis anterior et posterior a été mesuré en utilisant l’ultrason Doppler (USD), la tension de l’ A. brachialis, les doigts 1-5, A. poplitea et des orteils 1-3 en utilisant l’APPG. Résultats: Concernant l’A. brachialis et poplitea, nous avons trouvé une excellente corrélation entre l’ultrason Doppler et l’APPG en mode transmission (r: 0.92-0.99). La corrélation était inférieure en mode réflection (r: 0.81- 0.93). Les valeurs obtenues en mode réflection étaient significativement plus basses qu’en mode transmission (en moyenne 5.2 mmHg pour les mains, 12.9 mmHg pour les pieds). La pression des doigts était identique à la pression de l’A. brachialis. L’indice orteil/bras était de 0.81 à 0.86 (mode transmission) et de 0.72 à 0.78 (mode réflection). Nous n’avons pas remarqué de différence significatives entre chacun des doigts et des orteils. Conclusion: L’APPG est une méthode simple et fiable pour déterminer la tension artérielle acrale. L’examination doit être faite de préférence en mode transmission.

Keywords

Blood pressure - arteriosclerosis - ischemia - photoplethysmography

Schlüsselwörter

Blutdruck - Arterioskerose - Ischämie - Photoplethysmographie

Mots clés

Tension artérielle - artériosclerose - ischémie - photoplethysmographie

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