Reproducibility of pulse wave analysis and pulse wave velocity in patients with type 2 diabetes

Abstract

Aims. Patients with type 2 diabetes have increased arterial stiffness and a high incidence of cardiovascular disease compared with non-diabetics. Arterial stiffness and central waveforms can be assessed by carotid-femoral pulse wave velocity (PWV) and pulse wave analysis (PWA) using the SphygmoCor device. These methods can potentially improve cardiovascular risk stratification in the future. However, a prerequisite is acceptable reproducibility. The objective of this study was to assess the intra- and inter-observer reproducibility of PWV and PWA indices in patients with type 2 diabetes using the SphygmoCor device. Methods. Two trained observers (A and B) each undertook two PWA and two carotid-femoral PWV recordings in random order in 20 patients with type 2 diabetes under standardized conditions on the right side of the patients. Observer A also made double recordings on the left side. The mean of the two recordings was used for inter-observer comparison. Data were analyzed by Bland-Altman plots. Results. The mean intra-observer differences (± 2SD) on the right side for observer A and B, respectively, were 0.0 ± 2.8 mmHg and 0.3 ± 3.2 mmHg (aortic systolic blood pressue (BP)), 0.0 ± 1.2 mmHg and 0.1 ± 1.0 mmHg (aortic diastolic BP), − 1.1 ± 3.2% and 1.1 ± 9.6% (central augmentation index (Aix)), − 1.6 ± 6.6% and 0.1 ± 9.0% (Aix normalized to heart rate 75 beats/min (Aix@HR75)) and 0.1 ± 1.8 m/s and 0.0 ± 1.6 m/s (PWV). The mean inter-observer differences (± 2SD) were − 2.6 ± 13.0 mmHg (aortic systolic BP), − 2.1 ± 7.4 mmHg (aortic diastolic BP), − 0.8 ± 8.4% (Aix), − 1.5 ± 7.4% (Aix@HR75) and − 0.3 ± 1.6 m/s (PWV). Left-vs-right comparison showed comparable results (observer A). Conclusions. PWA and PWV assessed with the SphygmoCor device are characterized by good reproducibility in patients with type 2 diabetes.

Key Words::

• Applanation tonometry
• arterial stiffness
• central blood pressure
• augmentation index
• repeatability
• pulse wave velocity

Acknowledgements

We wish to thank laboratory technician Lisa Buus for excellent technical assistance during the study. We thank the patients who participated in this study.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Sources of funding were the University of Aarhus, The Regional Hospital Silkeborg, The Ministry of Science, Technology and Innovation, Denmark, and The Health Research Fund of Central Denmark Region.