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Clinical Hypertension Oct 2023Accurate blood pressure (BP) measurement is crucial for hypertension detection and management. The Korea National Health and Nutrition Examination Survey (KNHANES)... (Review)
Review
Accurate blood pressure (BP) measurement is crucial for hypertension detection and management. The Korea National Health and Nutrition Examination Survey (KNHANES) assesses the health of Koreans using representative cross-sectional data. BP measurements were historically done with mercury sphygmomanometers for participants aged ≥10 years. However, KNHANES transitioned to Greenlight 300 (mercury-free auscultatory device) in 2020 for participants aged ≥6 years and used dual devices (Microlife WatchBP Office AFIB and Greenlight) in 2021-2022. To ensure consistency, KNHANES will adopt Microlife as the unified BP device with Greenlight for device validation from 2023. Under the new protocol, participants aged ≥6 years will have their BP measured three times at 30-second intervals after a 5-minute rest under ambient temperature (20-25℃) and noise ≤65 dB. The average of the 2nd and 3rd readings will be used as the representative BP value. The quality control (QC) program involves four trained examiners passing the "quality control and assurance of BP measurement program" three times annually, and undergoing "video monitoring of weekly calibration process" once a year. Additionally, the QC team will conduct "on-site evaluations of BP measurement" at mobile examination centers three times a year. A Five-Step QC process for BP devices was also developed. This document outlines the standardized BP measurement protocol and rigorous QC program in KNHANES, aiming to ensure accurate and reliable BP data for epidemiological research and public health policymaking in South Korea.
PubMed: 37821979
DOI: 10.1186/s40885-023-00252-7 -
Brazilian Journal of Cardiovascular... Oct 2023To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).
OBJECTIVE
To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).
METHODS
This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared.
RESULTS
POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012).
CONCLUSION
COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.
Topics: Humans; Atrial Fibrillation; Pulse Wave Analysis; Vascular Stiffness; Oscillometry; Pulmonary Disease, Chronic Obstructive; Postoperative Complications; Risk Factors
PubMed: 37797089
DOI: 10.21470/1678-9741-2023-0017 -
The Journal of Allergy and Clinical... Aug 2023The effort-independent tidal breathing test used by oscillometry presents a viable alternative for following up patients whose condition is stable while they are...
BACKGROUND
The effort-independent tidal breathing test used by oscillometry presents a viable alternative for following up patients whose condition is stable while they are receiving biologic therapy.
OBJECTIVE
We aimed to determine intrasession and intersession repeatability values for airwave oscillometry (AOS) and spirometry in patients who were already taking benralizumab.
METHODS
In all, 21 patients with severe eosinophilic asthma attended the Scottish Centre for Respiratory Research as part of a clinical trial (EudraCT identification number 2019-003763-22). Paired AOS and spirometry values were obtained at 3 separate visits (baseline and days 28 and 56) with no change in asthma therapy.
RESULTS
Intrasession agreement between repeated measurements for AOS and spirometry was excellent (intraclass correlation coefficient ≥ 0.90) at all 3 visits. Intersession agreement was also excellent (intraclass correlation coefficient ≥ 0.80).
CONCLUSION
In this study we report medium-term intrasession and intersession repeatability values for airwave oscillometry and spirometry in a cohort of severely asthmatic patients receiving benralizumab therapy. Oscillometry can be used to follow up patients with asthma who are taking biologics.
PubMed: 37779519
DOI: 10.1016/j.jacig.2023.100119 -
Diagnostics (Basel, Switzerland) Sep 2023The investigation of arterial stiffening is a promising approach to estimating cardiovascular risk. Despite the widespread use of different methods, the dynamic nature...
The investigation of arterial stiffening is a promising approach to estimating cardiovascular risk. Despite the widespread use of different methods, the dynamic nature of measured and calculated stiffness parameters is marginally investigated. We aimed to determine the stability of large artery elasticity parameters assessed via commonly used, ultrasound-based and oscillometric methods in relation to peripheral resistance modulation. A human experimental environment was composed, and fifteen young males were investigated at rest after extremity heating and external compression. Functional vascular parameters were monitored in each session, and several arterial stiffness parameters were analysed. The distensibility coefficient (DC) did not show significant changes during heat provocation and extremity compression, while DC's stability seemed to be acceptable. The same stability of carotid-femoral pulse wave velocity (PWV) was detected with ultrasound measurement (5.43 ± 0.79, 5.32 ± 0.86 and 5.28 ± 0.77, with = 0.38, = 0.27 and = 0.76, respectively) with excellent intersession variability (intraclass correlation coefficient of 0.90, 0.88 and 0.91, respectively). However, the oscillometric PWV (oPWV) did change significantly between the heating and outer compression phase of the study (7.46 ± 1.37, 7.10 ± 1.18 and 7.60 ± 1.21, with = 0.05, = 0.68 and < 0.001, respectively), the alteration of which is closely related to wave reflection, represented by the changes in reflection time. Our results indicate the good stability of directly measured elastic parameters such as DC and PWV, despite the extreme modulation of peripheral resistance. However, the oscillometric, indirectly detected PWV might be altered by physical interventions, which depend on wave reflection. The effective modulation of wave reflection was characterized by changes in the augmentation index, detected using both oscillometry and applanation tonometry. Thus, the environment during oscillometric measurement should be rigorously standardized. Furthermore, our results suggest the dynamic nature of the reflection point, rather than being a fixed anatomical point, proposed previously as aortic bifurcation.
PubMed: 37761264
DOI: 10.3390/diagnostics13182897 -
ERJ Open Research Sep 2023Impulse oscillometry (IOS) is sensitive in detecting lung function impairment. In small studies, impaired IOS relates better to respiratory symptoms than spirometry. We...
BACKGROUND
Impulse oscillometry (IOS) is sensitive in detecting lung function impairment. In small studies, impaired IOS relates better to respiratory symptoms than spirometry. We studied how IOS related to spirometry and respiratory symptoms in a large population of individuals (n=10 360) in a cross-sectional analysis.
METHODS
Normal values for IOS and spirometry were defined in healthy, never-smoking individuals, aged 50-64 years, from the Swedish CArdioPulmonary bioImage Study (n=3664 for IOS and 3608 for spirometry). For IOS, abnormal values for resistance at 5 Hz () and at 20 Hz and area of reactance were defined using the 95th percentile. Abnormal reactance at 5 Hz for IOS and abnormal conventional spirometry indices (forced expiratory volume in 1 s (FEV), forced and slow vital capacity and their ratios) were defined using the 5th percentile.
RESULTS
Abnormal IOS parameters were found in 16% of individuals and were associated with increased odds ratios for nearly all respiratory symptoms when adjusted for age, gender and smoking. In individuals with normal spirometry, abnormal IOS resistance was related to cough and dyspnoea, while abnormal reactance was related to wheeze. In these individuals, the combination of abnormal with abnormal reactance resulted in approximately two-fold higher likelihood for having cough, chronic bronchitis and dyspnoea, even when further adjusting for FEV, expressed as % predicted.
CONCLUSIONS
Abnormal IOS is related to increased respiratory burden in middle-aged individuals with normal spirometry, especially when resistance and reactance parameters are combined. The different relationships between respiratory symptoms and reactance and resistance warrant further research.
PubMed: 37753278
DOI: 10.1183/23120541.00736-2022 -
Medicina Clinica Dec 2023Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of... (Observational Study)
Observational Study
OBJECTIVES
Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies.
METHODS
Observational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness.
RESULTS
After nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category.
CONCLUSIONS
More than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.
Topics: Male; Humans; Female; Cardiovascular Diseases; Pharmacies; Prospective Studies; Pulse Wave Analysis; Risk Factors; Blood Pressure; Vascular Stiffness
PubMed: 37735046
DOI: 10.1016/j.medcli.2023.06.002 -
Respiratory Medicine and Research Nov 2023The forced oscillation technique (FOT) may be useful for diagnosis and follow-up of respiratory diseases. It is unclear how global or regional alterations in airway...
BACKGROUND
The forced oscillation technique (FOT) may be useful for diagnosis and follow-up of respiratory diseases. It is unclear how global or regional alterations in airway resistance (Raw) and lung compliance (C) alter FOT measurements.
METHODS
A 2-compartment physical model of the respiratory system allowed to simulate variations in Raw, C, and their heterogeneity during tidal breathing in an adult human. Five-Hz respiratory system resistance (Rrs5) and reactance (Xrs5), area of reactance (AX), resonance frequency (Fresp) and intrabreath variation in Rrs5 and Xrs5 were measured by FOT. Frequency dependance of resistance could not be studied in this model. Relationships between model characteristics (Raw, C, and heterogeneity) and FOT measurements were explored by multiple regression.
RESULTS
Rrs5 and intrabreath variation in Rrs5 and Xrs5 strongly associated with model characteristics (R=0.753, 0.5 and 0.658). Associations of Xrs5, AX, and Fresp with model characteristics were weak (R=0.214, 0.349 and 0.076). Raw heterogeneity was the main determinant of Rrs5 (Coeff=0.594), AX (Coeff=0.566) and intrabreath variation in Rrs5 and Xrs5 (Coeff=0.586 and 0.732). Regional extremes in Raw strongly determined Rrs5 (Coeff=1.006). Xrs5 did not strongly associate with any model characteristic.
CONCLUSION
Raw heterogeneity and maximal regional Raw were the main determinants of FOT measurements, in particular Rrs5. Associations between C and FOT measurements were weak.
Topics: Adult; Humans; Asthma; Respiratory Function Tests; Lung; Airway Resistance; Respiration
PubMed: 37717385
DOI: 10.1016/j.resmer.2023.101027 -
Pediatric Pulmonology Nov 2023Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of...
INTRODUCTION
Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of underlying mechanisms. Preterm-born children with and without lung dysfunction and term controls were assessed using oscillometry before and after exercise, and after postexercise bronchodilation.
METHODS
Preterm-born children, born at gestation of 34 weeks or less, were classified into those with prematurity-associated obstructive lung disease (POLD; FEV < LLN, FEV /FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (pPRISm; FEV < LLN, FEV /FVC ≥ LLN) and compared to preterm (FEV ≥ LLN) and term controls (%predicted FEV > 90%). All children underwent cardiopulmonary exercise, and oscillometry assessment at baseline, postexercise, and after postexercise bronchodilator administration.
RESULTS
From 241 participants aged 7-12 years, complete data were available from 179: 15 children with POLD and 11 with pPRISm were compared with 93 preterm and 60 term controls. POLD group, when compared to both control groups, had impaired impedance, greater resistance, more negative (greater magnitude) reactance at low frequencies, and also had decreased compliance. pPRISm group demonstrated impaired reactance and compliance compared to term controls. No differences were noted between the preterm and term controls. Exercise had little impact on oscillometry values, but children with POLD had greatest improvements after postexercise bronchodilator administration, with decreased resistance and decreased magnitude of reactance, particularly at low frequencies.
CONCLUSION
Preterm-born children with obstructive airway disease had the greatest oscillometry impairments and the largest improvements after postexercise bronchodilator compared to control groups. Oscillometry can potentially be used to identify preterm-born children with lung disease to institute treatment.
Topics: Child; Female; Humans; Infant, Newborn; Bronchodilator Agents; Oscillometry; Forced Expiratory Volume; Premature Birth; Lung; Lung Diseases; Lung Diseases, Obstructive; Spirometry; Infant, Newborn, Diseases
PubMed: 37701982
DOI: 10.1002/ppul.26658 -
Translational Pediatrics Aug 2023Congenital diaphragmatic hernia (CDH) is associated with significant pulmonary morbidity. Previous investigation has shown that postnatal inpatient morbidity is linked...
BACKGROUND
Congenital diaphragmatic hernia (CDH) is associated with significant pulmonary morbidity. Previous investigation has shown that postnatal inpatient morbidity is linked to diaphragmatic defect size. The objective of this study was to evaluate long-term pulmonary outcomes by CDH study group defect size.
METHODS
A retrospective analysis was conducted for CDH patients (n=133) managed in a neonatal intensive care unit (NICU) at a single children's hospital within an adult hospital system and subsequently followed up at a comprehensive multidisciplinary CDH clinic (n=102) from January 2012 to April 2022. CDH patients were stratified according to Congenital Diaphragmatic Hernia Study Group (CDHSG) Stage, and then categorized as low-risk (LR), defect size A and B, or high-risk (HR), defect size C and D. Inpatient data, including the presence of pulmonary hypertension, extracorporeal life support (ECLS) utilization, and mechanical ventilation days, were collected. Post-discharge data including the prevalence of asthma, pulmonary hypertension, emergency department visits, the total number of hospitalizations, and average rehospitalization days were collected. Frequentist analysis was used.
RESULTS
The outcomes for 133 NICU patients were analyzed (HR: n=54, LR: n=79). During NICU stay, the prevalence of pulmonary hypertension [HR: 16/54 (30%) LR: 9/79 (12%), P=0.009], ECLS utilization [HR: 19/54 (35%) LR: 4/79 (5%), P<0.001], and the average number of mechanical ventilation days [HR: 17 days (IQR: 12-27) LR: 5 days (IQR: 2-9), P<0.001] were significantly higher in the HR CDH group. Post NICU discharge, the prevalence of asthma [HR: 20/54 (37%), LR: 17/79 (22%), P=0.050)] and the total days of rehospitalization [HR: 9 (IQR: 2-27) LR: 4 (IQR: 1-8), P=0.035] were significantly higher in HR group. Of the patients seen in the comprehensive multidisciplinary CDH clinic, obstructive lung disease measured by impulse oscillometry was increased in the HR CDH population compared to the reference group [median R5Hz was 12.95 kPa/(L/s) in CDH 9.8 kPa/(L/s) (P=0.010)].
CONCLUSIONS
HR CDHSG Stage is associated with worse inpatient and long-term pulmonary outcomes.
PubMed: 37692542
DOI: 10.21037/tp-23-14 -
Journal of Medical Case Reports Sep 2023Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be suspected when respiratory symptoms continue, air trapping persists on...
BACKGROUND
Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be suspected when respiratory symptoms continue, air trapping persists on expiratory CT scans, and imaging findings fail to improve despite objectively better conventional pulmonary function test (PFT) parameters. The forced oscillation technique (FOT) and Multiple breathing washout (MBW) are both very sensitive methods for detecting anomalies in the peripheral airways.
CASE PRESENTATION
We discuss the case of a 60-year-old Hispanic patient who had severe COVID-19 pneumonia and developed dyspnea, fatigue, and limited daily activity a year later. The PFTs revealed restrictive lung disease, as seen by significant diffusing capacity of the lungs for carbon monoxide (DLCO) decrease, severe desaturation, and poor 6-min walk test (6MWT) performance. The patient was treated with lowering corticosteroids as well as pulmonary rehabilitation (PR). During the 24-month follow-up, the dyspnea and fatigue persisted. On PFTs, 6MWT performance and restricted pattern improved slightly, but MBW discovered significant ventilatory inhomogeneity. FOT revealed substantial peripheral airway obstructive abnormalities. On CT scans, air trapping and ground-glass opacities (GGO) improved somewhat. The patient used a bronchodilator twice a day and low-dose inhaled corticosteroids (160 µg of budesonide and 4.5 µg of formoterol fumarate dihydrate) for nine months. PR sessions were resuming. The restricting parameters were stabilized and the DLCO had normalized after 36 months, with a 6MWT performance of 87% but significant desaturation. The CT scan revealed traction bronchiectasis, low GGO, and persistent air trapping. Without normalization, FOT and MBW scores improved, indicating small airway disease.
CONCLUSIONS
The necessity of integrating these tests when detecting SAD is emphasized in our paper. This article lays the foundation for future research into the best ways to manage and monitor SAD in post-acute COVID-19 patients.
Topics: Humans; Middle Aged; Post-Acute COVID-19 Syndrome; Follow-Up Studies; COVID-19; Asthma; Dyspnea; Fatigue
PubMed: 37691104
DOI: 10.1186/s13256-023-04113-7