Modeling and interpretation of the bioelectrical impedance signal for the determination of the local arterial stiffness

Purpose: Stiffness of the large arteries (e.g., aorta) plays an important role in the pathogenesis of cardiovascular diseases. To date, the reference method for the determination of regional arterial stiffness is the measurement of the carotid-femoral pulse wave velocity (PWV) by tonometric techniques. However, this method suffers from several drawbacks and it remains limited in clinical routine.Methods: In the present study, the authors propose a new method based on the analysis of bioelectrical impedance (BI) signals for the determination of the local arterial stiffness. They show, from a theoretical model, a novel interpretation of the BI signals and they establish the relationship between the variations in the BI signal and the kinetic energy of the blood flow in large arteries. From this model, BI signals are simulated in the thigh and compared to experimental BI data. Finally, from the model, they propose a new index ( Ira ) related to the properties of the large artery for the determination of the local arterial stiffness. Results: The results show a good correlation between the simulated and the experimental BI signals. The same variations for both of them with different characteristics for rigid and elasticarteries can be observed. The measurement of the Ira index on 20 subjects at rest (mean age of 44 ± 16 yr ) for the determination of the local aortic stiffness presents a significant correlation with the PWV reference method ( R 2 = 0.77 ; P < 0.0001 with the Spearman correlation coefficient and Ira = 4.25 * PWV + 23.54 ). Conclusions: All the results suggest that the theoretical model and the new index could give a reliable estimate of local arterial stiffness

Le pseudoxanthome élastique et la myopie

IntroductionNous souhaitons aborder le sujet de la réfraction chez le patient pseudoxanthome élastique (PXE). Nous voulons savoir si le PXE s’accompagne d’une myopie, tout comme le syndrome de Marfan, autre pathologie du tissu élastique. Patients et méthodes Nous avons réalisé une étude transversale chez 53 patients PXE consécutifs (21 hommes, 32 femmes, âge moyen 50 ans ± 16) de septembre 2009 à juin 2011 appariés sur l’âge et le sexe avec 53 témoins. Pour chaque patient, nous avons mesuré l’équivalent sphérique, l’acuité visuelle, la kératométrie (KM), la longueur axiale (LA) et la puissance du cristallin de chaque œil. Les résultats ont été comparés avec le test t de Student. Résultats Notre population PXE avait une myopie moyenne de –0,98 dioptrie versus –0,33 pour la population témoin (p < 0,0093). Cette myopie n’était pas liée à une augmentation de la longueur axiale (23,9 versus 23,69 ; p = 0,236), ni à une cornée plus courbe (43,53 versus 43,44 ; p = 0,68), ni à une puissance cristallinienne plus faible (22,03 versus 21,71 ; p = 0,225). Discussion Le PXE provoque une calcification des fibres élastiques dans plusieurs tissus (peau, rétine, parois vasculaires). Or, il n’y a pas de fibre élastique ni dans la cornée ni dans le cristallin, mais dans la zonule. Celle-ci pourrait être pathologique chez le patient PXE et expliquer une position du cristallin plus en avant que chez nos patients témoins. Conclusion Le PXE s’associe à une myopie significativement plus élevée que dans une population saine. Des études intégrant plus de patients avec une évaluation de la profondeur de la chambre antérieure et une étude histologique de la zonule pourraient aider à comprendre cette tendance à la myopie

Carotid-femoral pulse wave velocity estimated by an ultrasound system

To date, regional aortic stiffness can be evaluated by the reference tonometric technique via the pulse wave velocity (PWV) measured in two points: the carotid and the femoral arteries. Based on a similar intersecting tangent algorithm, we have developed a new method for the determination of carotid-femoral PWV using a high-resolution echo tracking ultrasound system. Herein, PWV can be computed from the measurement of the transit time between the foot of the carotid diameter waveform and the foot of the femoral diameter waveform. The study was carried out on 50 consecutive patients at rest (29 men, mean age 30 ± 18 yrs) recruited on the occasion of a vascular screening for atherosclerosis. Carotid-femoral PWV was determined by a trained operator using a tonometric technique, (PWVpp, PulsePen, Italy), and an echotracking ultrasound system, (PWVus, e-tracking Alpha 10, Aloka, Japan). Relationship between PWVpp and PWVus was evaluated by linear regression. A Pearson’s correlation coefficient of r=0.95 was found between both variables (95% confidence interval 0.90-0.99; P<0.0001; PWVus= 0,91*PWVpp+0.44). The Bland–Altman plot comparing PWVpp and PWVus showed a systematic offset of -0.07 m.s-1 with a limit of agreement from -1,33 to 1,19 m.s-1. Our results show an excellent and significant correlation between both techniques which confirms that ultrasound system can provide a reliable estimate of the regional aortic stiffness like the tonometric technique does. Additional studies are now needed to show the simplicity of the measurement using ultrasound system while maintaining reliability even in overweight patients

Self-reported estimation of usual walking speed improves the performance of questionnaires estimating walking capacity in patients with vascular-type claudication

OBJECTIVE: Most questionnaires do not estimate the usual walking speed of the patient, although it is well known that patients may experience apparently different walking capacities if walking slow or fast. We hypothesized that correcting the self-reported estimated walking capacity by a coefficient issued from the self-reported estimation of usual walking speed would significantly improve the correlation between questionnaire-estimated and treadmill-measured walking capacity. METHODS: Three hundred ten consecutive patients complaining of vascular-type claudication were asked to estimate their usual walking speed in comparison to people of their age (or friends or relatives) with ratings ranging from much slower (1 pt) to much faster (5 pts), in addition to the filling out of the walking impairment questionnaire (WIQ) and the estimated ambulatory capacity by history questionnaire (EACH-Q). Corrected WIQ (WIQc) and corrected EACH-Q (EACH-Qc) scores were obtained by multiplying the scores of each questionnaire by the "usual-speed" coefficient and dividing by 5. Results for questionnaire scores were compared to maximal walking time (MWT) on a treadmill. RESULTS: All but four patients self-completed the usual-speed question. Median scores (25-75 centiles) were 41% (26-59) for the WIQ and 24% (11-41) for the EACH-Q. Coefficients of correlation of the three WIQ subscales and of the EACH-Q with treadmill results were significantly improved after correction by the "usual-speed" question. Overall, WIQ (mean of the three WIQ subscales) tended to improve but did not reach significance. CONCLUSION: Correcting the self-reported estimation of walking capacity by a self-reported estimation of usual walking pace significantly improves the correlation of all WIQ subscale scores and of the EACH-Q score with treadmill measurements of capacity. This confirms the interest of speed estimation in patients with peripheral arterial occlusive disease and claudication

Objective determination of the predefined duration of a constant-load diagnostic tests in arterial claudication

OBJECTIVE: The predefined duration to arbitrarily stop the tests during constant-load treadmill exercise is a subject of debate and widely variable in the literature. We hypothesized that the upper and lower limits for predefined durations of constant-load 3.2 km/hour 10% grade tests could be derived from the distribution of walking distances observed on a treadmill in a population of subjects referred for claudication or from the optimal cutoff point distance on a treadmill to confirm a limitation self-reported by history.METHODS: We conducted a retrospective analysis using a referral center, institutional practice, and ambulatory patients. We studied 1290 patients (86% male), 62.1 +/- 11.2 years of age, 169 +/- 8 cm height, 75.7 +/- 14.2 kg weight. Patients performed a standard constant-load treadmill test: 3.2 km hour(-1), 10% slope, maximized to 1000 meters (approximately 20 minutes). We analyzed the maximal walking distance self-reported (MWD(SR)) by history and the maximal walking distance measured on the treadmill (MWD(TT)). Patients reporting MWD(SR) >or=1000 meters were considered unlimited by history. RESULTS: Only 197 patients (15.3%) completed the 20-minute treadmill test. Among the 504 patients who did not stop before 250 meters, 47.8% stopped within the next 250 meters (were unable to walk 500 meters). This proportion falls to 7.5% among the 213 patients who did not stop before 750 meters. When the final goal was to estimate whether the treadmill test can discriminate patients with or without limitation by history, area under the receiver operating characteristic (ROC) curve was 0.809 +/- 0.016 (95% confidence interval [CI], 0.778-0.841; P < .0001), the best diagnostic performance was attained for an MWD(TT) of 299 meters (approximately 6.15 minutes). CONCLUSION: In patients undergoing constant-load treadmill exercise with a protocol of 3.2 km hour(-1) and 10% slope: a predefined duration of 7 minutes could be proposed as a lower limit for the predefined duration of the tests specifically if one aims at confirming the limitation by history with treadmill testing. Owing to the low risk that patients that could walk 750 meters (approximately 15 minutes) will have to stop in the next 250 meters, 15 minutes seems a reasonable upper limit for the predefined test duration in clinical routine