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Inter and intra-raters reproducibility of flow-mediated slowing using local estimates of brachial artery pulse wave velocity
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INTRODUÇÃO: A desaceleração mediada pelo fluxo (DMF) mede de forma não invasiva a função endotelial braquial por meio de alterações na velocidade da onda de pulso (VOP) induzidas por uma hiperemia reativa, e é sugerido para mitigar as limitações bem conhecidas da dilatação mediada por fluxo (DMF), incluindo a reprodutibilidade subotima e a alta dependência da experiência do operador. No entanto, os poucos estudos que examinaram a reprodutibilidade da DMF mostraram resultados controversos, e usaram apenas medições regionais de VOP efetuadas por um único avaliador. Tal pode não refletir verdadeiramente as respostas exatas da rigidez da artéria braquial à hiperemia reativa e a sua aplicabilidade clínica. No presente trabalho avaliámos a reprodutibilidade inter- e intra- avaliadores das análises off-line do DMF através dos sinais brutos de distensibilidade arterial obtidos do procedimento DMF.
MÉTODOS: Vinte e quatro participantes saudáveis do sexo masculino com idades entre 23-75 anos, foram examinados por 2 avaliadores, em dois dias separados, para avaliar a reprodutibilidade inter- e intra-dias. As alterações na rigidez beta braquial e na VOP beta (DMF) induzidas pela hiperemia reativa foram calculadas de acordo com as fórmulas do fabricante através da utilização de um script R personalizado. A reprodutibilidade inter- e intra- avaliador foi examinada com coeficiente de correlação intraclasse (ICC), coeficiente de variação (CV) e gráficos Bland-Altman.
RESULTADOS: A reprodutibilidade inter- avaliador da DMS mostrou uma boa reprodutibilidade para as análises intra (bias: -0.12%; ICC: 0.84; 95% CI: 0.57 to 0.94; CV: 19%) e inter- dia (bias: -0.25%; ICC: 0.82; 95% CI: 0.57 to 0.92; CV: 16%). A reprodutibilidade intra avaliador mostrou uma reprodutibilidade moderada a boa para a análise inter- dia (1º Avaliador: bias: 0.39%; ICC: 0.78; 95% CI: 0.51 to 0.91; CV: 21%; 2º Avaliador: bias:0.14%; ICC: 0.53; 95% CI: -0.07 to 0.80; CV: 36%).
CONCLUSÕES: As análises off-line do DMS através dos sinais brutos de ultrassonografia são reprodutíveis entre diferentes avaliadores.
INTRODUCTION: Flow-mediated slowing (FMS) measures brachial endothelial function non-invasively through reactive hyperemia-induced changes on pulse wave velocity (PWV), and it is suggested to mitigate well-known pitfalls of flow-mediated dilation (FMD) including suboptimal reproducibility and high-operator dependency. However, the few studies that examined FMS reproducibility have shown controversial results and used only regional measurements of PWV performed by a single rater This might not truly reflect the exact stiffness responses of the brachial artery to reactive hyperemia and limit its clinical usefulness. In the present study we assessed inter- and intra-raters reproducibility of off-line analyses of FMS using the raw distensibility signals obtained from the FMD procedure. METHODS: Twenty-four healthy male participants aged 23 – 75 yr, were examined on two separate days to assess inter- and intra-day reproducibility. Reactive hyperemia-induced changes on brachial beta stiffness and beta PWV (FMS) were calculated according to the manufacturer's formulas using a tailored R-script. Inter- and int-rater reproducibility was examined with intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman plot estimates. RESULTS: Inter-rater reproducibility of FMS showed an overall good reproducibility for both intra (bias: -0.12%; ICC: 0.84; 95% CI: 0.57 to 0.94; CV: 19%) and inter-day (bias: -0.25%; ICC: 0.82; 95% CI: 0.57 to 0.92; CV: 16%) analyses. Intra-rater reproducibility showed an overall moderate-to-good reproducibility for inter-day (1st rater: bias: 0.39%; ICC: 0.78; 95% CI: 0.51 to 0.91; CV: 21%; 2nd rater: bias:0.14%; ICC: 0.53; 95% CI: -0.07 to 0.80; CV: 36%) analyses. CONCLUSIONS: Off-line analyses of FMS using raw signals from ultrasonography were reproducible among different raters.
INTRODUCTION: Flow-mediated slowing (FMS) measures brachial endothelial function non-invasively through reactive hyperemia-induced changes on pulse wave velocity (PWV), and it is suggested to mitigate well-known pitfalls of flow-mediated dilation (FMD) including suboptimal reproducibility and high-operator dependency. However, the few studies that examined FMS reproducibility have shown controversial results and used only regional measurements of PWV performed by a single rater This might not truly reflect the exact stiffness responses of the brachial artery to reactive hyperemia and limit its clinical usefulness. In the present study we assessed inter- and intra-raters reproducibility of off-line analyses of FMS using the raw distensibility signals obtained from the FMD procedure. METHODS: Twenty-four healthy male participants aged 23 – 75 yr, were examined on two separate days to assess inter- and intra-day reproducibility. Reactive hyperemia-induced changes on brachial beta stiffness and beta PWV (FMS) were calculated according to the manufacturer's formulas using a tailored R-script. Inter- and int-rater reproducibility was examined with intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman plot estimates. RESULTS: Inter-rater reproducibility of FMS showed an overall good reproducibility for both intra (bias: -0.12%; ICC: 0.84; 95% CI: 0.57 to 0.94; CV: 19%) and inter-day (bias: -0.25%; ICC: 0.82; 95% CI: 0.57 to 0.92; CV: 16%) analyses. Intra-rater reproducibility showed an overall moderate-to-good reproducibility for inter-day (1st rater: bias: 0.39%; ICC: 0.78; 95% CI: 0.51 to 0.91; CV: 21%; 2nd rater: bias:0.14%; ICC: 0.53; 95% CI: -0.07 to 0.80; CV: 36%) analyses. CONCLUSIONS: Off-line analyses of FMS using raw signals from ultrasonography were reproducible among different raters.
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Keywords
Flow mediated slowing Pulse wave velocity Reproducibility Flow mediated dilation