RESUMEN
OBJECTIVE: To validate two devices for self-measurement of blood pressure--The Omron Hem-705CP and the Omron Hem 706/711--according to the revised protocol of the British Hypertension Society (BHS). The results were also analysed according to the criteria for accuracy of the revised standard of the Association for the Advancement of Medical Instrumentation (AAMI). DESIGN: The British Hypertension protocol for the evaluation of blood pressure measuring devices. SETTING: Primare care. Zone III Health Care in Albacete (Spain). PARTICIPANTS: 95 subjects to validate the Omron 706/711 and 100 subjets to Omron 705. RESULTS: Two monitors surpassed the validation according to the standars set out by the BHS protocol (705 with a A grading for SBP and DBP, 706/711 obtained a B grading for SBP and an A grading for DBP and a PASS for SBP and DBP. Upon analyzing the behavior of the appliances by subgroups of BP measures (high, mid, and low), 705 for SBP > 160 mmHg obtained a B grading for the BHS protocol, but it did not pass the accuracy AAMI criteria (SD, 8.5, but difference between observers-device is -0.1 mmHg). The rest of subgroups of BP obtained a A grading for the BHS protocol and a PASS (AAMI). 706/711 surpassed in all BP subgroups BHS protocol, for DBP 80-100, SBP > 160 and DBP > 100 with a B grading, for the rest of BP subgroups obtained a B grading and a PASS (AAMI). CONCLUSIONS: On the basis of these results, we conclude both monitors Omron HEM 706/711 and the Omron 705CP surpassed the accuracy criteria required for BHS and AAMI, and can be recommended for clinical use.
Asunto(s)
Determinación de la Presión Sanguínea/instrumentación , Monitores de Presión Sanguínea , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
Objetivos. Validar 2 monitores semiautomáticos (Omron 705 y 706/711) para la medida de la presión arterial, y su comportamiento en presiones arteriales límites, de acuerdo con los protocolos de la British Hipertensión Society (BHS) y con los criterios de precisión de la Association for the Advancement of Medical Instrumentation (AAMI). Diseño. Protocolo de la BHS para la validación de monitores semiautomáticos de medida de la presión arterial. Emplazamiento. Atención primaria. Centro de Salud Zona III de Albacete. Participantes. Noventa y cinco sujetos para el monitor 706/711 y 100 para el 705. Resultados. Los 2 monitores superaron la validación según el protocolo de la BHS (705 con grado A para presiones arteriales sistólicas y diastólicas, 706/711 con grado B para sistólicas y A para las diastólicas); ambos monitores superaron también los criterios de precisión exigidos por la AAMI. Al analizar el comportamiento de los monitores por subgrupos de medidas de presión arterial (altas, medias y bajas), el 705 en sistólicas > 160 mmHg superó con grado B el protocolo BHS, pero no pasó los criterios de la AAMI (DE, 8,5), aunque las diferencias entre las medias de los 2 observadores de las columnas de Hg y la media del 705 fue -0,1 m Hg, el resto de subgrupos de presión arterial obtuvieron un grado A de la BHS y superaron los criterios exigidos por la AAMI. El 706/711 superó, a su vez, en todos los subgrupos de presión arterial el protocolo de la BHS, obtuvo un grado B para las diastólicas de 80-100 y > 100, y para sistólicas > 160; en el resto de subgrupos obtuvo un grado A; además cumplió en cada subgrupo los criterios de precisión exigidos por la AAMI. Conclusiones. En función de estos resultados puede concluirse que ambos monitores semiautomáticos superaron satisfactoriamente la gradación de la BHS y los criterios de precisión exigidos por la AAMI, por lo que pueden recomendarse para su uso clínico (AU)
Asunto(s)
Persona de Mediana Edad , Adulto , Adolescente , Anciano , Anciano de 80 o más Años , Masculino , Femenino , Humanos , Monitores de Presión Sanguínea , Calidad de Vida , Encuestas y Cuestionarios , Hipertensión , Años de Vida Ajustados por Calidad de Vida , Factores Sexuales , España , Sensibilidad y Especificidad , Estudios de Casos y Controles , Reproducibilidad de los Resultados , Estudios Prospectivos , Determinación de la Presión Sanguínea , Diseño de Equipo , Estado de SaludRESUMEN
A study is made of the characteristics of the atrial potentials recorded in the Koch triangle and its proximity, their variations on modifying the site of cardiac pacing, and their usefulness as markers of a distinct zone of the AV junction. In 12 isolated and perfused rabbit heart preparations an analysis was made of the endocardial atrial electrograms recorded with a multiple electrode positioned in the AV junction. The electrograms were obtained during spontaneous rhythm and on pacing at the crista terminalis (CT), interatrial septum (IAS), left atrium, and right ventricle. Double potentials were frequently obtained. On pacing at the CT, high-low double potentials (DP [H-L]) were more frequent (P < 0.05) in the low CT (11% +/- 4% of the electrodes) and posterior zone of the Koch triangle (6% +/- 5%), than in the IAS (1% +/- 2%) and anterior zone of the Koch triangle (2% +/- 3%). A similar tendency was observed either on pacing at the left atrium or during spontaneous rhythm. During pacing at the IAS the percentages of low-high double potentials (DP (L-H]) were significantly higher (P < 0.05) in the low CT (7% +/- 6%). DP (H-L) were of low sensitivity in indicating a given zone; maximum sensitivity was 61% in the low CT when pacing at the CT. DP (L-H) proved even less sensitive in indicating a given zone, though their specificity was greater in the low CT (91%) during pacing at the IAS. The specific zones in which the highest percentages of DP (H-L) or DP (L-H) are obtained depend on the site of cardiac pacing. On pacing at the IAS, DP (L-H) are more specific of the low CT. During pacing at both the CT and at the IAS, DP (H-L) sensitivity in indicating a given zone is low.
Asunto(s)
Nodo Atrioventricular/fisiopatología , Estimulación Cardíaca Artificial , Electrocardiografía , Potenciales de Acción , Animales , Función Atrial , Frecuencia Cardíaca , Técnicas In Vitro , Conejos , Sensibilidad y Especificidad , Función VentricularRESUMEN
An analysis was made in 14 isolated and perfused rabbit hearts of the electrophysiological effects of selective radiofrequency (RF) delivery in the anterior (group I, n = 7) or posterior zone (group II, n = 7) of the Koch triangle, with the aim of modifying atrioventricular nodal (AVN) conduction without suppressing 1:1 transmission. After opening the right atrium, RF was delivered (0.5 W) with a 1-mm diameter unipolar electrode positioned in the selected zone until a prolongation of no less than 15% was obtained in the Wenckebach cycle length (WCL). Before and after (30 min) RF, anterograde and retrograde AVN refractoriness and conduction were evaluated, stimulating from the crista terminalis (CT), the interatrial septum (IAS), and from the RV epicardium. After RF, the following percentage increments were observed in group I: AH(CT) = 36% +/- 9%, AH(IAS) = 38% +/- 11%, WCL(CT) = 28% +/- 8%, WCL(IAS) = 22% +/- 6%, functional refractory period (FRP) of the AVN(CT) = 13% +/- 11%, FRP-AVN(IAS) = 13% +/- 8%, retrograde WCL = 20% +/- 19%, and retrograde FRPVA = 13% +/- 16%. The increments observed in group II and the significances of the differences with respect to group I were: AH(CT) = 11% +/- 14% (P < 0.01), AH(IAS) = 19% +/- 32% (NS), WCL(CT) = 42% +/- 14% (P < 0.05), WCL(IAS) = 42% +/- 16% (P < 0.01), FRP-AVN(CT) = 28% +/- 28% (NS), FRP-AVN(LAS) = 21% +/- 19% (NS), retrograde WCL = 35% +/- 24% (NS), and retrograde FRP = 16% +/- 13% (NS). In both groups, the AH interval variations were not correlated with those of the rest of the parameters analyzed. Truncated nodal function curves suggestive of a dual AV nodal pathway were obtained in three experiments, though in only one of them was this observed under basal conditions. In the other two experiments, with dual AV nodal physiology only after RF (one from each group), AV nodal reentrant tachycardias were triggered with atrial extrastimulus at coupling intervals equal to or shorter than at those that cause a sudden lengthening of the AH interval, RF delivered in the anterior and posterior zones of the Koch triangle produced effects of different magnitude on the AH interval and Wenckebach cycle length. In the anterior zone the AH interval was prolonged to a greater extent, while in the posterior zone the effects were greater on the Wenckebach cycle length. No correlation existed between the variations in AH interval and Wenckebach cycle length, regardless of where RF was delivered. The evaluation of anterograde AV nodal refractoriness was similar when stimulating from the crista terminalis or from the interatrial septum. By delivering RF, it was possible to induce dual AV nodal physiology and reentrant tachycardias.