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Sensor Gel Packets ECG Clips PCG Weight PCG Sensor Touch Pen
(20 Sets) Model: HFA-RPE3-ECG Model: HFA-RPE3-W700 Model: HFA-RPE3-PCG Model: HBP-PEN
Model: HBP-FORM-101S
Non-invasive Vascular Screening Device
Model BP-203RPE
Left Arm Cuff, S Right Arm Cuff, S BP-203RPE Arm BP-203RPE Arm
Model: HEM-CS30-LEFT Model: HEM-CS30-RIGHT Cuff Air Tube (LEFT) Cuff Air Tube (RIGHT)
Model: HEM-CR30L-TUBE Model: HEM-CR30R-TUBE
Left Arm Cuff, M Right Arm Cuff, M
Model: HEM-CR30-LEFT Model: HEM-CR30-RIGHT
Options
The enhanced report formats enable easier presentation of information to patients. The report function includes more than 5 different formats: one
for doctors, three for patients, one for trend charts, one for exercise stress tests, etc.
ABI is a standard index used for detecting PAD (Peripheral Artery Disease)
• ABI is a primary non-invasive screening test for PAD. 1
• 75% of patients with arteriosclerosis obliterans die from coronary
• Byare thedetected
ABI screening test, approximately 3 times more cases artery or cerebral artery events. 3
and a predictive marker for cardiovascular disease. than those confirmed by their subjective symptoms
• Low ABI is a potential predictive factor of future cardiovascular
(intermittent claudication) at interviews. 2
events. In cases of ABI 㱡 0.90, risks of mortality of cardiovascular
events can increase from 3 to 6 times. 1
1) Inter-Society Consensus for the Management of PAD(TASC )
The blood pressure at ankles, which is distal from the heart, will be lower than that in the upper arm due to reduced blood flow in the lower 2) J.I.Weitz and Treatment of Chronic Arterial Insufficiently of the Lower Extremities: A Critical Review
extremities caused by atherosclerosis. ABI is suitable for making diagnosis, assessment of severity and postoperative follow-ups of PAD. (AHA Medical / Scientific Statement ) Circulation 1996 ; 94 : 3026-2029
onset of deflation, systolic blood pressures in all extremities are determined Cuff Evaluate other causes
Sectional drawing of lower limb
at the same time, resulting in high reproductibility of the ABI measurements. Bone, muscles tendons and Sensor cuff
1.00
Muscle
three arterial blood vessels Posterior tibial Abnormal
make up a more complex artery results PAD 0.50
Muscle
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The cardiovascular risk
marker, baPWV,
TBI Toe Brachial Index Post-Exercise ABI test in the era of metabolic
disorders
An index for assessment of severity of stenosis of peripheral artery in the For patients with ABI in the normal limit but have PAD suspicious
lower extremities. symptoms like intermittent claudication, observation of ABI changes after ■ Outline of the test
exercise stress helps to confirm the diagnosis of PAD and determines the
TBI is a diagnostic index for peripheral arterial disease that is not influenced by arterial calcification. So it is a useful index for patients with severity from recovery time.
• Lower extremity symptoms on exertion
longstanding diabetes and renal failure. • The symptoms above and gaps in the ABI values
■ Principle of TBI measurement ■ Features of TBI measurement ■ Usefulness of Post-Exercise ABI Tests
Treadmill Exercise* Standing at Plantar Flexion Position
Toe systolic blood pressure with VP-1000Plus ● For a patient with intermittent claudication and a single stenosis in
TBI = the iliac artery, the ABI value at rest may be at the normal limit
● Original cuffs exclusive for toes because the peripheral blood pressure at distal from the stenosis
Brachial blood pressure
(higher in right or left) Stable measurements can be obtained from patients with different lesion does not decline at rest. The ABI decline can be determined
toe shapes by using flexible material for the cuffs. during the recovery period and diagnosis of PAD can be confirmed.
[Criteria of TBI assessment] Inter-Society Consensus for the Management of PAD(TASC II )
● Similar accurate measurement to that of PPG method is
realized
TBI < 0.7 abnormal
Toe blood pressure measurement with the oscillometric method is
0.7 㱡 TBI normal realized by using blood pressure measurement techniques for ■ Features of Post-Exercise ABI tests
neonates with high measurement accuracy. Blood pressure with VP-1000Plus
Inter-Society Consensus for the Management of PAD(TASC) measurements with close correlation to the conventional PPG • Generally the patient walks on a treadmill of • It has been known that results from standing at
(photoplethysmography) method can be performed. ● The easy and useful recovery ratio mode is mounted 3.2kg/h in speed and with a 10 to 12% slope till a flexion position closely correlate with those of the
pain occurs or up to 5 minutes passes. treadmill exercise test, and thus this method can
be considered as an alternative to the treadmill
TBI measurement model ● Easy one-touch operation! • When a treadmill cannot be used, walking or stress test.
climbing steps are also acceptable.
The operation is done by simply placing the cuff exclusive for toes
and then pressing the button. The toe blood pressure and TBI are
RIGHT upper-arm LEFT upper-arm calculated automatically.
Systolic 136 Systolic 138 ABI measurement after exercise
▼ Replacing cuffs for toes ▼ Changeover screen
Diastolic 67 Diastolic 73
15 to 20% decline of ABI Normal ABI: PAD negative
Mean area of the wave form divided by amplitude of the wave form The time from the ascending point (foot) to the systolic peak of the
is represented in percentage. %MAP will be larger when a stenosis pulse waveform. This value correlates with vascular stiffness
38%
Normal wave form Standard value (for reference): up to 180 mg
Normal wave form
② Patients with the following conditions Peaked wave form
0%
amplitude
calcifications. Decline of arterial compliance 170ms
1) Diabetes mellitus %MAP 100%
Stenosis wave form
Stenosis wave form
• Combined screening tests of ABI and TBI can determine severity 2) Hemodialysis
3) Observed gaps between symptoms and the ABI
0%
50%
UT 200ms
of obstructive diseases.
values*
T.J.Orchard et al:
Assesment of Peripheral Vascular Disease in Diabetes.Report and Recommendations of an International Workshop
③ Patients with ABI ranges 0.9 to 1.0 (borderline) and symptoms
Sponsored by the American Diabetes Association and the American Heart Association.(AHA Medical/Scientific
Statement)Circulation 1993;88:819-828 * Symptoms refer to a pain, numbness, cold sensation, ulcers, etc. in the lower extremities or feet.
■ Diagnosis Supporting System 2 Supervisor: Kimihiko Yoshikawa, Professor, Department of Radiology,
Nara Medical University
The comprehensive assessment system including the PVR wave form analysis index and the ABI values detects early stage stenosis lesions in
lower extremities, which are difficult to detect by simple ABI measurement alone.
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The cardiovascular risk
■ Usefulness of baPWV marker, baPWV,
● baPWV is a novel index of arterial stiffness, easier to measure due to its Figure 1
baPWV is a parameter of arterial stiffening and a good independent good positive correlation with cfPWV (carotid-femoral PWV). 1 1.0
Cumulative survival rate by baPWV values
predictor for the presence of cardiovascular disease. ● baPWV and ABI are suggested to be useful as differential indices of
baPWV < 1700cm/s
complications. 2 0.8
As the artery compliance declines, the velocity of pulsation (pulse wave), when the heart is pumping blood, becomes faster. Flexibility of the 2010 to < 2380cm/s
vessels is assessed by the pulse wave velocity, calculated using time interval and distance between two points, of which pulse waves are detected ● baPWV has been demonstrated to be a potential prognosis predictive
at the upper arms and ankles. factor independent of other risk factors for atherosclerosis in 2
X = 57.8
p < 0.0001
hemodialysis patients with ABI≧0.9. 3 (Figure 1) 0.6
2380cm/s
■ Principle of baPWV measurements Lb-La (Length)
● baPWV has been considered to be an index for control in prophylactic
0
baPWV = anti-hypertension therapy against cardiovascular complications
0 200 400 600 800 1000 1200 1400 1600
When the blood vessel is flexible (cm / s) T (Time) because long-term intensive anti-hypertensive therapy significantly
Observation period (day)
Normal blood vessel is extensible like a rubber tube. The improve baPWV.4 (Figure 2)
La: Length from the aortic root to the upper arms. Subjects: 785 hemodialysis patients Observation period: 33.8 +- 10.8 months in the mean
pulsation (pulse wave) is absorbed by the arterial wall and thus Lb: Length from the aortic root to the ankle.
conducts slowly.
(Figure 2)
When the blood vessel is sclerotized baPWV improvement by long-term anti-hypertensive therapies In the mild anti-hypertensive therapy
i
The pulsation (pulse wave) is not absorbed by the arterial wall Changes in systolic and diastolic blood pressures and baPWV in intensive ( ) and moderate ( ) antihypertensive therapies. group baPWV slightly improved in
A B accordance with the early depressor
and thus conducts fast, causing damage to the blood vessels 180 2000
or organs. SBP effect and then increased again,
* *
PWV (cm/s)
ii
[Assessment criteria of baPWV] height
iii 1800
120
of baPWV was observed even after
The risks of cardiovascular diseases increases as the baPWV value increases due to risk factors of DBP * * * * 1700 achievement of the targeted depressor
arteriosclerosis as well as age and gender. 100
effect and stability of blood pressure.
①㸊T ②㸊T
(ii-i) (iii-i) 80 1600
* The results show that the improvement
Changes in ages and baPWV (Japanese healthy subjects) 60
* * * * 1500
* * * effect on baPWV is beyond the delay
2200 0 3 6 9 12 0 3 6 9 12
Male: n = 4488
Course (month) Course (month) effect on pulse wave velocity by the
2100 Female: n = 3393
C D : p< 0.05 vs difference in the groups
lowered blood pressure.
2000 *p < 0.005 vs onset of treatment
1900
1800 1) Munakata M et al : Utility of Automated Brachial Ankle Pulse Wave Velocity Measurements in Hypertensive Patients. Am J Hypertens 2003;16:653-657
2) Koji Y et al: Comparison of Ankle-Brachial Pressure Index and Pulse Wave Velocity as Markers of the Presence of Coronary Artery Disease in Subjects With a High Risk of Atherosclerotic Cardiovascular Disease. Am J Cardiol. 2004;94:868-72
1700
3) Kitahara T et al: Impact of Brachial-Ankle Pulse Wave Velocity and Ankle-Brachial Blood Pressure Index on Mortality in Hemodialysis Patients. Am J Kidney Dis. 2005;46:688-696
baPWV (cm/s)
1600 RIGHT
Upper Arm 4) Ichihara A et al: Long-Term Effects of Intensive Blood Pressure Lowering on Arterial Wall Stiffness in Hypertensive Patients. Am J Hypertens 2003 ; 16 : 959-65
1500
1400
LEFT
1300
1200
Upper Arm
■ baPWV nomogram by blood pressure groups: vascular assessment considering blood pressure fluctuation
1100
RIGHT Supervisor: Akira Yamashina, Professor, 2nd department of internal medicine,
1000
Ankle Joint
[An example of a useful assessment with baPWV by blood pressure groups] Tokyo Medical University
900
800 59-year-old male
LEFT
20 30 40 50 60 70 Age Ankle Joint Blood pressure: 168/109 mmHg
Observation The calculated nomogram here is not
The systolic blood pressure at measurement is more than 30 mmHg higher than usual and baPWV value is more than 2000 cm/s.
BaPWV: 2048 cm/s
Source: Tomiyama H et al: Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity intended to support the significance
measurement -a survey of 12517 subjects.
Atherosclerosis 166 (2003) 303-309
of calibrated PWV value with blood
The shorter xT is, the faster baPWV becomes. baPW (cm/s) RIGHT LEFT baPW (cm/s) RIGHT LEFT
2400 2400 pressure. Considering the risks of
2200 2200
+1SD +1SD
absolute value of PWV, the nomogram
2000 2000
● To ensure the reliability of the measured values, only pulse wave judged as appropriate by meeting the 20 30 40 50 60 70 80 Age 20 30 40 50 60 70 80 Age
criteria as the begging of measurement appears with cut-off line Conventional evaluation Evaluation with baPWV nomogram
● Accurate detection is possible by attaching a sensor box (right) adjacent to the ankle cuffs sensitive to Further measurement is recommended Another evaluation can be made like "Even
because "the elevation of baPWV can be considering influences of fluctuation of the
feeble pulse wave signals in the ankles. caused by transient fluctuation of blood present blood pressure, the baPWV value
● There is no need to measure the actual distance, because the distance calculation formula from body pressure." indicates the vascular risk is still high."
height is pre-installed in the main device.
Yamashina A et al : Nomogram of the relation of Brachial-Ankle Pulse Wave Velocity with Blood pressure. Hypertens Res.2003;26:801-806
ー7ー ー8ー
The cardiovascular risk
marker, baPWV,
Browsing Data By connecting VP-1000plus and PC, measurement result data in VP-1000plus can be browsed with Internet Explorer.
■ Principle of PWV measurement *For more details, please contact our authorized distributor.
PC *not included
R Barcode reader
Heart-femoral PWV T
(hfPWV) ECG P Q S HUB or LAN
carotid Sound Sound
Tcf+Tc (Time)
Other options
■ Usefulness of aortic PWV Relationship between PWV values and
Electrocardio system
Dielectric Tri-polar method (I dielectric)
Bar Code Reader Set
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