30 Jun '09

Cardio Pulse Wave :: What does it test?

by synergy

Cardio Pulse Wave (CPW) uses the BPro device and A-PULSE software. This is the state-of-the-art equipment, technology and software. Now learn what the measurements mean. This is somewhat technical so bear with me.

A-PULSE CASP is a revolutionary product patented by HealthSTATS International Pte Ltd. It is able to measure accurately the Central Aortic Systolic Pressure or CASP, which is the blood pressure at the root of the aorta. It is the only device which can be used in common clinical setting. CASP has been shown in many recent studies as an important determinant for strokes and CVS events. It has been validated via invasive study and achieved an accuracy (co-relation) R= 0.9917 independently. A-PULSE CASP is FDA and CE MDD approved. It is also being used in large drug trials by Pharmaceutical companies.

A-PULSE CASP® is designed to measure the CASP in a simple clinic or Pharmacy setting. The BPro device is used, together with a computer or laptop, using a USB port. It gives real time recording of the arterial waveforms which can be replay at any later time for further study. Another strong feature of A-Pulse is the ability to compare the various waveforms on different dates of the same patient, or different patients. All the parameters including the CASP are displayed instantaneously, the waveforms superimposed for comparison. The A-PULSE CASP® is the only device that can measure the CASP in a clinic setting, easy to use and accurate. It is the evidence-based approach to the management of hypertension.

What is arterial pulse waveform?

idealPulseWave

Diagrammatic Representation of a Radial Arterial Pulse Wave

When the left ventricle ejects blood into the aorta in systole, the perturbation generates a wave that initially travels through the arteries from the heart towards the arterial tree.

Pulse waveform has 2 components.
1. Forward traveling wave when the left ventricle contracts and
2. Reflected wave returning back from the peripheral.

What is CASP (Central Aortic Systolic Pressure)?

CASP (Central Aortic Systolic Pressure)

CASP (Central Aortic Systolic Pressure)

This is the blood pressure at the root of the aorta or the largest artery in the body, as the blood is being pumped out of the heart. This pressure is called Central Aortic Systolic Pressure or CASP. CASP has been shown to be an important factor in the relation to strokes and cardiovascular events, more so than the brachial pressure, or the pressure at the arm commonly.

CASP is different and usually lower than the brachial pressure in normal people. When we are young, below 40 years old, the difference between CASP and the brachial pressure can be significant (up to 30 mmHg). However, as we age, the aorta gets stiffer and the compliance reduces. As a result, the CASP increases and comes much closer to the brachial pressure. In patients with high blood pressure, the CASP can be abnormally high for his age, showing “pre-mature stiffening of the aorta.

It has also been shown that certain class of drugs used in the treatment of high blood pressure can also have an adverse effect on the CASP, increasing it instead of reducing, as shown in the CAFÉ study. Therefore it is important to show that the treatment a patient is taking actually result in lowering the CASP and not the reverse. By reducing the CASP of the patient, we are reducing the risks of stroke and heart events.

How to measure CASP? The Invasive Method

Catheter Method of Measuring the Cardio Pulse

Fig 1. Catheter Method of Measuring the Cardio Pulse - Invasive Method

This is direct measurement and has been considered as the most accurate method. To perform the measurement, a catheter must be inserted into the aortic root from bronchial or femoral artery, which is obviously an invasive method and could result in complications (Fig.1). This invasive method of measuring CASP is not available in clinical setting. However, A-PULSE CASP can be used in clinic and the accuracy
has been validated against this invasive method, the result is R=0.9917 (co-relation). (What this means, for those of you who are like me and don’t quite get the point, is the CPW is 99.17% as accurate as the catheter method!)

How to measure CASP? The Non-Invasive Method

Fig 2. CASP with A-PULSE CASP Software :: Non-Invasive Method

Fig 2. CASP with Computer

HealthSTATS (HS) invented a device named BPro which is able to capture radial pressure waveforms. Furthermore, HS developed a proprietary formula to derive central aortic systolic pressure (CASP) from the calibrated radial pressure waveform (Fig. 2).

Fig. 2 Non-invasive measurement of CASP using the Cardio Pulse Wave (which is the combination of HealthSTATS BPro device and A-PULSE software)

Augmentation index is the difference between the second and first systolic peaks expressed as a percentage of the pulse pressure.

Arterial compliance is the ability of an artery to increase the volume in response to a given increase in blood pressure is called compliance.

Pulse wave velocity or PWV is the speed at which the pressure waveform travels (wave propagation) along the aorta and large arteries, during each cardiac cycle.

Applanation tonometry is the principle of applanation tonometry is that the force acting on the plunger is proportional to the pressure in the artery when where the artery surface is flattened.

{ 10 comments… read them below or add one }

Beth Luce March 8, 2010 at 6:05 am

How do I find someone in the 34208 Bradenton, FL area to test me??

Reply

Richard Matwyshen January 14, 2011 at 6:50 pm

Hi Beth,
I didn’t notice a reply to your question. I was certified on the BPro last August and I have done 130 sessions since then. I get down to the Tampa area a few times a month usually on the weekend. Perhaps we could connect some time to get you tested.

Reply

Jennifer Duncan August 19, 2010 at 5:47 am

Nice read. Hypertension is not called ‘the silent killer’ for nothing… so many young people have died with heart failure because of an unnoticed hypertension..

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Kevin Szczepankowski November 1, 2010 at 1:41 pm

Regarding the Cardio Pulse Wave or BPRO testing device: The BPro makes two primary calculations that are vital for early detection of premature aging of the arteries. First, it measure the CASP or the Centeral Aortic Systolic Pressure. This is the blood pressure at the root of the aorta. Blood pressure at this location should be around 100 for an avg 20-30 yr old, 115 for an avg 60-70 yr old, etc… Until the BPro was invented the only way to obtain this measurement was through a cathaterization process preformed in a hospital setting. Now it can be determined in a home, or clinical setting… It is FDA approved, fast, safe, non-invasive and extremely accurate.

The other measurement is the rAi or the radial augmentation index. This is an indication of the stiffness of the arteries in the periphery…

The BPRO is an amazing invention to aid in the prevention and eradication of cardio vascular disease. Although I have not verified the numbers, the last I heard, there were fewer than 200 in use in the world and around 65 in the United States.

Kevin Szczepankowski
certified bpro technician, Sacramento, CA

Reply

Corey November 30, 2010 at 8:08 am

Kevin

I am Corey Sagstuen a Paramedic in Edmonton,Alberta, Canada and I have a question for you.
What is the error % of the BPro either from the unit or operator? I had recent testing here for the first time and the operator seemed to be having difficulty in the calibration or function of her unit, this lead me to believe that there would be an error in the reading.
How are the units calibrated and is there a specific function test that the operator performs to ensure QA/QC of the unit.
What is the expected failure rate of the machine’s and by that I mean how many consecutive test can this perform prior to failure to read or continues mis-reads?( as in my specific case)
As I am a stickler for accuracy in my profession and being introduced to this product I always want to be sure that I am 100% confident in the machines I use on a Pt or in this case on a member of the public to support my position when I make reference to the ProArginine product.
Again I just need to understand how this all works and would appreciate any feedback.

Have a great week

Respectfully

Corey Sagstuen
TEMT-P, CS,CD

Reply

Kevin Szczepankowski December 1, 2010 at 8:38 am

There is obviously a potential for operator error. The computer will issue a warning when it cannot sense the pulse wave or calibrate correctly. It also issues a failure when the blood pressure is out of range.

It is absolutely imperative that the user be accurate with the placement of the BPro device. They MUST know what they are doing in order to have an accurate reading. The device itself calibrates every 10 seconds. This is what it comes down to; If the operator is NOT placing the tonometer on the radial artery correctly the device will throw it out with an “error” message. In my opinion, the only people that should be using this device are the ones that have been trained to use it properly and take it seriously as a way to help others take charge of their health. The BPro device is 99.17% as accurate as a very invasive femoral catherization. All the research is out there for this device. Many studies, the CAFE, REASON and more.
You can also use my website with the first video that comes up with Dr. Siva explaining the BPro and ProArgi9+

Dr. Ting, the inventor of the Bpro, did a little 8 minute video to help explain the BPro…

http://miracleofhealth.com/science/cardioPulseWave/cardioPulseWave.html

Kevin Szczepankowski

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Jan Manolas, MD, PhD November 24, 2010 at 2:17 am

a more Effective Comeback of “Mechanocardiography”:
Combining Arterial with Left Ventricular Pulse-pressure & Phonocardiography With Isometric Exercise?

The comeback of “mechanocardiography” in our days is characterized by a wide application of “carotid pulse” for assessing the arterial stiffness and “phonocardiography” for improved teaching and as a pre-test before echo examination.
More recently, “apexcardiography” in form of “Pressocardiography with handgrip exercise” has also been proved a useful simple stress test modality for assessing LV diastolic dysfunction with exercise and detecting an “ischemic diastolic response”.
By using a simple modified device, every practitioner could get simultaneous recordings of arterial pulses + phono- + pressocardiography and, thus, significantly more clinical information about both arterial and stiffness of the left ventricle by evaluating heart sounds changes as well as LV pressure changes during isometric exercise…
In near future, we should probably obtain simultaneously the mentioned “mechanocardiographic” with echo recordings for a pathophysiologically correct evaluation of patient’s cardiac function…
Since you are obviously well informed about PWV & PhonoCG, but much less about “PRESSOCARDIOGRAPHY WITH HANDGRIP”, you could visit our web site: http://www.presso-test.com.
I would be personally willing to contribute in developing a combined “mechanocardiographic” tool…

With best wishes,
Jan Manolas, MD, PhD, FACC

Reply

PAMMIE November 26, 2010 at 1:59 am

Dear Jan

I am with SYNERGY (Australia) would love to know more……
Pammie

Reply

PAMMIE November 26, 2010 at 1:59 am

Can we connect?

Reply

PAMMIE November 26, 2010 at 2:07 am

Greetings Jan from the ‘land down under’….. I am doing this testing with exceptional magitude and results….. my email address is: powerof1@tpg.com.au
Our office here is overwhelmed with the positives… WOW what a product and WHAT a testing that validates the product of Dr Prendergast!!!!
Pammie- living and opening her heart and business to all in Australia- +617 5471 1870

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