Sphygmocor xcel device

Manufactured by AtCor Medical

Sourced in Australia

The SphygmoCor XCEL device is a non-invasive diagnostic instrument designed to measure central blood pressure and arterial stiffness parameters. It utilizes applanation tonometry technology to acquire pulse waveforms from the radial artery and provides information about the cardiovascular system's function.

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15 protocols using sphygmocor xcel device

Cardiovascular Assessments using SphygmoCor XCEL

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Cardiovascular assessments were carried out with the SphygmoCor® XCEL device (AtCor Medical, Sydney, Australia). Participants initially rested for five minutes in a supine position. Brachial systolic, diastolic, and pulse pressures were then measured via a cuff affixed to the upper left arm. Central (aortic) blood pressures were also automatically derived by the device during this process. For greater accuracy measurements were taken three times. The first was discarded, as this had the greatest chance of being artificially elevated due to apprehension and ‘white-coat syndrome’, and the final results were taken as the average of the second and third measurements.
To derive the carotid-femoral pulse wave velocity (CFPWV) measure of aortic stiffness, a cuff was placed high on the left leg to capture the femoral pulse waveform, while the carotid waveform was captured using a hand-held tonometer. The distance between these two sites was measured and then divided by the pulse transit time to calculate the CFPWV. This is considered the ‘gold standard’ method of central arterial stiffness assessment [37 (link)].

Kennedy G., Meyer D., Hardman R.J., Macpherson H., Scholey A.B, & Pipingas A. (2020). Modelling Modifiable Predictors of Age-Related Cognitive Decline: Exercise, Aortic Stiffness, and the Importance of Physical Fitness. Journal of Alzheimer's Disease Reports, 4(1), 79-89.

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Arterial Stiffness Assessment with SphygmoCor

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An indirect and non-invasive measure of arterial stiffness was determined by the SphygmoCor XCEL device (AtCor Medical Pvt, Ltd, Sydney, NSW, Australia). The arterial stiffness parameters included carotid-femoral arterial pulse wave velocity (PWV) and augmentation index (AIx). The participants rested quietly in a supine position at room temperature for 15 min before measurements of arterial pulse pressure waveforms, by an inflated cuff at the brachial artery. SphygmoCor system calculates the central aortic augmentation pressure (AP) by subtracting the pressure at the first systole resulting from the return of the reflected wave from the systolic pressure. The AIx was calculated as the ratio of AP to pulse pressure [33 (link)]. PWV was measured simultaneously with pressure transducers, by acquiring a carotid pulse by applanation tonometry and a femoral pulse by volumetric displacement, within a cuff around the upper thigh (femoral artery) [34 (link), 35 (link)]. The pulse waves were captured electronically on a computer using the SphygmoCor system and accepted by the system after consistent high-quality waveforms were measured. The average of approximately 3–5 measurements were taken.

Lee S.Y., Mac Aogáin M., Fam K.D., Chia K.L., Binte Mohamed Ali N.A., Yap M.M., Yap E.P., Chotirmall S.H, & Lim C.L. (2019). Airway microbiome composition correlates with lung function and arterial stiffness in an age-dependent manner. PLoS ONE, 14(11), e0225636.

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Carotid-Femoral Pulse Wave Velocity Measurement

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Carotid–femoral pulse wave velocity (PWV) was measured by trained biomedical scientists using an applanation tonometer according to a previously published protocol.^{21 (link)} In brief, measurements were made twice using the SphygmoCor XCEL device (from Atcor Medical, Sydney, NSW, Australia). The average of these measurements was used for analysis, and calculated using a correction factor of 0.8 in accordance with current international guidelines.^{22 (link)}

af Geijerstam P., Engvall J., Östgren C.J., Nyström F.H, & Rådholm K. (2022). Home Blood Pressure Compared With Office Blood Pressure in Relation to Dysglycemia. American Journal of Hypertension, 35(9), 810-819.

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Noninvasive Carotid-Femoral Pulse Wave Velocity

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We used the Sphygmocor XCEL device (AtCor Medical Pty Ltd., Sydney, Australia) to measure carotid-femoral pulse wave velocity (cfPWV) noninvasively while participants rested in a supine position. Both the femoral and carotid artery waveforms were captured simultaneously by means of a femoral cuff placed on the upper right thigh, and carotid artery applanation tonometry. In order to determine the cfPWV travel distance, 80% of the distance measured between the arterial points (carotid to cuff measured using an infantometer, and femoral to cuff via a tape measure) was calculated [15 (link)]. cfPWV was automatically calculated as distance/pulse transit time. In addition, we determined supine brachial SBP and DBP. Mean arterial pressure (MAP) was subsequently calculated using supine brachial blood pressures [bDBP + 1/3(bSBP − bDBP)]. cfPWV as well as blood pressure measurements were performed in duplicate, and repeated if PWV differed by more than 3 m/s.

Strauss M., Smith W., Wei W., Bagrov A.Y., Fedorova O.V, & Schutte A.E. (2018). Large artery stiffness is associated with marinobufagenin in young adults: the African-PREDICT study. Journal of hypertension, 36(12), 2333-2339.

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Carotid-Femoral Pulse Wave Velocity Assessment

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Carotid femoral pulse wave velocity and AIx75 were measured with the SphygmoCor XCEL device (software version 1.2, AtCor Medical, Australia), according to previous published guidelines [21 (link)]. The device has been previously validated for non-invasive measurement of cfPWV and central systolic pressure (cSP) in children [22 (link)]. cfPWV was calculated according to the equation PWV = (0.8 x D(m)/t (s)), where t denotes the transit time of the arterial pulse along the distance, and D the distance assimilated to the surface between the recording sites. Measurements were performed in supine position at the right carotid and femoral arteries. Two sequential recordings were obtained for each participant. Speaking and sleeping were avoided during measurements. Height adjusted cfPWV z score values were calculated [23 (link)]. Central systolic pressure and AIx75 were derived from PWA analysis using oscillometry, with the participants in seated position, their back and arm supported during the measurement. Appropriate cuff size according to participant's arm circumference was selected among three different cuff sizes available by the manufacturer (small adult 17–25 cm, adult 23–33 cm, large adult 31–40 cm).

Stabouli S., Kotsis V., Maliachova O., Printza N., Chainoglou A., Christoforidis A., Taparkou A., Dotis J., Farmaki E, & Zafeiriou D. (2020). Matrix metalloproteinase −2, −9 and arterial stiffness in children and adolescents: The role of chronic kidney disease, diabetes, and hypertension. International Journal of Cardiology Hypertension, 4, 100025.

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Brachial and Central Blood Pressure Measurement

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The participants were allowed to rest for 10 minutes before blood pressure (BP) measurements were taken. Duplicate brachial BP measurements were taken in the sitting position at 5-min intervals, using the validated OMRON M6 device (Omron Healthcare, Kyoto, Japan). An appropriate cuff size was used, and it was placed on the right arm over the brachial artery, with the arm supported at heart level and in a relaxed position. Pulse pressure and mean arterial pressure were calculated. Duplicate central systolic blood pressure (cSBP) was measured with the Sphygmocor XCEL device (Atcor Medical Pty. Ltd., Sydney, Australia), with the participant in the supine position.

Phalane E., Fourie C.M, & Schutte A.E. (2018). The metabolic syndrome and renal function in an African cohort infected with human immunodeficiency virus. Southern African Journal of HIV Medicine, 19(1), 813.

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Noninvasive Arterial Stiffness Measures

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The SphygmoCor XCEL device (AtCor Medical Pty. Ltd., Sydney, New South Wales, Australia) was used to measure cfPWV [22 (link)]. With the participants in supine position the right carotid artery was located by means of palpation to identify the strongest pulse point. The carotid pulse was measured using a tonometer while the femoral pulse was measured by a femoral cuff placed around the thigh of the participant. The transit-distance method was used and 80% of the distance calculated and entered after which the cfPWV was measured along the descending thoracic-abdominal aorta using the foot-to-foot velocity method. Duplicate measurements were taken and the mean value used in subsequent analyses. Any measurement not considered of sufficient quality were repeated based on an operator index and additional quality indices reflecting the degree of variation above acceptable limits [23 (link)]. The augmentation index was measured using pulse wave analysis with a cuff at the brachial artery. A central arterial waveform was produced that provided a central SBP (cSBP) reading, obtained from the peripheral arterial waveform [24 (link)], and central pulse pressure (cPP) was calculated.

Mels C.M., Delles C., Louw R, & Schutte A.E. (2019). Central systolic pressure and a nonessential amino acid metabolomics profile: the African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension. Journal of Hypertension, 37(6), 1157-1166.

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Vascular Health Assessment in Hospital Patients

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In this cross-sectional study, using a non-invasive SphygmoCor XCEL device (AtCor Medical), CBP indices (blood pressure, augmentation pressure, augmentation index, pulse pressure amplification, and pulse wave velocity) and traditional brachial blood pressure (BBP) were measured in 50 inpatients and outpatients at the University of Alberta Hospital and Kaye Edmonton Clinic. Non-English speaking subjects and those with a history of dementia, blindness, depression, anxiety, mental illness, substance abuse and chronic pain were excluded. Subjects were also excluded when they were medically unstable or terminally ill, under isolation precautions or unable to give informed consent. Data on demographic variables and vascular risk factors including hypertension, diabetes and hyperlipidemia was obtained. Information on history of transient ischemic attacks (TIA’s), strokes and anti-hypertensive medications was also obtained.

Suleman R., Padwal R., Hamilton P., Senthilselvan A, & Alagiakrishnan K. (2017). Association between central blood pressure, arterial stiffness, and mild cognitive impairment. Clinical Hypertension, 23, 2.

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Aortic-Femoral Pulse Wave Velocity Measurement

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Aortic-femoral PWV was measured with the SphygmoCor XCEL device (AtCor Medical, Sydney, NSW, Australia) using well-validated procedures [26 (link), 27 (link)] performed by trained operators. All measurements were collected with the participant in the supine position after 10 min of rest. Femoral pulse was measured using a blood pressure cuff around the upper thigh. Carotid pulse was simultaneously measured with a tonometer manually applied at the neck. On average, three PWV measurements were recorded, and the mean value was used in statistical analyses.

Bangen K.J., Smirnov D.S., Delano-Wood L., Wierenga C.E., Bondi M.W., Salmon D.P, & Galasko D. (2021). Arterial stiffening acts synergistically with APOE genotype and AD biomarker status to influence memory in older adults without dementia. Alzheimer's Research & Therapy, 13, 121.

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Arterial Stiffness Assessment Protocol

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The SphygmoCor® XCEL device (AtCor Medical, Sydney, Australia) was used to perform pulse wave analysis and determine carotid-femoral pulse PWV on the right-hand side with the participant in a supine position [24 (link)]. Pulse wave analysis was performed to produce an arterial wave form that provided brachial pulse pressure, estimated central SBP and central pulse pressure via a built-in generalized function [25 (link)]. Pulse wave velocity was measured using the femoral artery and carotid arterial waveforms which were captured simultaneously. To obtain these waveforms, an appropriate sized femoral cuff was placed on the upper right thigh and a tonometer was placed on the neck where the carotid pulse was felt the strongest. To determine the pulse wave travel distance, 80% of the distance measured between the two pulsating points (carotid-to-cuff measured using an infantometer, and femoral-to-cuff via a tape measure) was used [26 (link)]. Measurements were performed in duplicate, and repeated if PWV differed by more than 0.5 m/s.

Fourie C.M., Botha-Le Roux S., Smith W., Schutte A.E., Breet Y., Mels C.M., Gafane-Matemane L.F., Lammertyn L., Uys L., Burger A., Joseph J.S., Goswami N., De Boever P, & Strijdom H. (2020). Vascular function and cardiovascular risk in a HIV infected and HIV free cohort of African ancestry: baseline profile, rationale and methods of the longitudinal EndoAfrica-NWU study. BMC Infectious Diseases, 20, 473.

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