Abstract Details

Title Side-by-Side Comparison of Commonly Used Beat-to-Beat Blood Pressure Devices in the Autonomic Laboratory During the Valsalva Maneuver

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) S9 - Autonomic Disorders (12:03 PM-12:15 PM)

Poster/Presentation
Number 005

Objective To conduct a side-by-side comparison of blood pressure (BP) waveforms induced by the Valsalva maneuver (VM) using the two most commonly used beat-to-beat BP devices for clinical autonomic testing.

Background Anecdotal observations have suggested beat-to-beat BP changes, particularly rapid changes during and following the VM, may be captured with different fidelity by different non-invasive BP devices. Such differences may have significant implications for the interpretation of autonomic reflexes.

Design/Methods We included randomly selected patients undergoing routine clinical autonomic testing at Mayo Clinic Rochester in January 2023. After obtaining informed consent, subjects were instrumented with two beat-to beat BP devices while responses to the VM were recorded. Devices studied were 1) NOVA with nanocore, Finapres Medical Systems (Enschede, Netherlands), and 2) CNAP HD monitor, CNSystems (Graz, Austria). BP responses were quantified using magnitude and latency of the different phases of the VM. Measurements were compared using paired t-tests, 2 sided, using SPSS version 28.

Results 32 patients were included, average age was 60.9±15.1 years, 19 (59%) were female. Significant differences in the detection of BP changes between the devices were seen for the magnitude of the drop of BP during early phase II (Δ systolic BP, NOVA 36.9±18.0 vs CNAP 28.2±15.4mmHg, p<0.001) and phase IV overshoot (Δ systolic BP, NOVA 53.9±20.2 vs CNAP 39.4±18.0mmHg, p<0.001), while BP recovery during late phase II (Δ systolic BP, NOVA 8.9±7.1 vs CNAP 9.2±8.1mmHg, p=0.79) and BP recovery time (NOVA 5.5±5.5 vs CNAP 5.1±5.3sec, p=0.72) were measured comparably by the two devices.

Conclusions Findings confirm anecdotal observations of differences in the detection of rapid BP changes, resulting in an overall greater magnitude of BP swings reflected by NOVA compared to CNAP. However, the most important indices used to determine cardiovascular adrenergic failure were similar, suggesting both devices can be confidently used if the different appearance of waveforms is considered.

Authors/Disclosures
David M. Sletten, MBA (Mayo Clinic) PRESENTER	Mr. Sletten has nothing to disclose.
Jade Gehrking (Mayo Clinic, Neurology Dept)	Jade Gehrking has nothing to disclose.
Damaris Conley (Mayo Clinic)	No disclosure on file
Sarah McNamara (Mayo Clinic)	No disclosure on file
Phillip A. Low, MD, FAAN (Mayo Clinic)	Dr. Low has nothing to disclose.
Wolfgang Singer, MD, FAAN (Mayo Clinic)	Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theravance. The institution of Dr. Singer has received research support from NIH. The institution of Dr. Singer has received research support from FDA. The institution of Dr. Singer has received research support from Michael J. Fox Foundation. Dr. Singer has received intellectual property interests from a discovery or technology relating to health care.

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