Relation of digital arterial dysfunction to alternative frequency weightings of hand-transmitted vibration.

This study compared the relative performance of alternative frequency weightings of hand-transmitted vibration (HTV) to predict the extent of cold-induced vasoconstriction in the digital arteries of HTV workers. The cold response of digital arteries was related to measures of daily vibration exposure expressed in terms of r.m.s. acceleration magnitude normalised to an 8-h day, frequency weighted according to either the frequency weighting Wh defined in international standard ISO 5349-1:2001 (Ah(8) in ms-2 r.m.s.) or the hand-arm vascular frequency weighting Wp proposed in the ISO Technical Report 18570:2007 (Ap(8) in ms-2 r.m.s.). The measure of daily vibration exposure constructed with the frequency weighting Wp (Ap(8)) was a better predictor of the cold response of the digital arteries in the HTV workers than the metric derived from the conventional ISO frequency weighting Wh (Ah(8)). This finding suggests that a measure of daily vibration exposure constructed with the vascular weighting Wp, which gives more weight to intermediate- and high-frequency vibration (31.5-250 Hz), performed better for the prediction of cold induced digital arterial hyperresponsiveness than that obtained with the frequency weighting Wh recommended in ISO 5349-1 which gives more importance to lower frequency vibration (≤16 Hz).

Analyzing the results of finger systolic blood pressure tests in 28 healthy young adults / 中国职业医学

Objective To investigate the level of finger systolic blood pressure (FSBP) in healthy young adults. Methods A total of 28 healthy young adults were selected as the study subjects by convenient sampling method. The FSBP of the study subjects was detected at 30 and 10 ℃, and the FSBP index (Fi) was calculated. Results The FSBP of the study subjects at 30 and 10 ℃ were (102.0±16.5) and (104.4±15.2) mmHg, respectively. The FSBP in male group at 30 and 10 ℃ was (99.6±18.6) and (107.2±17.0) mmHg, respectively. The FSBP in female group at 30 and 10 ℃ was (104.4±13.9) and (101.5±2.8) mmHg, respectively. The results of factorial analysis showed that the interaction between gender and temperature on FSBP was statistically significant (P<0.05). FSBP in male group was higher at 10 than 30 ℃ (P<0.05) and higher than female group at 10 ℃ (P<0.05). There was no statistical significance for the main effect of gender, temperature, finger, or the interaction effect of gender and finger, temperature and finger for FSBP (all P>0.05). The average Fi of the study subjects was (98.0±16.6)%, with males and females having the average Fi of (100.7±20.7) % and (95.2±10.6) % respectively. The results of factorial analysis of variance showed that there was no significant difference on Fi in the main effect gender and fingers or the interaction effect between them(all P>0.05). Conclusion The FSBP test could be used as a detection method for assessing peripheral microcirculation function in Chinese population. However, further research is needed to establish reference ranges and influencing factors.

Digital pressure with laser Doppler flowmetry is better than photoplethysmography to characterize peripheral arterial disease of the upper limbs in end-stage renal disease patients.

OBJECTIVE: There is no consensual definition of significant peripheral arterial disease of the upper limbs. Patients with end-stage renal disease are usually explored with Doppler ultrasound, which seems insufficient to characterize and quantify the arterial disease in this anatomic site. Candidates for haemodialysis access tend to be increasingly older and have polyvascular disease, and a better assessment of the vascular status of their upper limbs with finger systolic blood pressure is necessary. Photoplethysmography is simple and currently used in practice, but laser Doppler flowmetry may be more sensitive for low values. Our objective is to investigate additional information in the digit assessment over the ultrasound assessment of the upper limbs of patients awaiting haemodialysis and compare digital pressure values taken by photoplethysmography and laser Doppler. METHODS: All included patients with end-stage renal disease scheduled for haemodialysis access received a prospective evaluation of their upper limbs with a clinical examination of the hands, an arterial upper limb Doppler ultrasound, and finger systolic blood pressure using photoplethysmography and laser Doppler flowmetry. Significant upper limb arterial disease was defined by a finger systolic blood pressure below 60 mm Hg or a finger brachial pressure index below 0.7. RESULTS: Twenty-four patients were included in the study. In all, 41.7% of patients (n = 10) had parietal calcifications to the antebrachial arteries on Doppler ultrasound, 8.3% of patients (n = 2) had bilateral finger systolic blood pressure values below 60 mm Hg with laser Doppler flowmetry (but not confirmed with photoplethysmography), and 16.6% of patients (n = 4) had a finger brachial pressure index below 0.7 on both laser Doppler flowmetry and photoplethysmography. While there was an agreement between these two methods, higher values were recorded with photoplethysmography. The Pearson coefficient was 0.493 for the median of basal digital pressures in absolute values and 0.489 for finger brachial pressure index (p < 0.001). CONCLUSION: Our study confirms the need to evaluate significant upper limb arterial disease in patients with end-stage renal disease not only with Doppler ultrasound but also with an evaluation of the finger systolic blood pressure. The correlation of the finger systolic blood pressure values using laser Doppler flowmetry and photoplethysmography was poor, which was probably due to an overestimation of the pressures with photoplethysmography. Despite the absence of a gold standard, we suggest that Laser Doppler flowmetry should be used rather than photoplethysmography to better characterize significant peripheral arterial disease of the upper limbs in patients with end-stage renal disease, particularly before creation of a new haemodialysis access. Protocol Record on clinical trial 38RC19.285.

Performance of finger systolic blood pressure measurement to detect digital occlusive arterial disease in systemic sclerosis.

OBJECTIVE: Digital ulcers related to digital occlusive arterial disease (DOAD) are frequent in patients with SSc. Finger systolic blood pressure (FSBP) and digital-brachial pressure index (DBI) using laser Doppler flowmetry constitute a non-invasive means of detecting DOAD in SSc, although thresholds have yet to be established for defining DOAD. The purpose of this study was to ascertain FSBP and DBI thresholds to detect DOAD in SSc patients. The intra/interday reproducibility of curve reading by four vascular physicians in relation to finger pressure measurement was also investigated. METHODS: SSc patients were followed in this single-centre study (Rennes University Hospital, France) between November 2017 and October 2019.These patients underwent tests before and after heating at two visits spaced 10 days apart. DOAD was diagnosed on the basis of post-warming skin blood flow of ≤206 arbitrary units measured by laser Doppler flowmetry, contingent on previous results validated by arteriography as a gold standard. An interday kappa coefficient with a 95% confidence interval was used to assess reproducibility. RESULTS: Sixteen [10 females; mean age: 63 (9) years] SSc patients were included. Mean time interval between visits was 9 (5) days. The best FSBP threshold for DOAD diagnosis was 76 mmHg and DBI was 0.74 after warming. FSBP and DBI sensitivity/specificity were 59.1% (95% CI: 49.6, 68.5%)/92.5% (95% CI: 85.3, 99.6%) and 73.3% (95% CI: 64.9, 81.8%)/83.0% (95% CI: 72.9, 93.1%), respectively. Intra/interday reproducibility ranged from fair to good. CONCLUSION: The conclusions drawn from this study suggest that FSBP ≤ 76 mmHg and DBI ≤ 0.74 thresholds are potentially reliable indicators of DOAD and demonstrate fair to good intra- and interday reproducibility. TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03264820.

Application of finger systolic blood pressure in the diagnosis of vibration-induced vascular injury / 中国职业医学

OBJECTIVE: To evaluate the application value of finger systolic blood pressure(FSBP) in the diagnosis of vibration-induced vascular injury. METHODS: Thirty patients with vibration-induced vascular injury [vibration-induced white finger(VWF)] were selected as the case group by a non-randomized concurrent controlled trial, and 30 hand-transmitted vibration workers without VWF were selected as the control group. The FSBP test was performed on the tested hands of all subjects, and the FSBP index of each Finger(F_( i)) was measured. RESULTS: The F_i of the index finger, middle finger, ring finger and tail finger of the tested hand in the case group were lower than that in the control group(all P<0.01). In the case group, the F_i of index finger was lower than ring finger and tail finger(all P<0.01). The abnormal rates of F_i on the index, middle and ring fingers in the case group were higher than those in the control group(86.7% vs 10.0%, 76.7% vs 13.3%, 43.3% vs 10.0%, all P<0.01). The area under the receiver operator characteristic curve of the measured F_i of the index finger, middle finger, ring finger and tail finger were 0.884, 0.843, 0.764 and 0.687 respectively. The diagnostic cut off value of the F_i of index finger was 80.2%. The sensitivity and specificity were 86.7% and 90.0%, respectively. CONCLUSION: FSBP test has a good application value in the diagnosis of vibration-induced vascular injuries. It is suggested that the F_i of index finger be the first choice as the diagnostic index, and the abnormal value can be set at 80.0%.

Optimizing finger systolic blood pressure measurements with laser Doppler: Validation of the second phalanx site.

OBJECTIVE: Finger systolic blood pressure measurement (FSBP) has been shown helpful in the detection of distal arterial insufficiency in upper limbs. This work assesses the possibility to measure FSBP on the 2nd phalanx instead of the first one in order to improve its sensitivity and to verify this would not alter the repeatability of the measurement. METHODS: In this multicenter study, FSBP was measured twice in all fingers but the thumbs in consecutive systemic sclerosis patients on the first phalanx and the second phalanx in alternate order using laser-Doppler flowmetry. RESULTS: Thirty-seven patients were enrolled. The repeatability of FSBP was excellent and similar on the first and 2nd phalanxes with coefficients of variation respectively of 7.1% and 7.6%. While the correlation between the FSBP at the two sites was fair (Pearson coefficient 0.69; p < 0.001). The agreement was poor, with a mean difference of 14 mm Hg between the two sites. Significantly higher differences were found in fingers with digital ulcers. The ROC curves showed a better prediction of the 2nd phalanx measurements. CONCLUSION: FSBP has an excellent repeatability whatever the site of phalanx. However, measurements performed on the 2nd phalanx have a better sensitivity for the prediction of digital ulcers.

Effect of room temperature on tests for diagnosing vibration-induced white finger: finger rewarming times and finger systolic blood pressures.

PURPOSE: This study investigates the effects of room temperature on two standard tests used to assist the diagnosis of vibration-induced white finger (VWF): finger rewarming times and finger systolic blood pressures. METHODS: Twelve healthy males and twelve healthy females participated in four sessions to obtain either finger skin temperatures (FSTs) during cooling and rewarming of the hand or finger systolic blood pressures (FSBPs) after local cooling of the fingers to 15 and 10 °C. The measures were obtained with the room temperature at either 20 or 28 °C. RESULTS: There were lower baseline finger skin temperatures, longer finger rewarming times, and lower finger systolic blood pressures with the room temperature at 20 than 28 °C. However, percentage reductions in FSBP at 15 and 10 °C relative to 30 °C (i.e. %FSBP) did not differ between the two room temperatures. Females had lower baseline FSTs, longer rewarming times, and lower FSBPs than males, but %FSBPs were similar in males and females. CONCLUSIONS: Finger rewarming times after cold provocation are heavily influenced by room temperature and gender. For evaluating peripheral circulatory function using finger rewarming times, the room temperature must be strictly controlled, and a different diagnostic criterion is required for females. The calculation of percentage changes in finger systolic blood pressure at 15 and 10 °C relative to 30 °C reduces effects of both room temperature and gender, and the test may be used in conditions where the ±1 °C tolerance on room temperature required by the current standard cannot be achieved.

Assessment of two alternative standardised tests for the vascular component of the hand-arm vibration syndrome (HAVS).

BACKGROUND: Vibration-induced white finger (VWF) is the vascular component of the hand-arm vibration syndrome (HAVS). Two tests have been standardised so as to assist the diagnosis of VWF: the measurement of finger rewarming times and the measurement of finger systolic blood pressures (FSBPs). OBJECTIVES: This study investigates whether the two tests distinguish between fingers with and without symptoms of whiteness and compares individual results between the two test methods. METHODS: In 60 men reporting symptoms of the HAVS, the times for their fingers to rewarm by 4°C (after immersion in 15°C water for 5 min) and FSBPs at 30°C, 15°C and 10°C were measured on the same day. RESULTS: There were significant increases in finger rewarming times and significant reductions in FSBPs at both 15°C and 10°C in fingers reported to suffer blanching. The FSBPs had sensitivities and specificities >90%, whereas the finger rewarming test had a sensitivity of 77% and a specificity of 79%. Fingers having longer rewarming times had lower FSBPs at both temperatures. CONCLUSIONS: The findings suggest that, when the test conditions are controlled according to the relevant standard, finger rewarming times and FSBPs can provide useful information for the diagnosis of VWF, although FSBPs are more sensitive and more specific.

Standardization of finger systolic blood pressure (FSBP) cooling tests.

A finger systolic blood pressure (FSBP) cooling test was introduced in 1977 and standardized during the following years for the optimal provocation and best characterization of an attack of vasospastic Raynaud's phenomenon (RP). The purpose of the present review is to compare and analyse some different techniques used in FSBP cooling tests from different countries and described in the final draft of the international standard, ISO/DIS 14835-2 (2004). The selected FSBP test results indicate to some extent that the tests are reliable and have acceptable diagnostic values despite the use of different techniques to obtain them. However, only a few studies used a zero-pressure FSBP%(0) to verify an ongoing attack of vasospastic RP. Most studies used an abnormal cold reaction FSBP%(A) located below the lower limit of controls, to make the anamnestic diagnosis of RP probable. According to the ISO draft, different types of finger cooling and body thermostating can be used together in the seated or supine position, and FSBP%(A) is indicated to be used for diagnostic purposes. Further studies are recommended to solve future standardization problems not included in the upcoming ISO standard. An international agreement on the presentation and comparison of test results is needed as a supplement to ISO/DIS 14835-2.

Test battery for assessing vascular disturbances of fingers.

The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital arteries is episodic and results in a characteristic blanching that is rarely observed by a clinician. Objective measurements of the response of the digital circulation to cold can assist in evaluating a patient for VWF. Finger systolic blood pressure (FSBP) following local cooling is a measure of cold-induced vasoconstriction in digital arteries and is an assessment of vasomotor tone. Low FSBPs following cooling are indicative of dysfunction. Finger skin temperature (FST) following hand cooling is a measure of cutaneous blood flow. The mechanism underlying the recovery of cutaneous blood flow following cooling is as yet not fully understood, but a delayed recovery is believed to arise from persistent vascular disturbances of the fingers or from a resulting in conflicting opinions concerning the utility of the measurements, a scarcity of comparable data from epidemiological investigations, and limited normative data to aid clinicians in decision-making. This review of evidence on which the tests are based is aimed at providing clinicians and researchers with an understanding of the factors that must be considered when conducting the tests, interpreting the results, and comparing results between different studies.

Factors influencing finger systolic blood pressure test for diagnosis of vibration-induced white finger.

Finger systolic blood pressure (FSBP) measurement during finger cooling is a feasible method for the diagnosis of vibration-induced white finger (VWF). The standardization of the FSBP test is required. The final draft of an international standard for the measurement and evaluation of FSBP (ISO/DIS 14835-2) has been proposed in 2004. The aim of this review is to overview factors influencing the FSBP test and discuss some issues in the final draft. The FSBP test is a method of diagnosing VWF with reasonable sensitivity and specificity, although the sensitivity was relatively low in studies of mild VWF. The test results depend on cold provocation procedures including finger cooling, body cooling, room temperature and other factors such clothing and smoking. There are some versions of procedures for cold provocation and the tested fingers in the final draft. These may cause a low sensitivity of the FSBP test. To determine how the methodological difference influence the results of the FSBP test, further studies are needed. Although there are issues in the draft, the international standard of the FSBP test is extremely useful for the diagnosis, treatment and compensation of VWF.

Factors Influencing Finger Systolic Blood Pressure Test for Diagnosis of Vibration-Induced White Finger

Finger systolic blood pressure (FSBP) measurement during finger cooling is a feasible method for the diagnosis of vibration-induced white finger (VWF). The standardization of the FSBP test is required. The final draft of an international standard for the measurement and evaluation of FSBP (ISO/DIS 14835-2) has been proposed in 2004. The aim of this review is to overview factors influencing the FSBP test and discuss some issues in the final draft. The FSBP test is a method of diagnosing VWF with reasonable sensitivity and specificity, although the sensitivity was relatively low in studies of mild VWF. The test results depend on cold provocation procedures including finger cooling, body cooling, room temperature and other factors such clothing and smoking. There are some versions of procedures for cold provocation and the tested fingers in the final draft. These may cause a low sensitivity of the FSBP test. To determine how the methodological difference influences the results of the FSBP test, further studies are needed. Although there are issues in the draft, the international standard of the FSBP test is extremely useful for the diagnosis, treatment and compensation of VWF.

Standardization of Finger Systolic Blood Pressure (FSBP) Cooling Tests

A finger systolic blood pressure (FSBP) cooling test was introduced in 1977 and standardized during the following years for the optimal provocation and best characterization of an attack of vasospastic Raynaud’s phenomenon (RP). The purpose of the present review is to compare and analyse some different techniques used in FSBP cooling tests from different countries and described in the final draft of the international standard, ISO/DIS 14835-2 (2004). The selected FSBP test results indicate to some extent that the tests are reliable and have acceptable diagnostic values despite the use of different techniques to obtain them. However, only a few studies used a zero-pressure FSBP%(0) to verify an ongoing attack of vasospastic RP. Most studies used an abnormal cold reaction FSBP%(A), located below the lower limit of controls, to make the anamnestic diagnosis of RP probable. According to the ISO draft, different types of finger cooling and body thermostating can be used together in the seated or supine position, and FSBP%(A) is indicated to be used for diagnostic purposes. Further studies are recommended to solve future standardization problems not included in the upcoming ISO standard. An international agreement on the presentation and comparison of test results is needed as a supplement to ISO/DIS 14835-2.

Test Battery for Assessing Vascular Disturbances of Fingers

The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital arteries is episodic and results in a characteristic blanching that is rarely observed by a clinician. Objective measurements of the response of the digital circulation to cold can assist in evaluating a patient for VWF. Finger systolic blood pressure (FSBP) following local cooling is a measure of cold-induced vasoconstriction in digital arteries and is an assessment of vasomotor tone. Low FSBPs following cooling are indicative of dysfunction. Finger skin temperature (FST) following hand cooling is a measure of cutaneous blood flow. The mechanism underlying the recovery of cutaneous blood flow following cooling is as yet not fully understood, but a delayed recovery is believed to arise from persistent vascular disturbances of the fingers or from a delayed release of vasospasm, or both. There are various methods of conducting both of these tests, resulting in conflicting opinions concerning the utility of the measurements, a scarcity of comparable data from epidemiological investigations, and limited normative data to aid clinicians in decision-making. This review of evidence on which the tests are based is aimed at providing clinicians and researchers with an understanding of the factors that must be considered when conducting the tests, interpreting the results, and comparing results between different studies.

Test battery for assessing vascular disturbances of fingers

The diagnosis of vibration-induced white finger (VWF) is difficult, often relying on medical interview and history. The condition is characterized by an exaggerated vasoconstriction of digital arteries in response to cold. The complete closure of digital arteries is episodic and results in a characteristic blanching that is rarely observed by a clinician. Objective measurements of the response of the digital circulation to cold can assist in evaluating a patient for VWF. Finger systolic blood pressure (FSBP) following local cooling is a measure of cold-induced vasoconstriction in digital arteries and is an assessment of vasomotor tone. Low FSBPs following cooling are indicative of dysfunction. Finger skin temperature (FST) following hand cooling is a measure of cutaneous blood flow. The mechanism underlying the recovery of cutaneous blood flow following cooling is as yet not fully understood, but a delayed recovery is believed to arise from persistent vascular disturbances of the fingers or from a resulting in conflicting opinions concerning the utility of the measurements, a scarcity of comparable data from epidemiological investigations, and limited normative data to aid clinicians in decision-making. This review of evidence on which the tests are based is aimed at providing clinicians and researchers with an understanding of the factors that must be considered when conducting the tests, interpreting the results, and comparing results between different studies.

Standardization of finger systolic blood pressure (FSBP) cooling tests

A finger systolic blood pressure (FSBP) cooling test was introduced in 1977 and standardized during the following years for the optimal provocation and best characterization of an attack of vasospastic Raynaud's phenomenon (RP). The purpose of the present review is to compare and analyse some different techniques used in FSBP cooling tests from different countries and described in the final draft of the international standard, ISO/DIS 14835-2 (2004). The selected FSBP test results indicate to some extent that the tests are reliable and have acceptable diagnostic values despite the use of different techniques to obtain them. However, only a few studies used a zero-pressure FSBP%(0) to verify an ongoing attack of vasospastic RP. Most studies used an abnormal cold reaction FSBP%(A) located below the lower limit of controls, to make the anamnestic diagnosis of RP probable. According to the ISO draft, different types of finger cooling and body thermostating can be used together in the seated or supine position, and FSBP%(A) is indicated to be used for diagnostic purposes. Further studies are recommended to solve future standardization problems not included in the upcoming ISO standard. An international agreement on the presentation and comparison of test results is needed as a supplement to ISO/DIS 14835-2.

Factors influencing finger systolic blood pressure test for diagnosis of vibration-induced white finger

Finger systolic blood pressure (FSBP) measurement during finger cooling is a feasible method for the diagnosis of vibration-induced white finger (VWF). The standardization of the FSBP test is required. The final draft of an international standard for the measurement and evaluation of FSBP (ISO/DIS 14835-2) has been proposed in 2004. The aim of this review is to overview factors influencing the FSBP test and discuss some issues in the final draft. The FSBP test is a method of diagnosing VWF with reasonable sensitivity and specificity, although the sensitivity was relatively low in studies of mild VWF. The test results depend on cold provocation procedures including finger cooling, body cooling, room temperature and other factors such clothing and smoking. There are some versions of procedures for cold provocation and the tested fingers in the final draft. These may cause a low sensitivity of the FSBP test. To determine how the methodological difference influence the results of the FSBP test, further studies are needed. Although there are issues in the draft, the international standard of the FSBP test is extremely useful for the diagnosis, treatment and compensation of VWF.