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Peer-reviewedCC BY 4.0Frontiers in Physiology

Agreement between upper-arm and wrist cuff occlusion for the assessment of vascular reactivity by digital thermal monitoring

  • Hamidreza Mohammadi1
  • Ali Hashemi1
  • Timothy O’Brien2
  • Hamed Ghoshouni1
  • Hirofumi Tanaka3
  • Robert A. Kloner4,5
  • Morteza Naghavi1
5 affiliations
  1. 1American Heart Technologies, Houston, TX, United States
  2. 2Temperature Specialists Inc., St. Francis, MN, United States
  3. 3The University of Texas at Austin, Austin, TX, United States
  4. 4Huntington Medical Research Institutes, Pasadena, CA, United States
  5. 5Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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Abstract

Background: Digital Thermal Monitoring (DTM) is an automated method for assessing vascular reactivity using the vascular reactivity index (VRI), a temperature-derived surrogate marker associated with endothelial function. Standard DTM requires five minutes of supra-systolic upper-arm cuff occlusion, which may cause discomfort and limit feasibility in some individuals. Whether wrist cuff occlusion provides comparable VRI measurements remains unknown.

Methods: In this method-comparison study, 48 healthy adults underwent DTM assessment using both upper-arm and wrist cuff occlusion in randomized order during the same visit. Agreement between the two occlusion sites for VRI, pulse rate (PR), and blood pressure (BP) was evaluated using paired comparisons and agreement analyses.

Results: Mean VRI was 1.70 ± 0.33 with upper-arm cuff occlusion and 1.76 ± 0.34 with wrist cuff occlusion, with no significant difference between sites (mean difference 0.06, 95% CI −0.04 to 0.15; p=0.25) and no significant proportional bias. Agreement for VRI was moderate (ICC = 0.53, 95% CI 0.29–0.70). In contrast, wrist measurements overestimated systolic BP by 10.5 mmHg (95% CI 7.3–13.7; p<0.001) and diastolic BP by 10 mmHg (95% CI 7.1–12.9; p<0.001), with poor agreement (ICC = 0.29, 95% CI −0.05 to 0.56 and ICC = 0.18, 95% CI −0.07 to 0.43, respectively).

Conclusions: Wrist cuff occlusion provides similar mean VRI values to upper-arm occlusion but demonstrates only moderate agreement at the individual level. Further studies with larger and more diverse populations, including repeated measurements, are required assessment before wrist and upper-arm cuff occlusion can be considered interchangeable for individual assessment.

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Cite

BibTeXRIS
BibTeX
@article{mohammadi2026agreement,
  title = {{Agreement between upper-arm and wrist cuff occlusion for the assessment of vascular reactivity by digital thermal monitoring}},
  author = {Hamidreza Mohammadi and Ali Hashemi and Timothy O’Brien and Hamed Ghoshouni and Hirofumi Tanaka and Robert A. Kloner and Morteza Naghavi},
  journal = {Frontiers in Physiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fphys.2026.1961953},
  url = {https://doi.org/10.3389/fphys.2026.1961953},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Agreement between upper-arm and wrist cuff occlusion for the assessment of vascular reactivity by digital thermal monitoring
AU  - Hamidreza Mohammadi
AU  - Ali Hashemi
AU  - Timothy O’Brien
AU  - Hamed Ghoshouni
AU  - Hirofumi Tanaka
AU  - Robert A. Kloner
AU  - Morteza Naghavi
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Physiology
DO  - 10.3389/fphys.2026.1961953
UR  - https://doi.org/10.3389/fphys.2026.1961953
AB  - Background: Digital Thermal Monitoring (DTM) is an automated method for assessing vascular reactivity using the vascular reactivity index (VRI), a temperature-derived surrogate marker associated with endothelial function. Standard DTM requires five minutes of supra-systolic upper-arm cuff occlusion, which may cause discomfort and limit feasibility in some individuals. Whether wrist cuff occlusion provides comparable VRI measurements remains unknown.  Methods: In this method-comparison study, 48 healthy adults underwent DTM assessment using both upper-arm and wrist cuff occlusion in randomized order during the same visit. Agreement between the two occlusion sites for VRI, pulse rate (PR), and blood pressure (BP) was evaluated using paired comparisons and agreement analyses.  Results: Mean VRI was 1.70 ± 0.33 with upper-arm cuff occlusion and 1.76 ± 0.34 with wrist cuff occlusion, with no significant difference between sites (mean difference 0.06, 95% CI −0.04 to 0.15; p=0.25) and no significant proportional bias. Agreement for VRI was moderate (ICC = 0.53, 95% CI 0.29–0.70). In contrast, wrist measurements overestimated systolic BP by 10.5 mmHg (95% CI 7.3–13.7; p<0.001) and diastolic BP by 10 mmHg (95% CI 7.1–12.9; p<0.001), with poor agreement (ICC = 0.29, 95% CI −0.05 to 0.56 and ICC = 0.18, 95% CI −0.07 to 0.43, respectively).  Conclusions: Wrist cuff occlusion provides similar mean VRI values to upper-arm occlusion but demonstrates only moderate agreement at the individual level. Further studies with larger and more diverse populations, including repeated measurements, are required assessment before wrist and upper-arm cuff occlusion can be considered interchangeable for individual assessment.
SN  - 1664-042X
ER  -