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Svačinová J, Hrušková J, Jakubík J, Budinskaya K, Hidegová S, Fabšík M, Sieglová H, Kaščáková Z, Novák J, Nováková Z. Variability of peripheral pulse wave velocity in patients with diabetes mellitus type 2 during orthostatic challenge. Physiol Res 2020; 69:S433-S441. [PMID: 33471543 DOI: 10.33549/physiolres.934594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus 2 (DM2) is the seventh cause of death worldwide. One of the reasons is late diagnosis of vascular damage. Pulse wave velocity (PWV) has become an independent marker of arterial stiffness and cardiovascular risk. Moreover, the previous studies have shown the importance of beat-to-beat PWV measurement due to its variability among the heart cycle. However, variability of PWV (PWVv) of the whole body hasn't been examined yet. We have studied a group of DM II and heathy volunteers, to investigate the beat-to-beat mean PWV (PWVm) and PWVv in the different body positions. PWV of left lower and upper extremities were measured in DM2 (7 m/8 f, age 68+/-10 years, BP 158/90+/-19/9 mm Hg) and healthy controls (5 m/6 f, age 23+/-2 years, BP 117/76+/-9/5 mm Hg). Volunteers were lying in the resting position and of head-up-tilt in 45° (HUT) for 6 min. PWVv was evaluated as a mean power spectrum in the frequency bands LF and HF (0.04-0.15 Hz, 0.15-0.5 Hz). Resting PWVm of upper extremity was higher in DM2. HUT increased lower extremity PWVm only in DM2. Extremities PWVm ratio was significantly lower in DM2 during HUT compared to controls. LF and HF PWVv had the same response to HUT. Resting PWVv was higher in DM2. Lower extremity PWVv increased during HUT in both groups. PWVm and PWVv in DM2 differed between extremities and were significantly influenced by postural changes due to hydrostatic pressure. Increased resting PWVm and PWVv in DM2 is a marker of increased arterial stiffness.
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Affiliation(s)
- J Svačinová
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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MEMS-Based Pulse Wave Sensor Utilizing a Piezoresistive Cantilever. SENSORS 2020; 20:s20041052. [PMID: 32075243 PMCID: PMC7070847 DOI: 10.3390/s20041052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 01/18/2023]
Abstract
This paper reports on a microelectromechanical systems (MEMS)-based sensor for pulse wave measurement. The sensor consists of an air chamber with a thin membrane and a 300-nm thick piezoresistive cantilever placed inside the chamber. When the membrane of the chamber is in contact with the skin above a vessel of a subject, the pulse wave of the subject causes the membrane to deform, leading to a change in the chamber pressure. This pressure change results in bending of the cantilever and change in the resistance of the cantilever, hence the pulse wave of the subject can be measured by monitoring the resistance of the cantilever. In this paper, we report the sensor design and fabrication, and demonstrate the measurement of the pulse wave using the fabricated sensor. Finally, measurement of the pulse wave velocity (PWV) is demonstrated by simultaneously measuring pulse waves at two points using the two fabricated sensor devices. Furthermore, the effect of breath holding on PWV is investigated. We showed that the proposed sensor can be used to continuously measure the PWV for each pulse, which indicates the possibility of using the sensor for continuous blood pressure measurement.
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Roberts PA, Cowan BR, Liu Y, Lin ACW, Nielsen PMF, Taberner AJ, Stewart RAH, Lam HI, Young AA. Real-time aortic pulse wave velocity measurement during exercise stress testing. J Cardiovasc Magn Reson 2015; 17:86. [PMID: 26438096 PMCID: PMC4594994 DOI: 10.1186/s12968-015-0191-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulse wave velocity (PWV), a measure of arterial stiffness, has been demonstrated to be an independent predictor of adverse cardiovascular outcomes. This can be derived non-invasively using cardiovascular magnetic resonance (CMR). Changes in PWV during exercise may reveal further information on vascular pathology. However, most known CMR methods for quantifying PWV are currently unsuitable for exercise stress testing. METHODS A velocity-sensitive real-time acquisition and evaluation (RACE) pulse sequence was adapted to provide interleaved acquisition of two locations in the descending aorta (at the level of the pulmonary artery bifurcation and above the renal arteries) at 7.8 ms temporal resolution. An automated method was used to calculate the foot-to-foot transit time of the velocity pulse wave. The RACE method was validated against a standard gated phase contrast (STD) method in flexible tube phantoms using a pulsatile flow pump. The method was applied in 50 healthy volunteers (28 males) aged 22-75 years using a MR-compatible cycle ergometer to achieve moderate work rate (38 ± 22 W, with a 31 ± 12 bpm increase in heart rate) in the supine position. Central pulse pressures were estimated using a MR-compatible brachial device. Scan-rescan reproducibility was evaluated in nine volunteers. RESULTS Phantom PWV was 22 m/s (STD) vs. 26 ± 5 m/s (RACE) for a butyl rubber tube, and 5.5 vs. 6.1 ± 0.3 m/s for a latex rubber tube. In healthy volunteers PWV increased with age at both rest (R(2) = 0.31 p < 0.001) and exercise (R(2) = 0.40, p < 0.001). PWV was significantly increased at exercise relative to rest (0.71 ± 2.2 m/s, p = 0.04). Scan-rescan reproducibility at rest was -0.21 ± 0.68 m/s (n = 9). CONCLUSIONS This study demonstrates the validity of CMR in the evaluation of PWV during exercise in healthy subjects. The results support the feasibility of using this method in evaluating of patients with systemic aortic disease.
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Affiliation(s)
- Paul A Roberts
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
| | - Brett R Cowan
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1142, New Zealand.
| | - Yingmin Liu
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1142, New Zealand.
| | - Aaron C W Lin
- Greenlane Cardiovascular Unit, Auckland City Hospital, Auckland, New Zealand.
| | - Poul M F Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
- Department of Engineering Science, University of Auckland, Auckland, New Zealand.
| | - Andrew J Taberner
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
- Department of Engineering Science, University of Auckland, Auckland, New Zealand.
| | - Ralph A H Stewart
- Greenlane Cardiovascular Unit, Auckland City Hospital, Auckland, New Zealand.
| | - Hoi Ieng Lam
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1142, New Zealand.
| | - Alistair A Young
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1142, New Zealand.
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de Vecchi A, Clough RE, Gaddum NR, Rutten MC, Lamata P, Schaeffter T, Nordsletten DA, Smith NP. Catheter-induced errors in pressure measurements in vessels: an in-vitro and numerical study. IEEE Trans Biomed Eng 2015; 61:1844-50. [PMID: 24845294 PMCID: PMC6217912 DOI: 10.1109/tbme.2014.2308594] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Accurate measurement of blood pressure is important because it is a biomarker for cardiovascular disease. Diagnostic catheterization is routinely used for pressure acquisition in vessels despite being subject to significant measurement errors. To investigate these errors, this study compares pressure measurement using two different techniques in vitro and numerical simulations. Pressure was acquired in a pulsatile flow phantom using a 6F fluid-filled catheter and a 0.014” pressure wire, which is considered the current gold standard. Numerical simulations of the experimental set-up with and without a catheter were also performed. Despite the low catheter-to-vessel radius ratio, the catheter traces showed a 24% peak systolic pressure overestimation compared to the wire. The numerical models replicated this difference and indicated the cause for overestimation was the increased flow resistance due to the presence of the catheter. Further, the higher frequency pressure oscillations observed in the wire and numerical data were absent in the catheter, resulting in an overestimation of the pulse wave velocity with the latter modality. These results show that catheter geometry produces significant measurement bias in both the peak pressure and the waveform shape even with radius ratios considered acceptable in clinical practice. The wire allows for more accurate pressure quantification, in agreement with the numerical model without a catheter.
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Affiliation(s)
- Adelaide de Vecchi
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
| | - Rachel E. Clough
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
| | - Nicholas R. Gaddum
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
| | - Marcel C.M. Rutten
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - Pablo Lamata
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
| | - Tobias Schaeffter
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
| | - David A. Nordsletten
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
| | - Nicolas P. Smith
- King’s College London, Department of Biomedical Engineering and Imaging Sciences Division, St Thomas’ Hospital, London SE1 7EH, UK
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Gaddum NR, Keehn L, Guilcher A, Gomez A, Brett S, Beerbaum P, Schaeffter T, Chowienczyk P. Altered dependence of aortic pulse wave velocity on transmural pressure in hypertension revealing structural change in the aortic wall. Hypertension 2015; 65:362-9. [PMID: 25403607 DOI: 10.1161/hypertensionaha.114.04370] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortic pulse wave velocity (aPWV), a major prognostic indicator of cardiovascular events, may be augmented in hypertension as a result of the aorta being stretched by a higher distending blood pressure or by a structural change. We used a novel technique to modulate intrathoracic pressure and thus aortic transmural pressure (TMP) to examine the variation of intrathoracic aPWV with TMP in hypertensive (n=20; mean±SD age, 52.1±15.3 years; blood pressure, 159.6±21.2/92.0±15.9 mm Hg) and normotensive (n=20; age, 55.5±11.1 years; blood pressure, 124.5±11.9/72.6±9.1 mm Hg) subjects. aPWV was measured using dual Doppler probes to insonate the right brachiocephalic artery and aorta at the level of the diaphragm. Resting aPWV was greater in hypertensive compared with normotensive subjects (897±50 cm/s versus 784±43 cm/s; P<0.05). aPWV was equal in hypertensive and normotensive subjects when measured at a TMP of 96 mm Hg. However, dependence of aPWV on TMP in normotensive subjects was greater than that in hypertensive subjects (9.6±1.6 versus 3.8±0.7 cm/s per mm Hg increase in TMP, respectively, means±SEM; P<0.01). This experimental behavior was best explained by a theoretical model incorporating strain-induced recruitment of stiffer fibers in normotensive subjects and fully recruited stiffer fibers in hypertensive subjects. These results explain previous contradictory findings with respect to isobaric aPWV in hypertensive compared with normotensive subjects. They suggest that hypertension is associated with a profound change in aortic wall mechanical properties possibly because of destruction of elastin leading to less strain-induced stiffening and predisposition to aortic dissection.
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Affiliation(s)
- Nicholas R Gaddum
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Louise Keehn
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Antoine Guilcher
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Alberto Gomez
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Sally Brett
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Philipp Beerbaum
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Tobias Schaeffter
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.)
| | - Philip Chowienczyk
- From the Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom (N.R.G., A. Gomez, T.S.); King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital, London, United Kingdom (L.K., A. Guilcher, S.B., P.C.); and Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany (P.B.).
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