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Physiological and clinical insights from reservoir-excess pressure analysis. J Hum Hypertens 2021; 35:758-768. [PMID: 33750902 PMCID: PMC7611663 DOI: 10.1038/s41371-021-00515-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
There is a growing body of evidence indicating that reservoir-excess pressure model parameters provide physiological and clinical insights above and beyond standard blood pressure (BP) and pulse waveform analysis. This information has never been collectively examined and was the aim of this review. Cardiovascular disease is the leading cause of mortality worldwide, with BP as the greatest cardiovascular disease risk factor. However, brachial systolic and diastolic BP provide limited information on the underlying BP waveform, missing important BP-related cardiovascular risk. A comprehensive analysis of the BP waveform is provided by parameters derived via the reservoir-excess pressure model, which include reservoir pressure, excess pressure, and systolic and diastolic rate constants and Pinfinity. These parameters, derived from the arterial BP waveform, provide information on the underlying arterial physiology and ventricular-arterial interactions otherwise missed by conventional BP and waveform indices. Application of the reservoir-excess pressure model in the clinical setting may facilitate a better understanding and earlier identification of cardiovascular dysfunction associated with disease. Indeed, reservoir-excess pressure parameters have been associated with sub-clinical markers of end-organ damage, cardiac and vascular dysfunction, and future cardiovascular events and mortality beyond conventional risk factors. In the future, greater understanding is needed on how the underlying physiology of the reservoir-excess pressure parameters informs cardiovascular disease risk prediction over conventional BP and waveform indices. Additional consideration should be given to the application of the reservoir-excess pressure model in clinical practice using new technologies embedded into conventional BP assessment methods.
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Aizawa K, Casanova F, Gates PE, Mawson DM, Gooding KM, Strain WD, Östling G, Nilsson J, Khan F, Colhoun HM, Palombo C, Parker KH, Shore AC, Hughes AD. Reservoir-Excess Pressure Parameters Independently Predict Cardiovascular Events in Individuals With Type 2 Diabetes. Hypertension 2021; 78:40-50. [PMID: 34058850 DOI: 10.1161/hypertensionaha.121.17001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Kunihiko Aizawa
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - Francesco Casanova
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - Phillip E Gates
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - David M Mawson
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - Kim M Gooding
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - W David Strain
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - Gerd Östling
- Department of Clinical Sciences, Lund University, Malmö, Sweden (G.O., J.N.)
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden (G.O., J.N.)
| | - Faisel Khan
- Division of Molecular & Clinical Medicine, University of Dundee, United Kingdom (F.K.)
| | - Helen M Colhoun
- Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (H.M.C.)
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy (C.P.)
| | - Kim H Parker
- Department of Bioengineering, Imperial College, London, United Kingdom (K.H.P.)
| | - Angela C Shore
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., W.D.S., A.C.S.)
| | - Alun D Hughes
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, United Kingdom (A.D.H.)
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Hughes AD, Parker KH. The modified arterial reservoir: An update with consideration of asymptotic pressure ( P∞) and zero-flow pressure ( Pzf). Proc Inst Mech Eng H 2020; 234:1288-1299. [PMID: 32367773 PMCID: PMC7705641 DOI: 10.1177/0954411920917557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article describes the modified arterial reservoir in detail. The modified arterial reservoir makes explicit the wave nature of both reservoir (Pres) and excess pressure (Pxs). The mathematical derivation and methods for estimating Pres in the absence of flow velocity data are described. There is also discussion of zero-flow pressure (Pzf), the pressure at which flow through the circulation ceases; its relationship to asymptotic pressure (P∞) estimated by the reservoir model; and the physiological interpretation of Pzf . A systematic review and meta-analysis provides evidence that Pzf differs from mean circulatory filling pressure.
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Affiliation(s)
- Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, UK
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Fortier C, Côté G, Mac-Way F, Goupil R, Desbiens LC, Desjardins MP, Marquis K, Hametner B, Wassertheurer S, Schultz MG, Sharman JE, Agharazii M. Prognostic Value of Carotid and Radial Artery Reservoir-Wave Parameters in End-Stage Renal Disease. J Am Heart Assoc 2019; 8:e012314. [PMID: 31220992 PMCID: PMC6662378 DOI: 10.1161/jaha.119.012314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Reservoir-wave approach is an alternative model of arterial hemodynamics based on the assumption that measured arterial pressure is composed of volume-related (reservoir pressure) and wave-related components (excess pressure). However, the clinical utility of reservoir-wave approach remains debatable. Methods and Results In a single-center cohort of 260 dialysis patients, we examined whether carotid and radial reservoir-wave parameters were associated with all-cause and cardiovascular mortality. Central pulse pressure and augmentation index at 75 beats per minute were determined by radial arterial tonometry through generalized transfer function. Carotid and radial reservoir-wave analysis were performed to determine reservoir pressure and excess pressure integral. After a median follow-up of 32 months, 171 (66%) deaths and 88 (34%) cardiovascular deaths occurred. In Cox regression analysis, carotid excess pressure integral was associated with a hazard ratio of 1.33 (95% CI , 1.14-1.54; P<0.001 per 1 SD) for all-cause and 1.45 (95% CI : 1.18-1.75; P<0.001 per 1 SD) for cardiovascular mortality. After adjustments for age, heart rate, sex, clinical characteristics and carotid-femoral pulse wave velocity, carotid excess pressure integral was consistently associated with increased risk of all-cause (hazard ratio per 1 SD, 1.30; 95% CI : 1.08-1.54; P=0.004) and cardiovascular mortality (hazard ratio per 1 SD, 1.31; 95% CI : 1.04-1.63; P=0.019). Conversely, there were no significant associations between radial reservoir-wave parameters, central pulse pressure, augmentation index at 75 beats per minute, pressure forward, pressure backward and reflection magnitude, and all-cause or cardiovascular mortality after adjustment for comorbidities. Conclusions These observations support the clinical value of reservoir-wave approach parameters of large central elastic vessels in end-stage renal disease.
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Affiliation(s)
- Catherine Fortier
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Gabrielle Côté
- 2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Fabrice Mac-Way
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Rémi Goupil
- 3 Hôpital du Sacré-Cœur de Montréal Montréal Quebec Canada
| | - Louis-Charles Desbiens
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Marie-Pier Desjardins
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
| | - Karine Marquis
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada
| | - Bernhard Hametner
- 4 Center for Health & Bioresources AIT Austrian Institute of Technology Vienna Austria
| | | | - Martin G Schultz
- 5 Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | - James E Sharman
- 5 Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | - Mohsen Agharazii
- 1 CHU de Québec Research Center L'Hôtel-Dieu de Québec Hospital Québec Quebec Canada.,2 Division of Nephrology Faculty of Medicine Université Laval Québec Quebec Canada
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Huang JT, Cheng HM, Yu WC, Lin YP, Sung SH, Wang JJ, Wu CL, Chen CH. Value of Excess Pressure Integral for Predicting 15-Year All-Cause and Cardiovascular Mortalities in End-Stage Renal Disease Patients. J Am Heart Assoc 2017; 6:JAHA.117.006701. [PMID: 29187389 PMCID: PMC5779003 DOI: 10.1161/jaha.117.006701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The excess pressure integral (XSPI), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high-risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long-term mortality in end-stage renal disease patients undergoing regular hemodialysis. METHODS AND RESULTS A total of 267 uremic patients (50.2% female; mean age 54.2±14.9 years) receiving regular hemodialysis for more than 6 months were enrolled. Cardiovascular parameters were obtained by echocardiography and applanation tonometry. Calibrated carotid arterial pressure waveforms were analyzed according to the wave-transmission and reservoir-wave theories. Multivariable Cox proportional hazard models were constructed to account for age, sex, diabetes mellitus, albumin, body mass index, and hemodialysis treatment adequacy. Incremental utility of the parameters to risk stratification was assessed by net reclassification improvement. During a median follow-up of 15.3 years, 124 deaths (46.4%) incurred. Baseline XSPI was significantly predictive of all-cause (hazard ratio per 1 SD 1.4, 95% confidence interval 1.15-1.70, P=0.0006) and cardiovascular mortalities (1.47, 1.18-1.84, P=0.0006) after accounting for the covariates. The addition of XSPI to the base prognostic model significantly improved prediction of both all-cause mortality (net reclassification improvement=0.1549, P=0.0012) and cardiovascular mortality (net reclassification improvement=0.1535, P=0.0033). XSPI was superior to carotid-pulse wave velocity, forward and backward wave amplitudes, and left ventricular ejection fraction in consideration of overall independent and incremental prognostics values. CONCLUSIONS In end-stage renal disease patients undergoing regular hemodialysis, XSPI was significantly predictive of long-term mortality and demonstrated an incremental value to conventional prognostic factors.
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Affiliation(s)
- Jui-Tzu Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan .,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Education, Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Ping Lin
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiun-Jr Wang
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chung-Li Wu
- Department of Medical Education, Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan .,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Education, Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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