Test of dynamic closed-loop baroreflex and autoregulatory control of total peripheral resistance in intact and conscious sheep

Measurement of vascular tone and stroke volume baroreflex gain

The arterial baroreflex system (BRS) consists of at least three closed-loop control systems: the heart rate (HR), vascular tone (VT), and stroke volume (SV) BRSs. Whereas HR-BRS gain is well studied, VT-BRS and SV-BRS gain are not. This study aimed to develop a method for quantifying VT-BRS and SV-BRS gain using an established HR-BRS gain measurement approach. ECG and beat-to-beat blood pressure (BP) were recorded in 31 young healthy participants during three tasks. Sequences of R-to-R wave intervals (RRI) of the ECG, pulse transit time (PTT), and SV were measured to assess HR-, VT-, and SV-BRS gain using the cross-spectral technique of computing the BP-RRI, BP-PTT, and BP-SV transfer functions. Gain in each BRS arch was measured in individuals with intact BRS functioning. Functional overlap and independence was noted in the BRS arches. The implications of the proposed method are discussed.

Simulation study of autoregulation responses of peripheral circulation to systemic pulsatility

BACKGROUND

This simulation study investigated potential modulations of total peripheral resistance (TPR), due to distributed peripheral vascular activity, by means of a lumped model of the arterial tree and a non linear model of microcirculation, inclusive of local controls of blood flow and tissue-capillary fluid exchange.

RESULTS

Numerical simulations of circulation were carried out to compute TPR under different conditions of blood flow pulsatility, and to extract the pressure-flow characteristics of the cardiovascular system. Simulations showed that TPR seen by the large arteries was increased in absence of pulsatility, while it decreased with an augmented harmonic content. This is a typically non linear effect due to the contribution of active, non linear autoregulation of the peripheral microvascular beds, which also generated a nonlinear relationship between arterial blood pressure and cardiac output.

CONCLUSION

This simulation study, though focused on a simple effect attaining TPR modulation due to pulsatility, suggests that non-linear autoregulation mechanisms cannot be overlooked while studying the integrated behavior of the global cardiovascular system, including the arterial tree and the peripheral vascular bed.

Estimation of the total peripheral resistance baroreflex impulse response from spontaneous hemodynamic variability

We previously developed a mathematical analysis technique for estimating the static gain values of the arterial total peripheral resistance (TPR) baroreflex (G(A)) and the cardiopulmonary TPR baroreflex (G(C)) from small, spontaneous beat-to-beat fluctuations in arterial blood pressure, cardiac output, and stroke volume. Here, we extended the mathematical analysis so as to also estimate the entire arterial TPR baroreflex impulse response [h(A)(t)] as well as the lumped arterial compliance (AC). The extended technique may therefore provide a linear dynamic characterization of TPR baroreflex systems during normal physiological conditions from potentially noninvasive measurements. We theoretically evaluated the technique with respect to realistic spontaneous hemodynamic variability generated by a cardiovascular simulator with known system properties. Our results showed that the technique reliably estimated h(A)(t) [error = 30.2 +/- 2.6% for the square root of energy (E(A)), 19.7 +/- 1.6% for absolute peak amplitude (P(A)), 37.3 +/- 2.5% for G(A), and 33.1 +/- 4.9% for the overall time constant] and AC (error = 17.6 +/- 4.2%) under various simulator parameter values and reliably tracked changes in G(C). We also experimentally evaluated the technique with respect to spontaneous hemodynamic variability measured from seven conscious dogs before and after chronic arterial baroreceptor denervation. Our results showed that the technique correctly predicted the abolishment of h(A)(t) [E(A) = 1.0 +/- 0.2 to 0.3 +/- 0.1, P(A) = 0.3 +/- 0.1 to 0.1 +/- 0.0 s(-1), and G(A) = -2.1 +/- 0.6 to 0.3 +/- 0.2 (P < 0.05)] and the enhancement of G(C) [-0.7 +/- 0.44 to -1.8 +/- 0.2 (P < 0.05)] following the chronic intervention. Moreover, the technique yielded estimates whose values were consistent with those reported with more invasive and/or experimentally difficult methods.

Baroreflex sensitivity, blood pressure buffering, and resonance: what are the links? Computer simulation of healthy subjects and heart failure patients

The arterial baroreflex buffers slow (<0.05 Hz) blood pressure (BP) fluctuations, mainly by controlling peripheral resistance. Baroreflex sensitivity (BRS), an important characteristic of baroreflex control, is often noninvasively assessed by relating heart rate (HR) fluctuations to BP fluctuations; more specifically, spectral BRS assessment techniques focus on the BP-to-HR transfer function around 0.1 Hz. Skepticism about the relevance of BRS to characterize baroreflex-mediated BP buffering is based on two considerations: 1) baroreflex-modulated peripheral vasomotor function is not necessarily related to baroreflex-HR transfer; and 2) although BP fluctuations around 0.1 Hz (Mayer waves) might be related to baroreflex BP buffering, they are merely a not-intended side effect of a closed-loop control system. To further investigate the relationship between BRS and baroreflex-mediated BP buffering, we set up a computer model of baroreflex BP control to simulate normal subjects and heart failure patients. Output variables for various randomly chosen combinations of feedback gains in the baroreflex arms were BP resonance, BP-buffering capacity, and BRS. Our results show that BP buffering and BP resonance are related expressions of baroreflex BP control and depend strongly on the sympathetic gain to the peripheral resistance. BRS is almost uniquely determined by the vagal baroreflex gain to the sinus node. In conclusion, BP buffering and BRS are unrelated unless coupled gains in all baroreflex limbs are assumed. Hence, the clinical benefit of a high BRS is most likely to be attributed to vagal effects on the heart instead of to effective BP buffering.

System identification: a multi-signal approach for probing neural cardiovascular regulation

Short-term, beat-to-beat cardiovascular variability reflects the dynamic interplay between ongoing perturbations to the circulation and the compensatory response of neurally mediated regulatory mechanisms. This physiologic information may be deciphered from the subtle, beat-to-beat variations by using digital signal processing techniques. While single signal analysis techniques (e.g., power spectral analysis) may be employed to quantify the variability itself, the multi-signal approach of system identification permits the dynamic characterization of the neural regulatory mechanisms responsible for coupling the variability between signals. In this review, we provide an overview of applications of system identification to beat-to-beat variability for the quantitative characterization of cardiovascular regulatory mechanisms. After briefly summarizing the history of the field and basic principles, we take a didactic approach to describe the practice of system identification in the context of probing neural cardiovascular regulation. We then review studies in the literature over the past two decades that have applied system identification for characterizing the dynamical properties of the sinoatrial node, respiratory sinus arrhythmia, and the baroreflex control of sympathetic nerve activity, heart rate and total peripheral resistance. Based on this literature review, we conclude by advocating specific methods of practice and that future research should focus on nonlinear and time-varying behaviors, validation of identification methods, and less understood neural regulatory mechanisms. Ultimately, we hope that this review stimulates such future investigations by both new and experienced system identification researchers.

Theoretical considerations in the dynamic closed-loop baroreflex and autoregulatory control of total peripheral resistance

The most important goal of this study is to enhance our understanding of the crucial functional relationships that determine the behavior of the systemic circulation and its underlying physiological regulatory mechanisms with minimal modeling. To the present day, much has been said about the indirect hydraulic effects of right atrial pressure (PRA) via cardiac output (CO) on arterial pressure (Pa) through the heart and pulmonary circulation or the direct regulatory effects of PRAon Pathrough the cardiopulmonary baroreflex; however, very little attention has been given to the hydraulic influence that PRAexerts directly through the systemic circulation. The experimental data reported by Guyton et al. in 1957 demonstrated that steady-state PRAand the rate at which blood passes through the systemic circulation are locked in a functional relationship independent of any consequence of altered PRAon cardiac function. With this in mind, we emphasize the analytic algebraic analysis of the systemic circulation composed of arteries, veins, and its underlying physiological regulatory mechanisms of baroreflex and autoregulatory modulation of total peripheral resistance (TPR), where the behavior of the system can be analytically synthesized from an understanding of its minimal elements. As a result of this analysis, we present a novel mathematical method to determine short-term TPR fluctuations, which accounts for the entirety of observed Pafluctuations, and propose a new cardiovascular system identification method to delineate the actual actions of the physiological mechanisms responsible for the dynamic couplings between CO, Pa, PRA, and TPR in an individual subject.