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Aizawa K, Hughes AD, Casanova F, Gooding KM, Gates PE, Mawson DM, Williams J, Goncalves I, Nilsson J, Khan F, Colhoun HM, Palombo C, Parker KH, Shore AC. Reservoir-excess pressure parameters are independently associated with NT-proBNP in older adults. ESC Heart Fail 2024. [PMID: 38946623 DOI: 10.1002/ehf2.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/22/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024] Open
Abstract
AIMS Parameters derived from reservoir-excess pressure analysis have been demonstrated to predict cardiovascular events. Thus, altered reservoir-excess pressure parameters could have a detrimental effect on highly-perfused organs like the heart. We aimed to cross-sectionally determine whether reservoir-excess pressure parameters were associated with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in older adults. METHODS We studied 868 older adults with diverse cardiovascular risk. Reservoir-excess pressure parameters were obtained through radial artery tonometry including reservoir pressure integral, peak reservoir pressure, excess pressure integral (INTXSP), systolic rate constant (SRC) and diastolic rate constant (DRC). Plasma levels of NT-proBNP, as a biomarker of cardiac overload, were analysed by the Proximity Extension Assay technology. RESULTS Multivariable linear regression analyses revealed that all reservoir-excess pressure parameters studied were associated with NT-proBNP after adjusting for age and sex. After further adjustments for conventional cardiovascular risk factors, INTXSP [β = 0.191 (95% confidence interval, CI: 0.099, 0.283), P < 0.001], SRC [β = -0.080 (95% CI: -0.141, -0.019), P = 0.010] and DRC [β = 0.138 (95% CI: 0.073, 0.202), P < 0.001] remained associated with NT-proBNP. Sensitivity analysis found that there were occasions where the association between SRC and NT-proBNP was attenuated, but both INTXSP and DRC remained consistently associated with NT-proBNP. CONCLUSIONS The observed associations between reservoir-excess pressure parameters and NT-proBNP suggest that altered reservoir-excess pressure parameters may reflect an increased load inflicted on the left ventricular cardiomyocytes and could have a potential to be utilized in the clinical setting for cardiovascular risk stratification.
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Affiliation(s)
- Kunihiko Aizawa
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Alun D Hughes
- MRC unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Francesco Casanova
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Kim M Gooding
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Phillip E Gates
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - David M Mawson
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Jennifer Williams
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Isabel Goncalves
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Faisel Khan
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Helen M Colhoun
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Kim H Parker
- Department of Bioengineering, Imperial College, London, UK
| | - Angela C Shore
- Vascular Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
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Springall GAC, Goldsmith G, Zannino D, Cheong J, Mynard JP, Yeo M, Cheung MMH. Carotid wave analysis in young adults with a history of adolescent anorexia nervosa: a case control study. J Eat Disord 2024; 12:21. [PMID: 38308371 PMCID: PMC10835867 DOI: 10.1186/s40337-023-00963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities that may increase the risk of future cardiovascular disease. This study assessed the cardiovascular health of individuals who recovered from AN during adolescence by conducting wave power analysis. METHODS Former AN patients discharged from the Royal Children's and Monash Children's Hospitals (N = 17) in Melbourne, Australia underwent ultrasound imaging of the right carotid artery. Wave power analysis was conducted to assess biomechanical interactions of the cardiovascular system. Patient measures were compared to healthy controls (N = 51). RESULTS Eighty-eight percent of the former AN patients and controls were female, aged approximately 25 years, with a healthy body mass index. Mean carotid flow and pulsatility index were not different between groups. Carotid arterial strain and distensibility were lower, and the wave speed and beta stiffness index higher in the former AN patients. Characteristic impedance was not different nor were the forward and backward wave amplitudes. However, wave reflection indices (ratios of backward-to-forward compression wave area, and wave-related effect on pressure and hydraulic power) were 12-18% lower in the former AN patients (p < 0.05). CONCLUSIONS Increased carotid artery stiffness and reduced wave reflection are evident in young adults who recovered from adolescent AN. This may relate to an adaptive process that helps to maintain or restore flow and characteristic impedance despite increased vessel stiffness, with this warranting future investigation.
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Affiliation(s)
- Gabriella A C Springall
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Greta Goldsmith
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jeanie Cheong
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
- Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
| | - Jonathan P Mynard
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Michele Yeo
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - Michael M H Cheung
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia
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3
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Pawlak-Chomicka R, Uruski P, Krauze T, Piskorski J, Tykarski A, Guzik P. Arterial Blood Pressure Features of Hypertensive Patients with Typical and Atypical 460 nm Skin Fluorescence Response to Transient Ischaemia. J Clin Med 2023; 12:5886. [PMID: 37762826 PMCID: PMC10531863 DOI: 10.3390/jcm12185886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Flow-mediated skin fluorescence (FMSF) at 460 nm is a non-invasive method for assessing dynamic changes in the reduced form of nicotinamide adenine dinucleotide (NADH) and microcirculation in forearm skin under varying conditions of tissue perfusion. Typically, fluorescence increases during ischaemia, but atypical cases show a temporary signal decrease instead of a constant increase. This study aimed to explore the clinical implications of atypical FMSF patterns in patients with newly diagnosed untreated hypertension. NADH fluorescence and pulse wave analysis were performed on 65 patients. Differences in peripheral and arterial pulse pressure profiles were examined based on FMSF curve courses. Patients with atypical curve courses had significantly (p < 0.05 or lower for all) higher heart rate, peripheral and central diastolic pressure, tension time index, central rate pressure product, shorter diastole duration, and reservoir pressure-time integral. Hypertensive patients with atypical FMSF signals had less advantageous blood pressure profiles. Although the underlying factors causing these symptoms are unknown, the atypical FMSF pattern may reflect increased sympathetic stimulation and vascular resistance. The visual assessment of the FMSF curve may have important clinical implications that deserve further investigation.
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Affiliation(s)
- Regina Pawlak-Chomicka
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (R.P.-C.); (P.U.); (A.T.)
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (R.P.-C.); (P.U.); (A.T.)
| | - Tomasz Krauze
- Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Jarosław Piskorski
- Institute of Physics, University of Zielona Gora, 65-516 Zielona Gora, Poland;
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland; (R.P.-C.); (P.U.); (A.T.)
| | - Przemysław Guzik
- Department of Cardiology-Intensive Therapy and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
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Du S, Yao Y, Sun G, Wang L, Alastruey J, Avolio AP, Xu L. Personalized aortic pressure waveform estimation from brachial pressure waveform using an adaptive transfer function. Comput Biol Med 2023; 155:106654. [PMID: 36791548 DOI: 10.1016/j.compbiomed.2023.106654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The aortic pressure waveform (APW) provides reliable information for the diagnosis of cardiovascular disease. APW is often measured using a generalized transfer function (GTF) applied to the peripheral pressure waveform acquired noninvasively, to avoid the significant risks of invasive APW acquisition. However, the GTF ignores various physiological conditions, which affects the accuracy of the estimated APW. To solve this problem, this study utilized an adaptive transfer function (ATF) combined with a tube-load model to achieve personalized and accurate estimation of APW from the brachial pressure waveform (BPW). METHODS The proposed method was validated using APWs and BPWs from 34 patients. The ATF was defined using a tube-load model in which pulse transit time and reflection coefficients were determined from, respectively, the diastolic-exponential-pressure-decay of the APW and a piece-wise constant approximation. The root-mean-square-error of overall morphology, mean absolute errors of common hemodynamic indices (systolic blood pressure, diastolic blood pressure and pulse pressure) were used to evaluate the ATF. RESULTS The proposed ATF performed better in estimating diastolic blood pressure and pulse pressure (1.63 versus 1.94 mmHg, and 2.37 versus 3.10 mmHg, respectively, both P < 0.10), and produced similar errors in overall morphology and systolic blood pressure (3.91 versus 4.24 mmHg, and 2.83 versus 2.91 mmHg, respectively, both P > 0.10) compared to GTF. CONCLUSION Unlike the GTF which uses fixed parameters trained on existing clinical datasets, the proposed method can achieve personalized estimation of APW. Hence, it provides accurate pulsatile hemodynamic measures for the evaluation of cardiovascular function.
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Affiliation(s)
- Shuo Du
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, Liaoning, China
| | - Yang Yao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, Liaoning, China
| | - Guozhe Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110122, Liaoning, China
| | - Lu Wang
- School of Computer Science and Engineering, Northeastern University, Shenyang, 110169, China
| | - Jordi Alastruey
- Department of Biomedical Engineering, King's College, London, SE1 7EH, United Kingdom
| | - Alberto P Avolio
- Macquarie School of Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lisheng Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, Liaoning, China; Neusoft Research of Intelligent Healthcare Technology, Co. Ltd, Shenyang, 110169, Liaoning, China.
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Picone DS, Kodithuwakku V, Mayer CC, Chapman N, Rehman S, Climie RE. Sex differences in pressure and flow waveform physiology across the life course. J Hypertens 2022; 40:2373-2384. [PMID: 36093877 DOI: 10.1097/hjh.0000000000003283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) has long been deemed a disease of old men. However, in 2019 CVD accounted for 35% of all deaths in women and, therefore, remains the leading cause of death in both men and women. There is increasing evidence to show that risk factors, pathophysiology and health outcomes related to CVD differ in women compared with men, yet CVD in women remains understudied, underdiagnosed and undertreated. Differences exist between the sexes in relation to the structure of the heart and vasculature, which translate into differences in blood pressure and flow waveform physiology. These physiological differences between women and men may represent an important explanatory factor contributing to the sex disparity in CVD presentation and outcomes but remain understudied. In this review we aim to describe sex differences in arterial pressure and flow waveform physiology and explore how they may contribute to differences in CVD in women compared to men. Given that unfavourable alterations in the cardiovascular structure and function can start as early as in utero, we report sex differences in waveform physiology across the entire life course.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Christopher C Mayer
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Sabah Rehman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Rachel E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Aizawa K, Hughes AD, Casanova F, Gates PE, Mawson DM, Gooding KM, Gilchrist M, Goncalves I, Nilsson J, Khan F, Colhoun HM, Palombo C, Parker KH, Shore AC. Reservoir Pressure Integral Is Independently Associated With the Reduction in Renal Function in Older Adults. Hypertension 2022; 79:2364-2372. [PMID: 35993228 DOI: 10.1161/hypertensionaha.122.19483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial hemodynamic parameters derived from reservoir-excess pressure analysis exhibit prognostic utility. Reservoir-excess pressure analysis may provide useful information about an influence of altered hemodynamics on target organ such as the kidneys. We determined whether the parameters derived from the reservoir-excess pressure analysis were associated with the reduction in estimated glomerular filtration rate in 542 older adults (69.4±7.9 years, 194 females) at baseline and after 3 years. METHODS Reservoir-excess pressure parameters, including reservoir pressure integral, excess pressure integral, systolic, and diastolic rate constants, were obtained by radial artery tonometry. RESULTS After 3 years, and in a group of 94 individuals (72.4±7.6 years, 26 females), there was an estimated glomerular filtration rate reduction of >5% per year (median reduction of 20.5% over 3 years). A multivariable logistic regression analysis revealed that higher baseline reservoir pressure integral was independently associated with a smaller reduction in estimated glomerular filtration rate after accounting for conventional cardiovascular risk factors and study centers (odds ratio: 0.660 [95% CIs, 0.494-0.883]; P=0.005). The association remained unchanged after further adjustments for potential confounders and baseline renal function (odds ratio: 0.528 [95% CIs, 0.351-0.794]; P=0.002). No other reservoir-excess pressure parameters exhibited associations with the reduction in renal function. CONCLUSIONS This study demonstrates that baseline reservoir pressure integral was associated with the decline in renal function in older adults at 3-year follow-up, independently of conventional cardiovascular risk factors. This suggests that reservoir pressure integral may play a role in the functional decline of the kidneys.
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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., M.G., A.C.S.)
| | - Alun D Hughes
- MRC unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, United Kingdom (A.D.H.)
| | - 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., M.G., 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., M.G., 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., M.G., 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., M.G., A.C.S.)
| | - Mark Gilchrist
- 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., M.G., A.C.S.)
| | - Isabel Goncalves
- Department of Clinical Sciences, Lund University, Malmö, Sweden (I.G., J.N.).,Department of Cardiology, Skåne University Hospital, Malmö, Sweden (I.G.)
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden (I.G., J.N.)
| | - Faisel Khan
- Division of Systems 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., M.G., A.C.S.)
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Abstract
The aorta contributes to cardiovascular physiology and function. Understanding biomechanics in health, disease, and after aortic interventions will facilitate optimization of perioperative patient care.
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Palombo C, Kozakova M, Morizzo C, Losso L, Pagani M, Salvi P, Parker KH, Hughes AD. Carotid Reservoir Pressure Decrease After Prolonged Head Down Tilt Bed Rest in Young Healthy Subjects Is Associated With Reduction in Left Ventricular Ejection Time and Diastolic Length. Front Physiol 2022; 13:866045. [PMID: 35399267 PMCID: PMC8990871 DOI: 10.3389/fphys.2022.866045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 01/09/2023] Open
Abstract
Background The arterial pressure waveform reflects the interaction between the heart and the arterial system and carries potentially relevant information about circulatory status. According to the commonly accepted 'wave transmission model', the net BP waveform results from the super-position of discrete forward and backward pressure waves, with the forward wave in systole determined mainly by the left ventricular (LV) ejection function and the backward by the wave reflection from the periphery, the timing and amplitude of which depend on arterial stiffness, the wave propagation speed and the extent of downstream admittance mismatching. However, this approach obscures the 'Windkessel function' of the elastic arteries. Recently, a 'reservoir-excess pressure' model has been proposed, which interprets the arterial BP waveform as a composite of a volume-related 'reservoir' pressure and a wave-related 'excess' pressure. Methods In this study we applied the reservoir-excess pressure approach to the analysis of carotid arterial pressure waveforms (applanation tonometry) in 10 young healthy volunteers before and after a 5-week head down tilt bed rest which induced a significant reduction in stroke volume (SV), end-diastolic LV volume and LV longitudinal function without significant changes in central blood pressure, cardiac output, total peripheral resistance and aortic stiffness. Forward and backward pressure components were also determined by wave separation analysis. Results Compared to the baseline state, bed rest induced a significant reduction in LV ejection time (LVET), diastolic time (DT), backward pressure amplitude (bP) and pressure reservoir integral (INTPR). INTPR correlated directly with LVET, DT, time to the peak of backward wave (bT) and stroke volume, while excess pressure integral (INTXSP) correlated directly with central pressure. Furthermore, Δ.INTPR correlated directly with Δ.LVET, and Δ.DT, and in multivariate analysis INTPR was independently related to LVET and DT and INTXSP to central systolic BP. Conclusion This is an hypothesis generating paper which adds support to the idea that the reservoir-wave hypothesis applied to non-invasively obtained carotid pressure waveforms is of potential clinical usefulness.
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Affiliation(s)
- Carlo Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carmela Morizzo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Losso
- Department of Medical Toxicology Unit and Poison Control Centre, Careggi University Hospital, Florence, Italy
| | - Massimo Pagani
- Department of Medicine, University of Milan, Milan, Italy
| | - Paolo Salvi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Kim H. Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Alun D. Hughes
- Department of Population Science and Experimental Medicine, University College of London, London, United Kingdom
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Paré M, Goupil R, Fortier C, Mac-Way F, Madore F, Hametner B, Wassertheurer S, Schultz MG, Sharman JE, Agharazii M. Increased Excess Pressure After Creation of an Arteriovenous Fistula in End-Stage Renal Disease. Am J Hypertens 2022; 35:149-155. [PMID: 34655294 PMCID: PMC8807157 DOI: 10.1093/ajh/hpab161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Reservoir-wave analysis (RWA) separates the arterial waveform into reservoir and excess pressure (XSP) components, where XSP is analogous to flow and related to left ventricular workload. RWA provides more detailed information about the arterial tree than traditional blood pressure (BP) parameters. In end-stage renal disease (ESRD), we have previously shown that XSP is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). In this study, we examined whether XSP increases after creation of an AVF in ESRD. METHODS Before and after a mean of 3.9 ± 1.2 months following creation of AVF, carotid pressure waves were recorded using arterial tonometry. XSP and its integral (XSPI) were derived using RWA through pressure wave analysis alone. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (CF-PWV). RESURLTS In 38 patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs. 72 ± 12 mm Hg, P = 0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs. 127 ± 26 mm Hg, P = 0.137). However, carotid XSP (14 [12-19] to 17 [12-22] mm Hg, P = 0.031) and XSPI increased significantly (275 [212-335] to 334 [241-439] kPa∙s, P = 0.015), despite a reduction in CF-PWV (13 ± 3.6 vs. 12 ± 3.5 m/s, P = 0.025). CONCLUSIONS Creation of an AVF resulted in increased XSP in this population, despite improvement in diastolic BP and aortic stiffness. These findings underline the complex hemodynamic impact of AVF on the cardiovascular system.
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Affiliation(s)
- Mathilde Paré
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Québec, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | - Rémi Goupil
- Hôpital du Sacré-Cœur de Montréal, Department of Medicine, Montréal, Québec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Québec, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada
- INSERM-U970-Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Québec, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada
| | - François Madore
- Hôpital du Sacré-Cœur de Montréal, Department of Medicine, Montréal, Québec, Canada
| | - Bernhard Hametner
- Center for Health & Bioresources, Department of Health and Environment, AIT Austrian Institute of Technology, Vienna, Austria
| | - Siegfried Wassertheurer
- Center for Health & Bioresources, Department of Health and Environment, AIT Austrian Institute of Technology, Vienna, Austria
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Mohsen Agharazii
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec City, Québec, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada
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Wustmann K, Constantine A, Davies J, Li W, Pennell D, Wort S, Kempny A, Price L, McCabe C, Mohiaddin R, Francis D, Gatzoulis M, Dimopoulos K. Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Armstrong MK, Schultz MG, Hughes AD, Picone DS, Sharman JE. 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] [MESH Headings] [Grants] [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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Affiliation(s)
- Matthew K Armstrong
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alun D Hughes
- MRC Unit for Lifelong Health & Aging, Institute of Cardiovascular Science, University College London, London, UK
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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12
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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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13
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Mitchell GF. Arterial Stiffness in Aging: Does It Have a Place in Clinical Practice?: Recent Advances in Hypertension. Hypertension 2021; 77:768-780. [PMID: 33517682 DOI: 10.1161/hypertensionaha.120.14515] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortic stiffness increases markedly with age and is associated with excess risk for various adverse clinical outcomes, including heart disease, dementia, and kidney disease. Although evidence for adverse effects of aortic stiffening is overwhelming, integration of direct and indirect measures of aortic stiffness into routine clinical assessment has lagged behind the science. This brief review will examine recent evidence supporting the value of stiffness as an important new risk factor for hypertension and cardiovascular disease and will offer suggestions for incorporating stiffness measures into routine clinical practice.
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14
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Cooper LL, Rong J, Pahlevan NM, Rinderknecht DG, Benjamin EJ, Hamburg NM, Vasan RS, Larson MG, Gharib M, Mitchell GF. Intrinsic Frequencies of Carotid Pressure Waveforms Predict Heart Failure Events: The Framingham Heart Study. Hypertension 2021; 77:338-346. [PMID: 33390053 PMCID: PMC7803452 DOI: 10.1161/hypertensionaha.120.15632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Supplemental Digital Content is available in the text. Intrinsic frequencies (IFs) derived from arterial waveforms are associated with cardiovascular performance, aging, and prevalent cardiovascular disease (CVD). However, prognostic value of these novel measures is unknown. We hypothesized that IFs are associated with incident CVD risk. Our sample was drawn from the Framingham Heart Study Original, Offspring, and Third Generation Cohorts and included participants free of CVD at baseline (N=4700; mean age 52 years, 55% women). We extracted 2 dominant frequencies directly from a series of carotid pressure waves: the IF of the coupled heart and vascular system during systole (ω1) and the IF of the decoupled vasculature during diastole (ω2). Total frequency variation (Δω) was defined as the difference between ω1 and ω2. We used Cox proportional hazards regression models to relate IFs to incident CVD events during a mean follow-up of 10.6 years. In multivariable models adjusted for CVD risk factors, higher ω1 (hazard ratio [HR], 1.14 [95% CI], 1.03–1.26]; P=0.01) and Δω (HR, 1.16 [95% CI, 1.03–1.30]; P=0.02) but lower ω2 (HR, 0.87 [95% CI, 0.77–0.99]; P=0.03) were associated with higher risk for incident composite CVD events. In similarly adjusted models, higher ω1 (HR, 1.23 [95% CI, 1.07–1.42]; P=0.004) and Δω (HR, 1.26 [95% CI, 1.05–1.50]; P=0.01) but lower ω2 (HR, 0.81 [95% CI, 0.66–0.99]; P=0.04) were associated with higher risk for incident heart failure. IFs were not significantly associated with incident myocardial infarction or stroke. Novel IFs may represent valuable markers of heart failure risk in the community.
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Affiliation(s)
- Leroy L Cooper
- From the Biology Department, Vassar College, Poughkeepsie, NY (L.L.C.)
| | - Jian Rong
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.)
| | - Niema M Pahlevan
- Department of Aerospace and Mechanical Engineering (N.M.P.), University of Southern California, Los Angeles.,Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine (N.M.P.), University of Southern California, Los Angeles
| | - Derek G Rinderknecht
- Graduate Aerospace Laboratories, Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena (D.G.R., M.G.)
| | - Emelia J Benjamin
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.).,Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA.,Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Naomi M Hamburg
- Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA
| | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.).,Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA.,Evans Department of Medicine (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Whitaker Cardiovascular Institute (E.J.B., N.M.H., R.S.V.), Boston University School of Medicine, MA.,Department of Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Martin G Larson
- Boston University and NHLBI's Framingham Heart Study, MA (J.R., E.J.B., R.S.V., M.G.L.).,Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA
| | - Morteza Gharib
- Graduate Aerospace Laboratories, Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena (D.G.R., M.G.).,Department of Medical Engineering, California Institute of Technology, Pasadena (M.G.)
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15
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Mynard JP, Kondiboyina A, Kowalski R, Cheung MMH, Smolich JJ. Measurement, Analysis and Interpretation of Pressure/Flow Waves in Blood Vessels. Front Physiol 2020; 11:1085. [PMID: 32973569 PMCID: PMC7481457 DOI: 10.3389/fphys.2020.01085] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/06/2020] [Indexed: 01/10/2023] Open
Abstract
The optimal performance of the cardiovascular system, as well as the break-down of this performance with disease, both involve complex biomechanical interactions between the heart, conduit vascular networks and microvascular beds. ‘Wave analysis’ refers to a group of techniques that provide valuable insight into these interactions by scrutinizing the shape of blood pressure and flow/velocity waveforms. The aim of this review paper is to provide a comprehensive introduction to wave analysis, with a focus on key concepts and practical application rather than mathematical derivations. We begin with an overview of invasive and non-invasive measurement techniques that can be used to obtain the signals required for wave analysis. We then review the most widely used wave analysis techniques—pulse wave analysis, wave separation and wave intensity analysis—and associated methods for estimating local wave speed or characteristic impedance that are required for decomposing waveforms into forward and backward wave components. This is followed by a discussion of the biomechanical phenomena that generate waves and the processes that modulate wave amplitude, both of which are critical for interpreting measured wave patterns. Finally, we provide a brief update on several emerging techniques/concepts in the wave analysis field, namely wave potential and the reservoir-excess pressure approach.
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Affiliation(s)
- Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia.,Department of Cardiology, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Avinash Kondiboyina
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Remi Kowalski
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Cardiology, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Cardiology, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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16
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Brumback LC, Jacobs DR, Duprez DA. PTC1 and PTC2: New Indices of Blood Pressure Waveforms and Cardiovascular Disease. Am J Epidemiol 2020; 189:726-734. [PMID: 31907510 PMCID: PMC7608079 DOI: 10.1093/aje/kwz280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
Systolic and diastolic blood pressures provide information about cardiovascular disease (CVD) but are only extremes of the pressure waveform during the cardiac cycle. We developed summaries of the pressure decay, called PTC1 and PTC2, that are related to arterial compliance and to an existing proprietary summary that has been shown to predict CVD. We derived the summaries from a Windkessel model (consisting of a decaying exponential plus a dampened cosine, with an intercept so they are independent of calibration with blood pressure, unlike the proprietary measures), and we estimated them using nonlinear least squares with standard, free software. Among 6,228 adults from the Multi-Ethnic Study of Atherosclerosis, initially free of CVD in 2000-2002, mean PTC2 was 94 (standard deviation, 46) milliseconds. During median 15-year follow-up, there were 911 CVD events (including 609 incidents of coronary heart disease and 270 strokes). One-standard-deviation higher PTC2 was associated with 17% (95% confidence interval: 10, 24) lower CVD risk, after adjustment for traditional risk factors. Results were similar for PTC1. PTC1 and PTC2 are relatively straightforward to compute and add information beyond traditional risk factors for prediction of CVD. Our work enables others to replicate and extend our results with waveforms from any suitable device.
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Affiliation(s)
- Lyndia C Brumback
- Correspondence to Dr. Lyndia C. Brumback, Collaborative Health Studies Coordinating Center, Building 29, Suite 210, University of Washington, Box 354922, 6200 NE 74th Street, Seattle, WA 98115 (e-mail: )
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17
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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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18
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Prediction models for cardiovascular disease risk in the hypertensive population: a systematic review. J Hypertens 2020; 38:1632-1639. [PMID: 32251200 DOI: 10.1097/hjh.0000000000002442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to identify, describe, and evaluate the available cardiovascular disease risk prediction models developed or validated in the hypertensive population. METHODS MEDLINE and the Web of Science were searched from database inception to March 2019, and all reference lists of included articles were reviewed. RESULTS A total of 4766 references were screened, of which 18 articles were included in the review, presenting 17 prediction models specifically developed for hypertensive populations and 25 external validations. Among the 17 prediction models, most were constructed based on randomized trials in Europe or North America to predict the risk of fatal or nonfatal cardiovascular events. The most common predictors were classic cardiovascular risk factors such as age, diabetes, sex, smoking, and SBP. Of the 17 models, only one model was externally validated. Among the 25 external validations, C-statistics ranged from 0.58 to 0.83, 0.56 to 0.75, and 0.64 to 0.78 for models developed in the hypertensive population, the general population and other specific populations, respectively. Most of the development studies and validation studies had an overall high risk of bias according to PROBAST. CONCLUSION There are a certain number of cardiovascular risk prediction models in patients with hypertension. The risk of bias assessment showed several shortcomings in the methodological quality and reporting in both the development and validation studies. Most models developed in the hypertensive population have not been externally validated. Compared with models developed for the general population and other specific populations, models developed for the hypertensive population do not display a better performance when validated among patients with hypertension. Research is needed to validate and improve the existing cardiovascular disease risk prediction models in hypertensive populations rather than developing completely new models.
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19
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Armstrong MK, Schultz MG, Picone DS, Black JA, Dwyer N, Roberts-Thomson P, Sharman JE. Associations of Reservoir-Excess Pressure Parameters Derived From Central and Peripheral Arteries With Kidney Function. Am J Hypertens 2020; 33:325-330. [PMID: 32006010 DOI: 10.1093/ajh/hpaa013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Central artery reservoir-excess pressure parameters are clinically important but impractical to record directly. However, diastolic waveform morphology is consistent across central and peripheral arteries. Therefore, peripheral artery reservoir-excess pressure parameters related to diastolic waveform morphology may be representative of central parameters and share clinically important associations with end-organ damage. This has never been determined and was the aim of this study. METHODS Intra-arterial blood pressure (BP) waveforms were measured sequentially at the aorta, brachial, and radial arteries among 220 individuals (aged 61 ± 10 years, 68% male). Customized software was used to derive reservoir-excess pressure parameters at each arterial site (reservoir and excess pressure, systolic and diastolic rate constants) and clinical relevance was determined by association with estimated glomerular filtration rate (eGFR). RESULTS Between the aorta and brachial artery, the mean difference in the diastolic rate constant and reservoir pressure integral was -0.162 S-1 (P = 0.08) and -0.772 mm Hg s (P = 0.23), respectively. The diastolic rate constant had the strongest and most consistent associations with eGFR across aortic and brachial sites (β = -0.20, P = 0.02; β = -0.20, P = 0.03, respectively; adjusted for traditional cardiovascular risk factors). Aortic, but not brachial peak reservoir pressure was associated with eGFR in adjusted models (aortic β = -0.48, P = 0.02). CONCLUSIONS The diastolic rate constant is the most consistent reservoir-excess pressure parameter, in both its absolute values and associations with kidney dysfunction, when derived from the aorta and brachial artery. Thus, the diastolic rate constant could be utilized in the clinical setting to improve BP risk stratification.
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Affiliation(s)
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - J Andrew Black
- Department of Cardiology, Royal Hobart Hospital, Australia
| | - Nathan Dwyer
- Department of Cardiology, Royal Hobart Hospital, Australia
| | | | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Australia
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20
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Association of brachial-cuff excess pressure with carotid intima-media thickness in Australian adults: a cross-sectional study. J Hypertens 2020; 38:723-730. [PMID: 32134846 DOI: 10.1097/hjh.0000000000002310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Reservoir pressure parameters [e.g. reservoir pressure (RP) and excess pressure (XSP)] measured using tonometry predict cardiovascular events beyond conventional risk factors. However, the operator dependency of tonometry impedes widespread use. An operator-independent cuff-based device can reasonably estimate the intra-aortic RP and XSP from brachial volumetric waveforms, but whether these estimates are clinically relevant to preclinical phenotypes of cardiovascular risk has not been investigated. METHODS The RP and XSP were derived from brachial volumetric waveforms measured using cuff oscillometry (SphygmoCor XCEL) in 1691 mid-life adults from the CheckPoint study (a population-based cross-sectional study nested in the Longitudinal Study of Australian Children). Carotid intima--media thickness (carotid IMT, n = 1447) and carotid--femoral pulse wave velocity (PWV, n = 1632) were measured as preclinical phenotypes of cardiovascular risk. Confounders were conventional risk factors that were correlated with both exposures and outcomes or considered as physiologically important. RESULTS There was a modest association between XSP and carotid IMT (β = 0.76 μm, 95% CI, 0.25-1.26 partial R = 0.8%) after adjusting for age, sex, BMI, heart rate, smoking, diabetes, high-density lipoprotein cholesterol and mean arterial pressure. Neither RP nor XSP were associated with PWV in the similarly adjusted models (β = -0.47 cm/s, 95% CI, -1.15 to 0.20, partial R = 0.2% for RP, and β = 0.04 cm/s, 95% CI, -0.59 to 0.67, partial R = 0.01% for XSP). CONCLUSION Cuff-based XSP associates with carotid IMT independent of conventional risk factors, including traditional BP, but the association was weak, indicating that further investigation is warranted to understand the clinical significance of reservoir pressure parameters.
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21
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Paré M, Goupil R, Fortier C, Mac-Way F, Madore F, Marquis K, Hametner B, Wassertheurer S, Schultz MG, Sharman JE, Agharazii M. Determinants of Increased Central Excess Pressure in Dialysis: Role of Dialysis Modality and Arteriovenous Fistula. Am J Hypertens 2020; 33:137-145. [PMID: 31419806 DOI: 10.1093/ajh/hpz136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/31/2019] [Accepted: 08/12/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Arterial reservoir-wave analysis (RWA)-a new model of arterial hemodynamics-separates arterial wave into reservoir pressure (RP) and excess pressure (XSP). The XSP integral (XSPI) has been associated with increased risk of clinical outcomes. The objectives of the present study were to examine the determinants of XSPI in a mixed cohort of hemodialysis (HD) and peritoneal dialysis (PD) patients, to examine whether dialysis modality and the presence of an arteriovenous fistula (AVF) are associated with increased XSPI. METHOD In a cross-sectional study, 290 subjects (232 HD and 130 with AVF) underwent carotid artery tonometry (calibrated with brachial diastolic and mean blood pressure). The XSPI was calculated through RWA using pressure-only algorithms. Logistic regression was used for determinants of XSPI above median. Through forward conditional linear regression, we examined whether treatment by HD or the presence of AVF is associated with higher XSPI. RESULTS Patients with XSPI above median were older, had a higher prevalence of diabetes and cardiovascular disease, had a higher body mass index, and were more likely to be on HD. After adjustment for confounders, HD was associated with a higher risk of higher XSPI (odds ratio = 2.39, 95% confidence interval: 1.16-4.98). In a forward conditional linear regression analysis, HD was associated with higher XSPI (standardized coefficient: 0.126, P = 0.012), but on incorporation of AVF into the model, AVF was associated with higher XSPI (standardized coefficient: 0.130, P = 0.008) and HD was excluded as a predictor. CONCLUSION This study suggests that higher XSPI in HD patients is related to the presence of AVF.
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Affiliation(s)
- Mathilde Paré
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec, Quebec, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Rémi Goupil
- Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada
| | - Catherine Fortier
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec, Quebec, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec, Quebec, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | | | - Karine Marquis
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec, Quebec, Canada
| | - Bernhard Hametner
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mohsen Agharazii
- CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Québec, Quebec, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
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22
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Sex differences in excess and reservoir arterial blood pressures as markers of phenotype. J Hypertens 2019; 37:2159-2167. [DOI: 10.1097/hjh.0000000000002135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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23
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Su J, Hughes AD, Simonsen U, Nielsen-Kudsk JE, Parker KH, Howard LS, Mellemkjaer S. Impact of pulmonary endarterectomy on pulmonary arterial wave propagation and reservoir function. Am J Physiol Heart Circ Physiol 2019; 317:H505-H516. [PMID: 31225986 PMCID: PMC6703995 DOI: 10.1152/ajpheart.00181.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
High wave speed and large wave reflection in the pulmonary artery have previously been reported in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We assessed the impact of pulmonary endarterectomy (PEA) on pulmonary arterial wave propagation and reservoir function in patients with CTEPH. Right heart catheterization was performed using a combined pressure and Doppler flow sensor-tipped guidewire to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery in eight patients with CTEPH before and 3 mo after PEA. Wave intensity and reservoir-excess pressure analyses were then performed. Following PEA, mean pulmonary arterial pressure (PAPm; ∼49 vs. ∼32 mmHg), pulmonary vascular resistance (PVR; ∼11.1 vs. ∼5.1 Wood units), and wave speed (∼16.5 vs. ∼8.1 m/s), i.e., local arterial stiffness, markedly decreased. The changes in the intensity of the reflected arterial wave and wave reflection index (pre: ∼28%; post: ∼22%) were small, and patients post-PEA with and without residual pulmonary hypertension (i.e., PAPm ≥ 25 mmHg) had similar wave reflection index (∼20 vs. ∼23%). The reservoir and excess pressure decreased post-PEA, and the changes were associated with improved right ventricular afterload, function, and size. In conclusion, although PVR and arterial stiffness decreased substantially following PEA, large wave reflection persisted, even in patients without residual pulmonary hypertension, indicating lack of improvement in vascular impedance mismatch. This may continue to affect the optimal ventriculoarterial interaction, and further studies are warranted to determine whether this contributes to persistent symptoms in some patients.NEW & NOTEWORTHY We performed wave intensity analysis in the pulmonary artery in patients with chronic thromboembolic pulmonary hypertension before and 3 mo after pulmonary endarterectomy. Despite substantial reduction in pulmonary arterial pressures, vascular resistance, and arterial stiffness, large pulmonary arterial wave reflection persisted 3 mo postsurgery, even in patients without residual pulmonary hypertension, suggestive of lack of improvement in vascular impedance mismatch.
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Affiliation(s)
- Junjing Su
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alun D Hughes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Luke S Howard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Soren Mellemkjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Behnam V, Rong J, Larson MG, Gotal JD, Benjamin EJ, Hamburg NM, Vasan RS, Mitchell GF. Windkessel Measures Derived From Pressure Waveforms Only: The Framingham Heart Study. J Am Heart Assoc 2019; 8:e012300. [PMID: 31266389 PMCID: PMC6662135 DOI: 10.1161/jaha.119.012300] [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: 11/17/2022]
Abstract
Background Waveform parameters derived from pressure‐only Windkessel models are related to cardiovascular disease risk and could be useful for understanding arterial system function. However, prior reports varied in their adjustment for potential confounders. Methods and Results Carotid tonometry waveform data from 2539 participants (mean age 63±11 years, 58% women) of the Framingham Heart Study were used to derive Windkessel measures using pressure and assuming a linear model with fixed diastolic time constant (τdias) and variable asymptotic pressure (Pinf, median 54.5; 25th, 75th percentiles: 38.4, 64.9 mm Hg) or nonlinear model with inverse pressure‐dependent τdias and fixed Pinf (20 mm Hg). During follow‐up (median 15.1 years), 459 (18%) participants had a first cardiovascular disease event. In proportional hazards models adjusted for age, sex, total cholesterol, high‐density lipoprotein cholesterol, smoking, antihypertensive medication use, diabetes mellitus, and physician‐acquired systolic blood pressure, only the systolic time constant (τsys) derived from the nonlinear model was related to risk for cardiovascular disease events (hazard ratio=0.91 per 1 SD, 95% CI=0.84–0.99, P=0.04). When heart rate was added to the model, τsys (hazard ratio=0.92, CI=0.84–1.00, P=0.04) and reservoir pressure amplitude (hazard ratio=1.14, CI=1.01–1.28, P=0.04) were related to events. In contrast, measures derived from the linear model were not related to events in models that adjusted for risk factors including systolic blood pressure (P>0.31) and heart rate (P>0.19). Conclusions Our results suggest that pressure‐only Windkessel measures derived by using a nonlinear model may provide incremental risk stratification, although associations were modest and further validation is required.
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Affiliation(s)
- Vira Behnam
- 1 Cardiovascular Engineering, Inc. Norwood MA
| | - Jian Rong
- 2 Boston University and NHLBI's Framingham Study Framingham MA
| | - Martin G Larson
- 2 Boston University and NHLBI's Framingham Study Framingham MA.,3 Department of Biostatistics Boston University School of Public Health Boston MA
| | | | - Emelia J Benjamin
- 2 Boston University and NHLBI's Framingham Study Framingham MA.,4 Cardiology and Preventive Medicine Sections Department of Medicine Boston University School of Medicine Boston MA.,5 Department of Epidemiology Boston University School of Medicine Boston MA
| | - Naomi M Hamburg
- 6 Evans Department of Medicine Boston University School of Medicine Boston MA.,7 Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- 2 Boston University and NHLBI's Framingham Study Framingham MA.,4 Cardiology and Preventive Medicine Sections Department of Medicine Boston University School of Medicine Boston MA.,5 Department of Epidemiology Boston University School of Medicine Boston MA.,6 Evans Department of Medicine Boston University School of Medicine Boston MA.,7 Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA
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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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Di Lascio N, Gemignani V, Bianchini E, Bruno RM, Ghiadoni L, Faita F. Effects of carotid pressure waveforms on the results of wave separation, wave intensity and reservoir pressure analysis. Physiol Meas 2018; 39:114003. [PMID: 30398165 DOI: 10.1088/1361-6579/aae6eb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Recently great attention has been paid to innovative cardiovascular biomarkers obtained from wave separation (WS), wave intensity (WI) and reservoir-wave (RW) theories. All these approaches share a requirement for pressure information. The aim of this study was to evaluate differences in WS-, WI- and RW-derived parameters obtained achieving pressure waveforms in different ways. APPROACH Twenty-two individuals (49 ± 17 years, 59% males) were examined. Common carotid blood flow waveforms were obtained from pulsed-wave Doppler images. Carotid pressure waveforms were achieved in four different ways: (1) with applanation tonometry, used as a reference method; (2) linear scaling from an ultrasound (US)-derived diameter curve; (3) exponential scaling from a US-derived diameter curve; and (4) linear scaling from an accelerometric-derived diameter signal. For each case, the reflection magnitude (RM) and index (RI) were obtained from the WS. The amplitude of the first positive peak (W 1), of the second positive peak (W 2) and of the negative peak (W b) were calculated from the WI, while the maximum of the reservoir (maxPr) and the excess (maxPex) pressure were achieved from the RW. MAIN RESULTS According to the intra-class coefficient values, the agreement between the standard method and all the others was excellent for the RM (linear: 0.82; exponential: 0.83; accelerometric: 0.86), RI (linear: 0.84; exponential: 0.85; accelerometric: 0.87), maxPr (linear: 0.97; exponential: 0.96; accelerometric: 0.97) and maxPex (linear: 0.85; exponential: 0.87; accelerometric: 0.89), while only a fair/good level was reached for W 1 (linear: 0.67; exponential: 0.77; accelerometric: 0.52), W 2 (linear: 0.52; exponential: 0.69; accelerometric: 0.83) and W b (linear: 0.60; exponential: 0.44; accelerometric: 0.50). SIGNIFICANCE Measuring carotid pressure waveforms with different approaches does not influence the cardiovascular parameters obtained by WS and RW; those derived by WI are affected by the carotid pressure curve employed.
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Affiliation(s)
- N Di Lascio
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy. Nicole Di Lascio, IFC-CNR, Pisa, Italy. Author to whom any correspondence should be addressed
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Gregory A, Kruger M, Maher N, Moore R, Dobson G. Non-invasive Determination of Aortic Mechanical Properties and Their Effects on Left Ventricular Function Following Endovascular Abdominal Aneurysm Repair. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0455-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Neumann S, Sophocleous F, Kobetic MD, Hart EC, Nightingale AK, Parker KH, Hamilton MK, Biglino G. Wave intensity analysis in the internal carotid artery of hypertensive subjects using phase-contrast MR angiography and preliminary assessment of the effect of vessel morphology on wave dynamics. Physiol Meas 2018; 39:104003. [PMID: 30192235 PMCID: PMC6372132 DOI: 10.1088/1361-6579/aadfc5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Hypertension is associated with reduced cerebral blood flow, but it is not known how this impacts on wave dynamics or potentially relates to arterial morphology. Given the location of the internal carotid artery (ICA) and risks associated with invasive measurements, wave dynamics in this artery have not been extensively assessed in vivo. This study explores the feasibility of studying wave dynamics in the internal carotid artery non-invasively. Approach: Normotensive, uncontrolled and controlled hypertensive participants were recruited (daytime ambulatory blood pressure <135/85 mmHg and >135/85 mmHg, respectively; n = 38). Wave intensity, reservoir pressure and statistical shape analyses were performed on the right ICA and ascending aorta high-resolution phase-contrast magnetic resonance angiography data. Main results: Wave speed in the aorta was significantly lower in normotensive compared to hypertensive participants (6.7 ± 1.8 versus 11.2 ± 6.2 m s−1 for uncontrolled and 11.8 ± 4.6 m s−1 for controlled hypertensives, p = 0.02), whilst there were no differences in wave speed in the ICA. There were no significant differences between the groups for the wave intensity or reservoir pressure. Interestingly, a significant association between the anatomy of the ICA and wave energy (FCW and size, r2 = 0.12, p = 0.04) was found. Significance: This study shows it is feasible to study wave dynamics in the ICA non-invasively. Whilst changes in aortic wave speed confirmed an expected increase in arterial stiffness, this was not observed in the ICA. This might suggest a protective mechanism in the cerebral circulation, in conjunction with the effect of vessel tortuosity. Furthermore, it was observed that ICA shape correlated with wave energy but not wave speed.
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Affiliation(s)
- S Neumann
- University of Bristol, Bristol, United Kingdom
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Michail M, Narayan O, Parker KH, Cameron JD. Relationship of aortic excess pressure obtained using pressure-only reservoir pressure analysis to directly measured aortic flow in humans. Physiol Meas 2018; 39:064006. [DOI: 10.1088/1361-6579/aaca87] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Reservoir pressure analysis of aortic blood pressure: an in-vivo study at five locations in humans. J Hypertens 2018; 35:2025-2033. [PMID: 28582283 DOI: 10.1097/hjh.0000000000001424] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The development and propagation of the aortic blood pressure wave remains poorly understood, despite its clear relevance to major organ blood flow and potential association with cardiovascular outcomes. The reservoir pressure model provides a unified description of the dual conduit and reservoir functions of the aorta. Reservoir waveform analysis resolves the aortic pressure waveform into an excess (wave related) and reservoir (compliance related) pressure. The applicability of this model to the pressure waveform as it propagates along the aorta has not been investigated in humans. METHODS We analysed invasively acquired high-fidelity aortic pressure waveforms from 40 patients undergoing clinically indicated coronary catheterization. Aortic waveforms were measured using a solid-state pressure catheter at five anatomical sites: the ascending aorta, the transverse aortic arch, the diaphragm, the level of the renal arteries, and at the aortic bifurcation. Ensemble average pressure waveforms were obtained for these sites for each patient and analysed to obtain the reservoir pressure [Pr(t)] and the excess pressure [Px(t)] at each aortic position. RESULTS Systolic blood pressure increased at a rate of 2.1 mmHg per site along the aorta, whereas diastolic blood pressure was effectively constant. Maximum Pr decreased only slightly along the aorta (changing by -0.7 mmHg per site), whereas the maximum of Px increased from the proximal to distal aorta (+4.1 mmHg per site; P < 0.001). The time, relative to the start of systolic upstroke, of the occurrence of the maximum excess pressure did not vary along the aorta. Of the parameters used to derive the reservoir pressure waveform the systolic and diastolic rate constants showed divergent changes with the systolic rate constant (ks) decreasing and the diastolic rate constant (kd) increasing along the aorta. CONCLUSIONS This analysis confirms the proposition that the magnitude of the calculated reservoir pressure waveform, despite known changes in aortic structure, is effectively constant throughout the aorta. A progressive increase of excess pressure accounts for the increase in pulse pressure from the proximal to distal aorta. The reservoir pressure rate constants seem to behave as arterial functional parameters. The accompanying decrease in ks and increase in kd are consistent with a progressive decrease in aortic compliance and increase in impedance. The reservoir pressure waveform therefore provides a model that might have utility in understanding the generation of central blood pressure and in specific cases might have clinical utility.
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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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Hydren JR, Richardson RS, Symons JD, Mynard JP, Smolich JJ, Ramos JS, Dias KA, Dalleck LC, Drummond C, Westerhof B, Westerhof N, Zuo L, Zhou T. Commentaries on Viewpoint: Origin of the forward-going "backward" wave. J Appl Physiol (1985) 2017; 123:1408-1410. [PMID: 29167201 DOI: 10.1152/japplphysiol.00758.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Katrin A Dias
- Institute for Exercise and Environmental Medicine.,University of Texas Southwestern Medical Center
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Ramos JS, Ramos MV, Dalleck LC, Borrani F, Walker KB, Fassett RG, Sharman JE, Coombes JS. Fitness Is Independently Associated with Central Hemodynamics in Metabolic Syndrome. Med Sci Sports Exerc 2017; 48:1539-47. [PMID: 27433960 DOI: 10.1249/mss.0000000000000916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Fit individuals with metabolic syndrome (MetS) have lower mortality risk compared with less fit counterparts, despite the presence of obesity as a component of the syndrome. To understand the importance of fitness in treating this condition, we examined the association of fitness and fatness with central hemodynamic indices that are known independent predictors of cardiovascular events. METHODS Sixty-eight individuals with MetS participated in this cross-sectional study. Central hemodynamics is calculated from radial applanation tonometry and comprised aortic reservoir pressure, backward pressure wave (Pb), reflection magnitude (RM), and augmentation index at 75 bpm (AIx75). Cardiorespiratory fitness (CRF) and body fat percentage (BF%) were determined via indirect calorimetry during maximal exercise testing and dual-energy x-ray absorptiometry, respectively. RESULTS CRF was inversely associated with aortic reservoir pressure (r = -0.29, P = 0.02), Pb (r = -0.42, P < 0.001), RM (r = -0.48, P < 0.001), and AIx75 (r = -0.65, P < 0.001). BF% was also correlated with AIx75 (r = 0.37, P < 0.05) and RM (r = 0.36, P < 0.005) but at a weaker association compared with CRF. Multiple regression analysis revealed CRF as a predictor of aortic reservoir pressure (β = -0.52, P = <0.01), Pb (β = -0.41, P < 0.03), and AIx75 (β = -0.45, P = 0.01), independent of BF% and other confounding factors. CONCLUSIONS CRF predicts central hemodynamics independent of BF% and other confounding factors. This suggests that CRF improvement may be a higher priority when compared with fat loss for lowering the risk of cardiovascular mortality in MetS individuals.
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Affiliation(s)
- Joyce S Ramos
- 1Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, AUSTRALIA; 2Institute of Biomedical Technologies, School of Engineering, Auckland University of Technology, Auckland, NEW ZEALAND; 3Recreation, Exercise, and Sport Science Department, Western State Colorado University, Gunnison, CO; 4The Institute of Sport Sciences University of Lausanne, University of Lausanne, Lausanne, SWITZERLAND; 5Department of Physiology, Faculty of Biology and Medicine, Lausanne University, Lausanne, SWITZERLAND; and 6Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, AUSTRALIA
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On aortic pressure waveforms and a happy or unhappy marriage between wave propagation and Windkessel models. J Hypertens 2017; 35:1955-1957. [PMID: 28858197 DOI: 10.1097/hjh.0000000000001448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Climie RED, Picone DS, Sharman JE. Longitudinal Changes in Excess Pressure Independently Predict Declining Renal Function Among Healthy Individuals-A Pilot Study. Am J Hypertens 2017; 30:772-775. [PMID: 28575172 DOI: 10.1093/ajh/hpx091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/10/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Aortic reservoir function independently predicts end-organ damage in cross-sectional analyses. However, longitudinal associations are more important regarding causation, but this has never been examined at rest or in response to light-moderate intensity exercise. The aim of this study was to determine the association between the change in aortic reservoir characteristics, in particular excess pressure integral (Pexcess) at rest and in response to exercise and the change in kidney function among healthy individuals followed over time. METHODS Aortic reservoir function (Pexcess and reservoir pressure), aortic stiffness, brachial and central blood pressure (BP), and renal function (estimated glomerular filtration rate [eGFR]) were recorded among 33 healthy individuals (57 ± 9 years; 55% male) at baseline and after an average 3.0 ± 0.3 years. RESULTS Over the follow up period, there was a significant increase in resting brachial BP, central BP, Pexcess, and aortic stiffness (P < 0.05 all). The change over time in resting Pexcess (but not aortic stiffness) was significantly related to the change in eGFR (r = -0.38, P = 0.038) and remained independent of age at follow up, change in 24-hour ambulatory systolic BP and body mass index (β = -0.0300, P = 0.043). There was no association between the change in aortic pulse wave velocity and the change eGFR (P = 0.46) nor were there any associations with exercising hemodynamics. CONCLUSIONS Pexcess is independently associated with a decline in renal function among healthy people followed over 3 years. These novel findings indicate the need to determine the underlying physiological determinants of aortic reservoir function.
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Affiliation(s)
- Rachel E D Climie
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Heart rate dependent and independent effects of beta-blockers on central hemodynamic parameters. J Hypertens 2016; 34:1535-43. [DOI: 10.1097/hjh.0000000000000978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cheng HM, Chuang SY, Wang JJ, Shih YT, Wang HN, Huang CJ, Huang JT, Sung SH, Lakatta EG, Yin FCP, Chou P, Yeh CJ, Bai CH, Pan WH, Chen CH. Prognostic significance of mechanical biomarkers derived from pulse wave analysis for predicting long-term cardiovascular mortality in two population-based cohorts. Int J Cardiol 2016; 215:388-95. [PMID: 27128568 PMCID: PMC10617614 DOI: 10.1016/j.ijcard.2016.04.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous mechanical biomarkers derived from pulse wave analysis (PWA) have been proposed to predict cardiovascular outcomes. However, whether these biomarkers carry independent prognostic value and clinical utility beyond traditional cardiovascular risk factors hasn't been systematically evaluated. We aimed to investigate the additive utility of PWA-derived biomarkers in two independent population-based cohorts. METHODS PWA on central arterial pressure waveforms obtained from subjects without a prior history of cardiovascular diseases of two studies was conducted based on the wave transmission and reservoir-wave theory: firstly in the Kinmen study (1272 individuals, a median follow-up of 19.8years); and then in the Cardiovascular Disease Risk Factors Two-Township Study (2221 individuals, median follow-up of 10years). The incremental value of the biomarkers was evaluated by net reclassification index (NRI). RESULTS In multivariate Cox analyses accounting for age, gender, body mass index, systolic blood pressure, fasting glucose, high-density- and low-density-lipoprotein cholesterol, and smoking, only systolic (SC) and diastolic rate constant (DC) of reservoir pressure could independently and consistently predict cardiovascular mortality in both cohorts and the combined cohort (SC: hazard ratio 1.18 [95% confidence interval 1.08-1.28, p<0.001; DC: 1.18 [1.09-1.28], p<0.001]. Risk prediction estimates in traditional risk prediction models were significantly more accurate when incorporating peak of reservoir pressure (NRI=0.049, p=0.0361), SC (NRI=0.043, p=0.0236) and DC (NRI=0.054, p=0.047). CONCLUSIONS Of all PWA-derived biomarkers, SC and DC were consistently identified as valuable parameters for incremental cardiovascular risk prediction in two large prospective cohorts.
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Affiliation(s)
- Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Division of Preventive Medicine and Health Service, Research Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Jiun-Jr Wang
- School of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, Taiwan
| | - Yuan-Ta Shih
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ning Wang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jui-Tzu Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Edward G Lakatta
- The Laboratory of Cardiovascular Science in the National Institute on Aging Intramural Research Program in Baltimore, MD, USA
| | - Frank C P Yin
- Department of Biomedical Engineering, Washington University, St Louis, MO, USA
| | - Pesus Chou
- Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | | | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health, National Yang-Ming University, Taipei, Taiwan.
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