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Hong S, Coté G. Development of a Tetherless Bioimpedance Device That Uses Morphologic Changes to Predict Blood Flow Restrictions Mimicking Peripheral Artery Disease Progression. BIOSENSORS 2024; 14:286. [PMID: 38920590 PMCID: PMC11202059 DOI: 10.3390/bios14060286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
A tetherless multi-targeted bioimpedance device was designed, modeled, built, and tested for measuring arterial pulse and, using morphological analysis, its potential for monitoring blood flow restrictions that mimic Peripheral Artery Disease (PAD) was assessed across multiple peripheral arteries. Specifically, we first developed a small form factor, tetherless, bioimpedance device, based on high-frequency structure simulator (HFSS) simulations. After designing and building the device we then tested it in vivo on human subjects on multiple arteries and found that we did not need to modify the gain on the device compared to the bench top system. Further, it was found that changes in the morphology of the bioimpedance signal over time, depicted through the ratio of the first and second harmonic in the signal frequency, could be used to predict blood flow restrictions that mimic peripheral artery disease (PAD). The HFSS simulations helped guide the modulation frequency selection and the placement of the bioimpedance electrodes. We built the device and compared it to two commercially available bioimpedance devices and it was shown to demonstrate a distinct advantage in its multi-target capability, enabling more accurate pulse measurements from different arteries without the need for tuning the circuit for each artery. Comparing the ratio of the 1st and 2nd harmonics as a function of the blood flow restriction, the two commercial devices showed a maximum error across arteries of between 22% and 27% depending on the measurement location, whereas our system consistently displayed a stable value of just below 4%. With this system, there is the potential for comprehensive and personalized medical examinations for PAD at the point of care (POC).
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Affiliation(s)
- Sungcheol Hong
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Gerard Coté
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA;
- Department of Electrical Engineering, Texas A&M University, College Station, TX 77843, USA
- Center for Remote Health Technologies and Systems, Texas A&M Engineering Experiment Station, Texas A&M University, College Station, TX 77843, USA
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Tasmin S, Aschebrook-Kilfoy B, Hedeker D, Gopalakrishnan R, Connellan E, Kibriya MG, Young MT, Kaufman JD, Ahsan H. Long-term exposure to ambient air pollution and measures of central hemodynamics and arterial stiffness among multiethnic Chicago residents. Environ Health 2024; 23:47. [PMID: 38715087 PMCID: PMC11075200 DOI: 10.1186/s12940-024-01077-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To examine whether long-term air pollution exposure is associated with central hemodynamic and brachial artery stiffness parameters. METHODS We assessed central hemodynamic parameters including central blood pressure, cardiac parameters, systemic vascular compliance and resistance, and brachial artery stiffness measures [including brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR)] using waveform analysis of the arterial pressure signals obtained from a standard cuff sphygmomanometer (DynaPulse2000A, San Diego, CA). The long-term exposures to particles with an aerodynamic diameter < 2.5 μm (PM2.5) and nitrogen dioxide (NO2) for the 3-year periods prior to enrollment were estimated at residential addresses using fine-scale intra-urban spatiotemporal models. Linear mixed models adjusted for potential confounders were used to examine associations between air pollution exposures and health outcomes. RESULTS The cross-sectional study included 2,387 Chicago residents (76% African Americans) enrolled in the ChicagO Multiethnic Prevention And Surveillance Study (COMPASS) during 2013-2018 with validated address information, PM2.5 or NO2, key covariates, and hemodynamics measurements. We observed long-term concentrations of PM2.5 and NO2 to be positively associated with central systolic, pulse pressure and BAR, and negatively associated with BAD, and BAC after adjusting for relevant covariates. A 1-µg/m3 increment in preceding 3-year exposures to PM2.5 was associated with 1.8 mmHg higher central systolic (95% CI: 0.98, 4.16), 1.0 mmHg higher central pulse pressure (95% CI: 0.42, 2.87), a 0.56%mmHg lower BAD (95% CI: -0.81, -0.30), and a 0.009 mL/mmHg lower BAC (95% CI: -0.01, -0.01). CONCLUSION This population-based study provides evidence that long-term exposures to PM2.5 and NO2 is related to central BP and arterial stiffness parameters, especially among African Americans.
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Affiliation(s)
- Saira Tasmin
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
| | | | - Elizabeth Connellan
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Muhammad G Kibriya
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Michael T Young
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA.
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA.
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Tamborini A, Gharib M. Validation of a Suprasystolic Cuff System for Static and Dynamic Representation of the Central Pressure Waveform. J Am Heart Assoc 2024; 13:e033290. [PMID: 38591330 DOI: 10.1161/jaha.123.033290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Noninvasive pulse waveform analysis is valuable for central cardiovascular assessment, yet controversies persist over its validity in peripheral measurements. Our objective was to compare waveform features from a cuff system with suprasystolic blood pressure hold with an invasive aortic measurement. METHODS AND RESULTS This study analyzed data from 88 subjects undergoing concurrent aortic catheterization and brachial pulse waveform acquisition using a suprasystolic blood pressure cuff system. Oscillometric blood pressure (BP) was compared with invasive aortic systolic BP and diastolic BP. Association between cuff and catheter waveform features was performed on a set of 15 parameters inclusive of magnitudes, time intervals, pressure-time integrals, and slopes of the pulsations. The evaluation covered both static (subject-averaged values) and dynamic (breathing-induced fluctuations) behaviors. Peripheral BP values from the cuff device were higher than catheter values (systolic BP-residual, 6.5 mm Hg; diastolic BP-residual, 12.4 mm Hg). Physiological correction for pressure amplification in the arterial system improved systolic BP prediction (r2=0.83). Dynamic calibration generated noninvasive BP fluctuations that reflect those invasively measured (systolic BP Pearson R=0.73, P<0.001; diastolic BP Pearson R=0.53, P<0.001). Static and dynamic analyses revealed a set of parameters with strong associations between catheter and cuff (Pearson R>0.5, P<0.001), encompassing magnitudes, timings, and pressure-time integrals but not slope-based parameters. CONCLUSIONS This study demonstrated that the device and methods for peripheral waveform measurements presented here can be used for noninvasive estimation of central BP and a subset of aortic waveform features. These results serve as a benchmark for central cardiovascular assessment using suprasystolic BP cuff-based devices and contribute to preserving system dynamics in noninvasive measurements.
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Affiliation(s)
- Alessio Tamborini
- Department of Medical Engineering California Institute of Technology Pasadena CA USA
| | - Morteza Gharib
- Department of Medical Engineering California Institute of Technology Pasadena CA USA
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Tokioka S, Nakaya N, Nakaya K, Takase M, Kogure M, Hatanaka R, Chiba I, Kanno I, Nochioka K, Metoki H, Murakami T, Satoh M, Nakamura T, Obara T, Hamanaka Y, Kobayashi T, Uruno A, Sugawara J, N Kodama E, Ogishima S, Izumi Y, Fuse N, Kuriyama S, Tsuji I, Hozawa A. Association of Central Blood Pressure and Carotid Intima Media Thickness with New-Onset Hypertension in People with High Normal Blood Pressure. J Atheroscler Thromb 2023; 30:1905-1916. [PMID: 37407442 DOI: 10.5551/jat.64151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
AIM People with high normal blood pressure (BP) have a higher risk of cardiovascular events than those with normal BP; therefore, progression to hypertension (HT) should be prevented. We aimed to assess the HT risk using central BP and carotid intima media thickness (CIMT) in people with high normal BP. METHODS This prospective cohort study used the Tohoku Medical Megabank Community-Based Project Cohort Study (conducted from 2013 in Miyagi Prefecture in Japan). The participants had a high normal BP, defined as a systolic BP of 120-139 mmHg and diastolic BP <90 mmHg using brachial BP measurement during the baseline survey. The outcome was new-onset HT during the secondary survey, conducted four years after the baseline survey. RESULTS Overall, 4,021 participants with high normal BP during the baseline survey, with an average age of 58.7 years, were included; 1,030 (26%) were diagnosed with new-onset HT during the secondary survey, 3.5±0.7 years after the baseline survey. The multivariable odds ratio (95% confidence interval) for HT in the highest versus lowest quartile of central BP was 1.7 (1.2-2.4, p=0.0030), and that of CIMT was 1.8 (1.4-2.4, p<0.001). Subgroup analysis according to age (<60 and ≥ 60 years) and sex revealed that the central BP was influential in groups with younger age and female individuals; CIMT was influential in all groups. CONCLUSIONS Higher central BP and thicker CIMT at the baseline were correlated with new-onset HT in individuals with high normal BP, independent of brachial systolic BP and other cardiovascular risk factors.
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Affiliation(s)
| | - Naoki Nakaya
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Kumi Nakaya
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | | | - Mana Kogure
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Rieko Hatanaka
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Ippei Chiba
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Ikumi Kanno
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Kotaro Nochioka
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku Medical and Pharmaceutical University
| | - Takahisa Murakami
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku Medical and Pharmaceutical University
| | - Michihiro Satoh
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku Medical and Pharmaceutical University
| | - Tomohiro Nakamura
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Taku Obara
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Yohei Hamanaka
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Tomoko Kobayashi
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Akira Uruno
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Junichi Sugawara
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
- Suzuki Memorial Hospital
| | - Eiichi N Kodama
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Soichi Ogishima
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Yoko Izumi
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Nobuo Fuse
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Shinichi Kuriyama
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- International Research Institute of Disaster Science, Tohoku University
| | - Ichiro Tsuji
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Atsushi Hozawa
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
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Tamborini A, Gharib M. A Pneumatic Low-Pass Filter for High-Fidelity Cuff-Based Pulse Waveform Acquisition. Ann Biomed Eng 2023; 51:2617-2628. [PMID: 37479898 DOI: 10.1007/s10439-023-03312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023]
Abstract
Cuff-based pulse waveform acquisition (CBPWA) devices are reliable solutions for non-invasive cardiovascular diagnostics. However, poor signal resolution has limited clinical applications. This study aims to demonstrate the improved signal quality of CBPWA devices by implementing passive pneumatic low-pass filters (pLPF). Conventionally, pressure sensor output resolution is a percentage of the operating range. Therefore, measurement of small pressure changes in a large range must sacrifice signal resolution to accommodate for the large mean pressures. We design a pLPF to obtain the running mean pressure and combine it with a high-resolution differential pressure sensor for isolating the signal's pulsatile component. Thirty-one volunteers participated in a device proof-of-concept study at Caltech. Volunteers were measured at rest in the supine position on the left arm. The filtering behavior is mathematically modeled and experimentally verified, showing good agreement between measured and predicted cutoff frequencies. In the human study, the device successfully captured high-fidelity pulse waveform measurements for all volunteers: a blood pressure (BP) reading was followed by inflate-and-hold acquisition in diastolic BP (DBP), mean arterial pressure (MAP), and supra systolic BP (sSBP). The study demonstrated the reliability and high signal resolution of pLPF for CBPWA. Considering the widespread use of the brachial cuff, a system for high-resolution CBPWA motivates the clinical implementation of non-invasive pulse waveform analysis (PWA).
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Affiliation(s)
- Alessio Tamborini
- California Institute of Technology, 1200 E California BLVD MC 105-50, Pasadena, CA, 91125, USA.
| | - Morteza Gharib
- California Institute of Technology, 1200 E California BLVD MC 105-50, Pasadena, CA, 91125, USA
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6
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Murakami T. Central Blood Pressure Estimation. J Atheroscler Thromb 2023; 30:1108-1110. [PMID: 36948636 PMCID: PMC10499467 DOI: 10.5551/jat.ed229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Affiliation(s)
- Tomoaki Murakami
- Department of Pediatrics, Sapporo Tokushukai Hospital, Sapporo, Japan
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7
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Katsuda SI, Hazama A. Estimation of Central Systolic Blood Pressure from Peripheral Pressure Waves using a Novel Second Systolic Pressure-Based Method in Normal and Heritable Hypercholesterolemic Rabbits. J Atheroscler Thromb 2023; 30:1132-1141. [PMID: 36642536 PMCID: PMC10499456 DOI: 10.5551/jat.63793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/25/2022] [Indexed: 01/15/2023] Open
Abstract
AIM Central systolic blood pressure (cSBP) was closely related to hypertension-related organ damage rather than peripheral systolic blood pressure (pSBP). We aimed to estimate cSBP from pSBP without generalized transfer function in normal and Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits aged 12 months. METHODS Two catheter-tip transducers were advanced into the ascending aorta (AA) and distal end of the right brachial artery (Br) through the right common carotid and right radial arteries, respectively, under pentobarbital anesthesia. Pressure waves in response to the intravenous administration of angiotensin II and sodium nitroprusside were simultaneously recorded in AA and Br under regular cardiac pacing. RESULTS The first (pSBP) and second peaks (pSBP2) of the brachial blood pressure and their average (pSBPm) were significantly correlated with cSBP, despite Murgo's wave pattern of central pressure waves in both rabbit groups. In Bland-Altman plot and its modification as a function of the peripheral augmentation index (pAI) analyses, the differences between pSBP and cSBP decreased, and those between pSBP2 and cSBP increased significantly in their average- or pAI-dependent manner, with undeniable mean biases in both rabbit groups. When the same analyses for SBPm were performed instead, the mean bias was around zero, with reduced variance in the two rabbit groups. The observed pressure or pAI-dependent systematic biases for pSBP and pSBP2 disappeared, representing the precise feature of pSBPm as a cSBP estimate. CONCLUSIONS We conclude that pSBPm could be more precise than pSBP2 as a cSBP estimate, irrespective of blood pressure levels, pAI, or the presence of atherosclerosis.
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Affiliation(s)
- Shin-ichiro Katsuda
- Department of Cellular and Integrative Physiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akihiro Hazama
- Department of Cellular and Integrative Physiology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Tasmin S, Aschebrook-Kilfoy B, Hedeker D, Gopalakrishnan R, Stepniak E, Kibriya MG, Young MT, Kaufman JD, Ahsan H. Long-term exposure to ambient air pollution and measures of central hemodynamics and arterial stiffness among multiethnic Chicago residents. RESEARCH SQUARE 2023:rs.3.rs-3171526. [PMID: 37503099 PMCID: PMC10371125 DOI: 10.21203/rs.3.rs-3171526/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objectives To examine whether air pollution exposure is associated with central hemodynamic and brachial artery stiffness parameters. Methods We assessed central hemodynamic parameters, brachial artery stiffness measures [including brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR)] using waveform analysis of the arterial pressure signals obtained from a standard cuff sphygmomanometer (DynaPulse2000A, San Diego, CA). The long-term exposures to particles with an aerodynamic diameter < 2.5μm (PM2.5) and nitrogen dioxide (NO2) for the 3-year periods prior to enrollment were estimated at residential addresses using fine-scale intra-urban spatiotemporal models. Linear mixed models adjusted for potential confounders were used to examine associations between air pollution exposures and health outcomes. Results The cross-sectional study included 2,387 Chicago residents (76% African Americans) enrolled in the ChicagO Multiethnic Prevention And Surveillance Study (COMPASS) during 2013-2018 with validated address information, PM2.5 or NO2, key covariates, and hemodynamics measurements. We observed long-term concentrations of PM2.5 and NO2 to be positively associated with central systolic, pulse pressure and BAR, and negatively associated with BAD, and BAC after adjusting for relevant covariates. A 1-μg/m3 increment in preceding 3-year exposures to PM2.5 was associated with 1.8 mmHg higher central systolic (95% CI: 0.98, 4.16), 1.0 mmHg higher central pulse pressure (95% CI: 0.42, 2.87), a 0.56%mmHg lower BAD (95% CI: -0.81, -0.30), and a 0.009 mL/mmHg lower BAC (95% CI: -0.01, -0.01). Conclusion This population-based study provides evidence that long-term exposures to PM2.5 and NO2 is related to central BP and arterial stiffness parameters, especially among African Americans.
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Molloy C, Choy EH, Arechavala RJ, Buennagel D, Nolty A, Spezzaferri MR, Sin C, Rising S, Yu J, Al-Ezzi A, Kleinman MT, Kloner RA, Arakaki X. Resting heart rate (variability) and cognition relationships reveal cognitively healthy individuals with pathological amyloid/tau ratio. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1168847. [PMID: 37587981 PMCID: PMC10428767 DOI: 10.3389/fepid.2023.1168847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Introduction Resting heart rate (HR) and heart rate variability (HRV) have been linked with cognition in the general population and in older individuals. The knowledge of this aspect of heart-brain relationship is relatively absent in older individuals with early Alzheimer's disease (AD) pathology. This study explores relationships of the HR, HRV, and cognition in cognitively healthy individuals with pathological amyloid/tau ratio (CH-PATs) in cerebral spinal fluid (CSF) compared to those with normal ratio (CH-NATs). Methods We examined therelationshipsbetween1) resting HR and Mini-Mental State Examination (MMSE); 2) resting HR and brain processing during Stroop interference; and 3) resting vagally mediated HRV (vmHRV) and task switching performance. Results Our studies showed that compared to CH-NATs, those CH-PATs with higher resting HR presented with lower MMSE, and less brain activation during interference processing. In addition, resting vmHRV was significantly correlated with task switching accuracy in CH-NATs, but not in CH-PATs. Discussion Thesethreedifferenttestsindicatedysfunctionalheart-brainconnections in CH-PATs, suggesting a potential cardio-cerebral dysfunctional integration.
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Affiliation(s)
- Cathleen Molloy
- Cognition and Brain Integration Laboratory, Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, United States
| | - Elizabeth H. Choy
- Department of Environmental and Occupational Health, University of California, Irvine, Irvine, CA, United States
| | - Rebecca J. Arechavala
- Department of Environmental and Occupational Health, University of California, Irvine, Irvine, CA, United States
| | - David Buennagel
- Clinical Neuroscience Laboratory, Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, United States
| | - Anne Nolty
- Graduate School of Psychology & Marriage and Family Therapy, Fuller Theological Seminary, Pasadena, CA, United States
| | - Mitchell R. Spezzaferri
- Graduate School of Psychology & Marriage and Family Therapy, Fuller Theological Seminary, Pasadena, CA, United States
| | - Caleb Sin
- Graduate School of Psychology & Marriage and Family Therapy, Fuller Theological Seminary, Pasadena, CA, United States
| | - Shant Rising
- Graduate School of Psychology & Marriage and Family Therapy, Fuller Theological Seminary, Pasadena, CA, United States
| | - Jeremy Yu
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, United States
| | - Abdulhakim Al-Ezzi
- Cognition and Brain Integration Laboratory, Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, United States
| | - Michael T. Kleinman
- Department of Environmental and Occupational Health, University of California, Irvine, Irvine, CA, United States
| | - Robert A. Kloner
- Clinical Neuroscience Laboratory, Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, United States
- Cardiovascular Research, Huntington Medical Research Institutes, Pasadena, CA, United States
- Cardiovascular Division, Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, United States
| | - Xianghong Arakaki
- Cognition and Brain Integration Laboratory, Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, United States
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10
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Latchman PL, Yang Q, Kong L, Zhang H, Sebagisha J, De Meersman RE. Heart Rate Recovery, Central Systolic Pressure, and Augmentation Index in Young Healthy Individuals. Vasc Health Risk Manag 2022; 18:17-25. [PMID: 35173435 PMCID: PMC8841569 DOI: 10.2147/vhrm.s340483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Measuring heart rate recovery (HRR) holds valuable cardiovascular information and requires minimal technical skill and cost. Understanding the associations between HRR and more robust cardiovascular indicators, such as central systolic blood pressure (CSBP), can provide valuable cardiovascular information with less involvement. CSBP is a strong predictor of certain cardiovascular diseases. The study aims to examine the association between measures of HRR and CSBP and the augmentation index (AIx) in a group of young, healthy individuals and based on sex. Participants and Methods One-hundred and seven participants (men – 55, women – 52) were measured for HRR at one minute (HRR1) and two minutes (HRR2) after maximum oxygen consumption (VO2max) testing, CSBP, and the AIx at a heart rate of 75 beats∙min−1 (AIx@75). Results The Pearson correlation indicated no association between HRR1, HRR2, and CSBP in men and women combined: r = 0.06, P = 0.53; r = 0.05, P = 0.59, respectively, or based on sex: men = r = 0.01, P = 0.95; r = 0.04, P = 0.79, respectively, and women = r = −0.05, P = 0.75; r = −0.09, P = 0.52, respectively. However, there were associations between HRR1 and AIx@75 in men and women combined: r = −0.37, P < 0.001, and based on sex: men = r = −0.31, P = 0.02, and women = r = −0.38, P < 0.01. Conclusion Measures of HRR were not associated with CSBP in a combined group of young men and women or based on sex. Most measures of HRR, especially those established by parasympathetic nervous activity, were associated with lower AIx@75. Though measures of HRR might be good indicators of cardiovascular disease, they might not be good indicators of CSBP in young, healthy individuals.
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Affiliation(s)
- Peter L Latchman
- Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, CT, USA
- Correspondence: Peter L Latchman, Department of Health and Movement Sciences, Southern Connecticut State University, 501 Crescent Street, New Haven, CT, 06515, USA, Tel +1 203-392-6081, Fax +1 203-392-6093, Email
| | - Qin Yang
- School of Health Promotion and Kinesiology, Texas Woman’s University, Denton, TX, USA
| | - Lingsong Kong
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
| | - Hengbo Zhang
- College of Physical Education, Hunan First Normal University, Changsha, People’s Republic of China
| | | | - Ronald E De Meersman
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Raj KV, Nabeel PM, Chandran D, Sivaprakasam M, Joseph J. High-frame-rate A-mode ultrasound for calibration-free cuffless carotid pressure: feasibility study using lower body negative pressure intervention. Blood Press 2022; 31:19-30. [PMID: 35014940 DOI: 10.1080/08037051.2021.2022453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Existing technologies to measure central blood pressure (CBP) intrinsically depend on peripheral pressure or calibration models derived from it. Pharmacological or physiological interventions yielding different central and peripheral responses compromise the accuracy of such methods. We present a high-frame-rate ultrasound technology for cuffless and calibration-free evaluation of BP from the carotid artery. The system uses a pair of single-element ultrasound transducers to capture the arterial diameter and local pulse wave velocity (PWV) for the evaluation of beat-by-beat BP employing a novel biomechanical model. MATERIALS AND METHODS System's functionality assessment was conducted on eight male subjects (26 ± 4 years, normotensive and no history of cardiovascular risks) by perturbing pressure via short-term moderate lower body negative pressure (LBNP) intervention (-40 mmHg for 1 min). The ability of the system to capture dynamic responses of carotid pressure to LBNP was investigated and compared against the responses of peripheral pressure measured using a continuous BP monitor. RESULTS While the carotid pressure manifested trends similar to finger measurements during LBNP, the system also captured the differential carotid-to-peripheral pressure response, which corroborates the literature. The carotid diastolic and mean pressures agreed with the finger pressures (limits-of-agreement within ±7 mmHg) and exhibited acceptable uncertainty (mean absolute errors were 2.4 ± 3.5 and 2.6 ± 4.0 mmHg, respectively). Concurrent to the literature, the carotid systolic and pulse pressures (PPs) were significantly lower than those of the finger pressures by 11.1 ± 9.4 and 11.3 ± 8.2 mmHg, respectively (p < .0001). CONCLUSIONS The study demonstrated the method's potential for providing cuffless and calibration-free pressure measurements while reliably capturing the physiological aspects, such as PP amplification and dynamic pressure responses to intervention.
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Affiliation(s)
- Kiran V Raj
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India
| | - P M Nabeel
- Healthcare Technology Innovation Centre, IIT Madras, Chennai, India
| | - Dinu Chandran
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India.,Healthcare Technology Innovation Centre, IIT Madras, Chennai, India
| | - Jayaraj Joseph
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India
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12
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El Fol A, Ammar W, Sharaf Y, Youssef G. The central arterial stiffness parameters in decompensated versus compensated states of heart failure: a paired comparative cohort study. Egypt Heart J 2022; 74:2. [PMID: 34978636 PMCID: PMC8724513 DOI: 10.1186/s43044-021-00236-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Arterial stiffness is strongly linked to the pathogenesis of heart failure and the development of acute decompensation in patients with stable chronic heart failure. This study aimed to compare arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during the acute decompensated state, and three months later after hospital discharge during the compensated state. Results One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction ≤ 35% were included in the study. During the initial and follow-up visits, all patients underwent full medical history taking, clinical examination, transthoracic echocardiography, and non-invasive pulse wave analysis by the Mobil-O-Graph 24-h device for measurement of arterial stiffness. The mean age was 51.6 ± 6.1 years and 80% of the participants were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state compared to the decompensated state. During the decompensated state, patients presented with NYHA FC IV (n = 64) showed higher AI (24.5 ± 10.0 vs. 16.8 ± 8.6, p < 0.001) and pulse wave velocity (9.2 ± 1.3 vs. 8.5 ± 1.2, p = 0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males. Conclusions Central arterial stiffness indices in patients with HFrEF were significantly lower in the compensated state than in the decompensated state. Patients with NYHA FC IV and female patients showed higher stiffness indices in their decompensated state of heart failure.
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Affiliation(s)
- Ahmed El Fol
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Waleed Ammar
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Sharaf
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada Youssef
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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13
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Fortier C, Garneau CA, Paré M, Obeid H, Côté N, Duval K, Goupil R, Agharazii M. Modulation of Arterial Stiffness Gradient by Acute Administration of Nitroglycerin. Front Physiol 2021; 12:774056. [PMID: 34975528 PMCID: PMC8715004 DOI: 10.3389/fphys.2021.774056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Physiologically, the aorta is less stiff than peripheral conductive arteries, creating an arterial stiffness gradient, protecting microcirculation from high pulsatile pressure. However, the pharmacological manipulation of arterial stiffness gradient has not been thoroughly investigated. We hypothesized that acute administration of nitroglycerin (NTG) may alter the arterial stiffness gradient through a more significant effect on the regional stiffness of medium-sized muscular arteries, as measured by pulse wave velocity (PWV). The aim of this study was to examine the differential impact of NTG on regional stiffness, and arterial stiffness gradient as measured by the aortic-brachial PWV ratio (AB-PWV ratio) and aortic-femoral PWV ratio (AF-PWV ratio). Methods: In 93 subjects (age: 61 years, men: 67%, chronic kidney disease [CKD]: 41%), aortic, brachial, and femoral stiffnesses were determined by cf-PWV, carotid-radial (cr-PWV), and femoral-dorsalis pedis artery (fp-PWV) PWVs, respectively. The measurements were repeated 5 min after the sublingual administration of NTG (0.4 mg). The AB-PWV and AF-PWV ratios were obtained by dividing cf-PWV by cr-PWV or fp-PWV, respectively. The central pulse wave profile was determined by radial artery tonometry through the generalized transfer function. Results: At baseline, cf-PWV, cr-PWV, and fp-PWV were 12.12 ± 3.36, 9.51 ± 1.81, and 9.71 ± 1.89 m/s, respectively. After the administration of NTG, there was a significant reduction in cr-PWV of 0.86 ± 1.27 m/s (p < 0.001) and fp-PWV of 1.12 ± 1.74 m/s (p < 0.001), without any significant changes in cf-PWV (p = 0.928), leading to a significant increase in the AB-PWV ratio (1.30 ± 0.39 vs. 1.42 ± 0.46; p = 0.001) and AF-PWV ratio (1.38 ± 0.47 vs. 1.56 ± 0.53; p = 0.001). There was a significant correlation between changes in the AF-PWV ratio and changes in the timing of wave reflection (r = 0.289; p = 0.042) and the amplitude of the heart rate-adjusted augmented pressure (r = − 0.467; p < 0.001). Conclusion: This study shows that acute administration of NTG reduces PWV of muscular arteries (brachial and femoral) without modifying aortic PWV. This results in an unfavorable profile of AB-PWV and AF-PWV ratios, which could lead to higher pulse pressure transmission into the microcirculation.
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Affiliation(s)
- Catherine Fortier
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Charles-Antoine Garneau
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Mathilde Paré
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Hasan Obeid
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
| | - Nadège Côté
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Karine Duval
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
| | - Rémi Goupil
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Mohsen Agharazii
- CHU de Québec Research Center-Université Laval, L’Hôtel-Dieu de Québec Hospital, Québec, QC, Canada
- Division of Nephrology, Faculty of Medicine, Université Laval, Québec, QC, Canada
- *Correspondence: Mohsen Agharazii,
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Parameter estimation for closed-loop lumped parameter models of the systemic circulation using synthetic data. Math Biosci 2021; 343:108731. [PMID: 34758345 DOI: 10.1016/j.mbs.2021.108731] [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: 05/28/2021] [Revised: 09/07/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
Physics-based models can be applied to describe mechanisms in both health and disease, which has the potential to accelerate the development of personalized medicine. The aim of this study was to investigate the feasibility of personalizing a model of systemic hemodynamics by estimating model parameters. We investigated the feasibility of estimating model parameters for a closed-loop lumped parameter model of the left heart and systemic circulation using the step-wise subset reduction method. This proceeded by first investigating the structural identifiability of the model parameters. Secondly we performed sensitivity analysis to determine which parameters were most influential on the most relevant model outputs. Finally, we constructed a sequence of progressively smaller subsets including parameters based on their ranking by model output influence. The model was then optimized to data for each set of parameters to evaluate how well the parameters could be estimated for each subset. The subsequent results allowed assessment of how different data sets, and noise affected the parameter estimates. In the noiseless case, all parameters could be calibrated to less than 10-3% error using time series data, while errors using clinical index data could reach over 100%. With 5% normally distributed noise the accuracy was limited to be within 10% error for the five most sensitive parameters, while the four least sensitive parameters were unreliably estimated for waveform data. The three least sensitive parameters were particularly challenging to estimate so these should be prioritised for measurement. Cost functions based on time series such as pressure waveforms, were found to give better parameter estimates than cost functions based on standard indices used in clinical assessment of the cardiovascular system, for example stroke volume (SV) and pulse pressure (PP). Averaged parameter estimate errors were reduced by several orders of magnitude by choosing waveforms for noiseless synthetic data. Also when measurement data were noisy, the parameter estimation procedure based on continuous waveforms was more accurate than that based on clinical indices. By application of the step-wise subset reduction method we demonstrated that by the addition of venous pressure to the cost function, or conversely fixing the systemic venous compliance parameter at an accurate value improved all parameter estimates, especially the diastolic filling parameters which have least influence on the aortic pressure.
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15
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Kim H, Kim IC, Hwang J, Lee CH, Cho YK, Park HS, Chung JW, Nam CW, Han S, Hur SH. Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease. J Hum Hypertens 2021; 35:994-1002. [PMID: 33408327 DOI: 10.1038/s41371-020-00472-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP-CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s') than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s', LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ -8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jongmin Hwang
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, Keimyung University Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Lee K, Yoo HJ. Simultaneous Electrical Bio-Impedance Plethysmography at Different Body Parts: Continuous and Non-Invasive Monitoring of Pulse Wave Velocity. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:1027-1038. [PMID: 34559662 DOI: 10.1109/tbcas.2021.3115021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A simultaneous and time-synchronized electrical bio-impedance plethysmography (BPG) sensor system is implemented for long-term, continuous, and non-invasive measurement of arterial pulse wave velocity (PWV). The proposed BPG sensor system electrically separates each ground plane of two BPG channels and controller, and the two different BPG channels are time-synchronized by the controller transmitting periodic pulse signal to the two BPG channels. Furthermore, net parasitic capacitance between the ground planes is minimized by removing isolated DC-DC converter, limiting the number of digital capacitive isolators, and adopting optimal layout of the ground planes. The proposed sensor system is integrated on 278cm2 printed circuit board. The sensor system consumes 0.35 W/channel, and outstanding channel-to-channel isolation is expected by coupling factor performance of -77.7 dB. In addition, modified electrode configuration for BPG at chest drastically reduces baseline wandering by respiratory motion artifact, thereby further facilitating long-term, continuous, and non-invasive PWV measurement. As a result, long-term, continuous, and non-invasive PWV measurement more than 95 minutes is successfully performed to pave the way for developing pulse transit time (PTT)-based cuff-less blood pressure (BP) estimation technique.
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17
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Barros JP, de Paula T, Mediano MFF, Rangel MVDS, Monteiro W, da Cunha FA, Farinatti P, Borges JP. The Effects of Acute Aerobic Exercise on Blood Pressure, Arterial Function, and Heart Rate Variability in Men Living With HIV. Front Physiol 2021; 12:685306. [PMID: 34335295 PMCID: PMC8320391 DOI: 10.3389/fphys.2021.685306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aims to investigate the effects of acute cycling on blood pressure (BP), arterial function, and heart rate variability (HRV) in men living with HIV (MLHIV) using combined antiretroviral therapy (cART). METHODS Twelve MLHIV (48.7 ± 9.2 years; 25.2 ± 2.8 kg m-2) and 13 healthy controls (41.2 ± 9.9 years; 26.3 ± 2.9 kg m-2) performed a cycling bout (ES) (intensity: 50% oxygen uptake reserve; duration: time to achieve 150 kcal-MLHIV: 24.1 ± 5.5 vs. controls: 23.1 ± 3.0 min; p = 0.45), and a 20-min non-exercise session (NES). RESULTS At rest (p < 0.05), MLHIV presented higher brachial systolic/diastolic BP (SBP/DBP: 123.2 ± 14.2/76.8 ± 6.3 vs. 114.3 ± 5.1/71.6 ± 2.6 mmHg) and central BP (cSBP/cDBP: 108.3 ± 9.3/76.5 ± 6.5 vs. 101.6 ± 4.9/71.3 ± 4.4 mmHg) vs. controls but lower absolute maximal oxygen uptake (2.1 ± 0.5 vs. 2.5 ± 0.3 L min-1) and HRV indices reflecting overall/vagal modulation (SDNN: 24.8 ± 7.1 vs. 42.9 ± 21.3 ms; rMSSD: 20.5 ± 8.5 vs. 38.1 ± 22.8 ms; pNN50: 3.6 ± 4.2 vs. 13.6 ± 11.3%). DBP postexercise lowered in controls vs. MLHIV (∼4 mmHg, p < 0.001; ES: 0.6). Moreover, controls vs. MLHIV had greater reductions (p < 0.05) in augmentation index (-13.6 ± 13.7 vs. -3.1 ± 7.2% min-1; ES: 2.4), and HRV indices up to 5 min (rMSSD: -111.8 ± 32.1 vs. -75.9 ± 22.2 ms min-1; ES: 3.8; pNN50: -76.3 ± 28.3 vs. -19.0 ± 13.7% min-1; ES: 4.4). Within-group (ES vs. NES; p < 0.05) reductions occurred in controls for SBP (∼10 mmHg, 2 h), DBP (∼6 mmHg, 20, 30, and 70 min), cSBP (∼9 mmHg, 30 min), cDBP (∼7 mmHg, 30 and 70 min), augmentation index (∼10%, 30 min), and pNN50 (∼20%; up to 2 h), while in MLHIV only cSBP (∼6 mmHg, 70 min) and cDBP (∼4 mmHg, 30 min) decreased. Similar increases (up to 5 min) in heart rate (∼22 bpm) and decreases in SDNN (∼18 ms) and rMSSD (∼20 ms) occurred in both groups. CONCLUSION MLHIV under cART exhibited attenuated postexercise hypotension vs. healthy controls, which seemed to relate with impairments in vascular function.
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Affiliation(s)
- Juliana Pereira Barros
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Tainah de Paula
- Department of Clinical Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Research and Education, National Institute of Cardiology, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Walace Monteiro
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, Brazil
| | - Felipe Amorim da Cunha
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, Brazil
| | - Juliana Pereira Borges
- Graduate Program in Exercise and Sports Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
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18
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Cardiovascular Effects of Aerobic Exercise With Self-Selected or Predetermined Intensity in Adolescents With Obesity. Pediatr Exerc Sci 2021; 33:125-131. [PMID: 34010805 DOI: 10.1123/pes.2020-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid-femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = -9 mm Hg; PEI, Δ = -4 mm Hg; P < .01), central systolic BP (SEI, Δ = -4 mm Hg; PEI, Δ = -4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = -4 mm Hg; PEI, Δ = -3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid-femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.
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Spronck B, Tan I, Reesink KD, Georgevsky D, Delhaas T, Avolio AP, Butlin M. Heart rate and blood pressure dependence of aortic distensibility in rats: comparison of measured and calculated pulse wave velocity. J Hypertens 2021; 39:117-126. [PMID: 32784350 PMCID: PMC7752216 DOI: 10.1097/hjh.0000000000002608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/12/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES When assessing arterial stiffness, heart rate (HR) and blood pressure (BP) are potential confounders. It appears that the HR/BP dependences of pulse wave velocity (PWV) and distensibility are different, even though both assess arterial stiffness. This study aims to compare aortic PWV as measured using pulse transit time (PWVTT) and as calculated from distensibility (PWVdist) at the same measurement site and propose a solution to the disparity in dependences of PWVTT and PWVdist. METHODS Adult anaesthetized rats (n = 24) were randomly paced at HRs 300-500 bpm, at 50 bpm steps. At each step, aortic PWVTT (two pressure-tip catheters) and PWVdist (pressure-tip catheter and ultrasound wall-tracking; abdominal aorta) were measured simultaneously while BP was varied pharmacologically. RESULTS HR dependence of PWVdist paradoxically decreased at higher levels of BP. In addition, BP dependence of PWVdist was much larger than that of PWVTT. These discrepancies are explained in that standard PWVdist uses an approximate derivative of pressure to diameter, which overestimates PWV with increasing pulse pressure (PP). In vivo, PP decreases as HR increases, potentially causing a PWVdist decrease with HR. Estimating the full pressure-diameter curve for each HR corrected for this effect by enabling calculation of the true derivative at diastolic BP. This correction yielded a PWVdist that shows HR and BP dependences similar to those of PWVTT. As expected, BP dependence of all PWV metrics was much larger than HR dependence. CONCLUSION Measured and calculated PWV have different dependences on HR and BP. These differences are, at least in part, because of approximations made in using systolic and diastolic values to calculate distensibility.
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Affiliation(s)
- Bart Spronck
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, School of Engineering & Applied Science, Yale University, New Haven, Connecticut, USA
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Koen D. Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Dana Georgevsky
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Alberto P. Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Panula T, Koivisto T, Pänkäälä M, Niiranen T, Kantola I, Kaisti M. An instrument for measuring blood pressure and assessing cardiovascular health from the fingertip. Biosens Bioelectron 2020; 167:112483. [PMID: 32818750 DOI: 10.1016/j.bios.2020.112483] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Despite blood pressure being one the leading modifiable risk factors for cardiovascular disease and death, it is severely under-monitored. For this challenge we propose a finger artery non-invasive tono-oscillometric monitor (FANTOM) which is an automated low-cost instrument for measuring blood pressure and hemodynamic parameters from the fingertip. The sensing technology is highly scalable and could be integrated to a pulse oximeter probe for increased patient comfort. A tonometric cuff-less mechatronic system is used to apply pressure on the fingertip for (i) measuring oscillometric blood pressure, (ii) recording arterial waveform and for (iii) constructing central blood pressure (CBP) waveform. Clinical study on volunteers (n = 33) was performed against a commercially available arm cuff device yielding systolic and diastolic readings ((mean±SD) mmHg) of (-0.9 ± 7.3) mmHg and (-3.3 ± 6.6) mmHg respectively. The results comply with the Association for the Advancement of Medical Instrumentation (AAMI) standard for non-invasive blood pressure monitors. The arterial pulse recording morphology was compared against a volume clamp device (CNSystems CNAP 500) (n = 3) resulting in similar performance. Comparison of CBP against a pulse wave analysis (PWA) device (Atcor Medical Sphygmocor XCEL) (n = 5) revealed central aortic systolic pulse (CASP) and central augmentation index (cAIx) estimates with precision and accuracy of (2.0 ± 3.7) mmHg and (1.4 ± 6.2)% respectively. In conclusion, the results indicate that the proposed technology could be useful in the development of new portable or wearable blood pressure monitors. The sensing technology is highly scalable and could be integrated to a pulse oximeter probe for increased patient comfort.
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Affiliation(s)
- Tuukka Panula
- Department of Future Technologies, University of Turku, 20520, Turku, Finland.
| | - Tero Koivisto
- Department of Future Technologies, University of Turku, 20520, Turku, Finland
| | - Mikko Pänkäälä
- Department of Future Technologies, University of Turku, 20520, Turku, Finland
| | - Teemu Niiranen
- Department of Clinical Medicine, University of Turku, 20520, Turku, Finland
| | | | - Matti Kaisti
- Department of Future Technologies, University of Turku, 20520, Turku, Finland; Department of Bioengineering, Imperial College London, London SW7 2AZ, UK.
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21
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Battistoni A, Michielon A, Marino G, Savoia C. Vascular Aging and Central Aortic Blood Pressure: From Pathophysiology to Treatment. High Blood Press Cardiovasc Prev 2020; 27:299-308. [PMID: 32572706 DOI: 10.1007/s40292-020-00395-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/13/2020] [Indexed: 12/30/2022] Open
Abstract
Large conductive arteries undergo to structural modifications by aging, eventually leading to increased vascular stiffness. As consequence, cardiovascular hemodynamic changes by increasing central blood pressure which may be also associated to the remodelling of peripheral resistance arteries that contribute to increase further the central vascular stiffness and blood pressure. These modifications resemble the ones that has been shown in essential hypertension, thus a condition of "early vascular aging" has been described in hypertensive patients. Since hypertension related target organs, particularly the heart, face aortic blood pressure rather than brachial blood pressure, it has been recently suggested that central blood pressure and other parameters of large arteries' stiffness, including pulse wave velocity (PWV), may better correlate with subclinical organ damage and might be useful to assess the cardiovascular risk of patients beyond the traditional risk factors. Different devices have been validated to measure central blood pressure and PWV, and are currently available for clinical use. The increasing application of these tools in clinical practice could improve the management of hypertensive patients by better defining the cardiovascular risk and address the antihypertensive therapy.
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Affiliation(s)
- Allegra Battistoni
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Division of Cardiology, Cardiology Unit and Chair Sant Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035-37 00189, Rome, Italy
| | - Alberto Michielon
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Division of Cardiology, Cardiology Unit and Chair Sant Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035-37 00189, Rome, Italy
| | - Gaetano Marino
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Division of Cardiology, Cardiology Unit and Chair Sant Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035-37 00189, Rome, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Division of Cardiology, Cardiology Unit and Chair Sant Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035-37 00189, Rome, Italy.
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22
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Wang J, Liu K, Sun Q, Ni X, Ai F, Wang S, Yan Z, Liu D. Diaphragm-based optical fiber sensor for pulse wave monitoring and cardiovascular diseases diagnosis. JOURNAL OF BIOPHOTONICS 2019; 12:e201900084. [PMID: 31219245 DOI: 10.1002/jbio.201900084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
Arterial pulse wave has been considered as a vital sign in assessment of cardiovascular diseases. Noninvasive pulse sensor with compact structure, immunity to electro-magnetic interference and high sensitivity is the research focus in recent years. While, optical fiber biosensor is a competitive option to meet these needs. Here, a diaphragm-based optical fiber pulse sensor was proposed to achieve high-precision radial pulse wave monitoring. A wearable device was developed, composed of a sports wristband and an aluminum diaphragm-based optical fiber sensor tip of only 1 cm in diameter, which was highly sensitive to the weak acoustic signal. In particular, coherent phase detection was adopted to improve detection signal-to-noise ratio, so as to recover the high-fidelity pulse waveforms. A clinical experiment was carried out to detect and morphological analyze the pulse waveforms of four subjects, the results of which preliminarily demonstrated the feasibility of pulse diagnosis method. The proposed pulse fiber sensor provides a comfortable way for pulse diagnosis, which is promising in early cardiovascular diseases indicating.
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Affiliation(s)
- Jingyi Wang
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Kewei Liu
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qizhen Sun
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiaoling Ni
- Hospital of Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Fan Ai
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Senmao Wang
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhijun Yan
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Deming Liu
- School of Optical and Electronic Information, Wuhan National Laboratory for Optoelectronics, and National Engineering Laboratory for Next Generation Internet Access System, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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23
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Kaisti M, Panula T, Leppänen J, Punkkinen R, Jafari Tadi M, Vasankari T, Jaakkola S, Kiviniemi T, Airaksinen J, Kostiainen P, Meriheinä U, Koivisto T, Pänkäälä M. Clinical assessment of a non-invasive wearable MEMS pressure sensor array for monitoring of arterial pulse waveform, heart rate and detection of atrial fibrillation. NPJ Digit Med 2019; 2:39. [PMID: 31304385 PMCID: PMC6550190 DOI: 10.1038/s41746-019-0117-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/11/2019] [Indexed: 01/07/2023] Open
Abstract
There is an unmet clinical need for a low cost and easy to use wearable devices for continuous cardiovascular health monitoring. A flexible and wearable wristband, based on microelectromechanical sensor (MEMS) elements array was developed to support this need. The performance of the device in cardiovascular monitoring was investigated by (i) comparing the arterial pressure waveform recordings to the gold standard, invasive catheter recording (n = 18), (ii) analyzing the ability to detect irregularities of the rhythm (n = 7), and (iii) measuring the heartrate monitoring accuracy (n = 31). Arterial waveforms carry important physiological information and the comparison study revealed that the recordings made with the wearable device and with the gold standard device resulted in almost identical (r = 0.9–0.99) pulse waveforms. The device can measure the heart rhythm and possible irregularities in it. A clustering analysis demonstrates a perfect classification accuracy between atrial fibrillation (AF) and sinus rhythm. The heartrate monitoring study showed near perfect beat-to-beat accuracy (sensitivity = 99.1%, precision = 100%) on healthy subjects. In contrast, beat-to-beat detection from coronary artery disease patients was challenging, but the averaged heartrate was extracted successfully (95% CI: −1.2 to 1.1 bpm). In conclusion, the results indicate that the device could be useful in remote monitoring of cardiovascular diseases and personalized medicine.
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Affiliation(s)
- Matti Kaisti
- 1Department of Future Technologies, University of Turku, 20500 Turku, Finland.,2Department of Bioengineering, Imperial College London, London, SW7 2AZ UK
| | - Tuukka Panula
- 1Department of Future Technologies, University of Turku, 20500 Turku, Finland
| | | | - Risto Punkkinen
- 1Department of Future Technologies, University of Turku, 20500 Turku, Finland
| | - Mojtaba Jafari Tadi
- 1Department of Future Technologies, University of Turku, 20500 Turku, Finland
| | - Tuija Vasankari
- 4Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland
| | - Samuli Jaakkola
- 4Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland
| | - Tuomas Kiviniemi
- 4Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland.,5Harvard Medical School, MacRae Laboratory Brigham and Women's Hospital, Boston, MA 02115 USA
| | - Juhani Airaksinen
- 4Heart Center, Turku University Hospital and University of Turku, 20521 Turku, Finland
| | | | | | - Tero Koivisto
- 1Department of Future Technologies, University of Turku, 20500 Turku, Finland
| | - Mikko Pänkäälä
- 1Department of Future Technologies, University of Turku, 20500 Turku, Finland
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24
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Noninvasive central systolic blood pressure, not peripheral systolic blood pressure, independently predicts the progression of carotid intima-media thickness in a Chinese community-based population. Hypertens Res 2018; 42:392-399. [DOI: 10.1038/s41440-018-0175-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/20/2018] [Accepted: 09/04/2018] [Indexed: 01/22/2023]
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25
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Harbin MM, Hultgren NE, Kelly AS, Dengel DR, Evanoff NG, Ryder JR. Measurement of Central Aortic Blood Pressure in Youth: Role of Obesity and Sex. Am J Hypertens 2018; 31:1286-1292. [PMID: 30107492 DOI: 10.1093/ajh/hpy128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The relationship between pediatric severe obesity (SO) and central aortic blood pressure (BP) has yet to be established. METHODS We conducted a cross-sectional study of 348 youth (48.5% male, age 12.7 ± 0.1 years) with a wide range of body mass index (BMI) values: normal weight (NW; ≥5th and <85th BMI percentiles), overweight/obesity (OW/OB; 85th to <120% of the 95th BMI percentile), and SO (≥120% of the 95th BMI percentile). Measures of central aortic BP were obtained via applanation tonometry with SphygmoCor MM3 software. RESULTS After adjustment for covariates, no significant sex differences were observed for radial-aortic systolic blood pressure (SBP) (P = 0.39), carotid-aortic SBP (P = 0.99), radial-aortic diastolic blood pressure (DBP) (P = 0.44), and carotid-aortic DBP (P = 0.53). Compared to youth with NW, youth with SO exhibited higher radial-aortic SBP (SO vs. NW: 102 ± 1 mm Hg vs. 90 ± 1 mm Hg, P<0.001), carotid-aortic SBP (SO vs. NW: 121 ± 1 mm Hg vs. 109 ± 1 mm Hg, P<0.001), and carotid-aortic DBP (SO vs. NW: 60 ± 1 mm Hg vs. 56 ± 1 mm Hg, P = 0.04). Compared to youth with OW/OB, youth with SO had higher radial-aortic SBP (OW/OB: 97 ± 1 mm Hg, P = 0.002) and carotid-aortic SBP (OW/OB: 114 ± 1 mm Hg, P = 0.007). After adjusting for either total-body percent fat mass or visceral adipose tissue, BMI was still a significant predictor of both radial-aortic and carotid-aortic SBP and DBP (P<0.001, all). CONCLUSIONS In a cohort of youth with a wide range of adiposity levels, central aortic BP was elevated among individuals with SO and associated with BMI but not body fatness.
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Affiliation(s)
- Michelle M Harbin
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Neil E Hultgren
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Donald R Dengel
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nicholas G Evanoff
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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26
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Joseph J, P M N, Shah MI, Sivaprakasam M. Arterial compliance probe for cuffless evaluation of carotid pulse pressure. PLoS One 2018; 13:e0202480. [PMID: 30114216 PMCID: PMC6095577 DOI: 10.1371/journal.pone.0202480] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/04/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Assessment of local arterial properties has become increasingly important in cardiovascular research as well as in clinical domains. Vascular wall stiffness indices are related to local pulse pressure (ΔP) level, mechanical and geometrical characteristics of the arterial vessel. Non-invasive evaluation of local ΔP from the central arteries (aorta and carotid) is not straightforward in a non-specialist clinical setting. In this work, we present a method and system for real-time and beat-by-beat evaluation of local ΔP from superficial arteries-a non-invasive, cuffless and calibration-free technique. METHODS The proposed technique uses a bi-modal arterial compliance probe which consisted of two identical magnetic plethysmograph (MPG) sensors located at 23 mm distance apart and a single-element ultrasound transducer. Simultaneously measured local pulse wave velocity (PWV) and arterial dimensions were used in a mathematical model for calibration-free evaluation of local ΔP. The proposed approach was initially verified using an arterial flow phantom, with invasive pressure catheter as the reference device. The developed porotype device was validated on 22 normotensive human subjects (age = 24.5 ± 4 years). Two independent measurements of local ΔP from the carotid artery were made during physically relaxed and post-exercise condition. RESULTS Phantom-based verification study yielded a correlation coefficient (r) of 0.93 (p < 0.001) for estimated ΔP versus reference brachial ΔP, with a non-significant bias and standard deviation of error equal to 1.11 mmHg and ±1.97 mmHg respectively. The ability of the developed system to acquire high-fidelity waveforms (dual MPG signals and ultrasound echoes from proximal and distal arterial walls) from the carotid artery was demonstrated by the in-vivo validation study. The group average beat-to-beat variation in measured carotid local PWV, arterial diameter parameters-distension and end-diastolic diameter, and local ΔP were 4.2%, 2.6%, 3.3%, and 10.2% respectively in physically relaxed condition. Consistent with the physiological phenomenon, local ΔP measured from the carotid artery of young populations was, on an average, 22 mmHg lower than the reference ΔP obtained from the brachial artery. Like the reference brachial blood pressure (BP) monitor, the developed prototype device reliably captured variations in carotid local ΔP induced by an external intervention. CONCLUSION This technique could provide a direct measurement of local PWV, arterial dimensions, and a calibration-free estimate of beat-by-beat local ΔP. It can be potentially extended for calibration-free cuffless BP measurement and non-invasive characterization of central arteries with locally estimated biomechanical properties.
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Affiliation(s)
- Jayaraj Joseph
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Nabeel P M
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Malay Ilesh Shah
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Mohanasankar Sivaprakasam
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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27
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Melville S, Teskey R, Philip S, Simpson JA, Lutchmedial S, Brunt KR. A Comparison and Calibration of a Wrist-Worn Blood Pressure Monitor for Patient Management: Assessing the Reliability of Innovative Blood Pressure Devices. J Med Internet Res 2018; 20:e111. [PMID: 29695375 PMCID: PMC5943631 DOI: 10.2196/jmir.8009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 01/09/2023] Open
Abstract
Background Clinical guidelines recommend monitoring of blood pressure at home using an automatic blood pressure device for the management of hypertension. Devices are not often calibrated against direct blood pressure measures, leaving health care providers and patients with less reliable information than is possible with current technology. Rigorous assessments of medical devices are necessary for establishing clinical utility. Objective The purpose of our study was 2-fold: (1) to assess the validity and perform iterative calibration of indirect blood pressure measurements by a noninvasive wrist cuff blood pressure device in direct comparison with simultaneously recorded peripheral and central intra-arterial blood pressure measurements and (2) to assess the validity of the measurements thereafter of the noninvasive wrist cuff blood pressure device in comparison with measurements by a noninvasive upper arm blood pressure device to the Canadian hypertension guidelines. Methods The cloud-based blood pressure algorithms for an oscillometric wrist cuff device were iteratively calibrated to direct pressure measures in 20 consented patient participants. We then assessed measurement validity of the device, using Bland-Altman analysis during routine cardiovascular catheterization. Results The precalibrated absolute mean difference between direct intra-arterial to wrist cuff pressure measurements were 10.8 (SD 9.7) for systolic and 16.1 (SD 6.3) for diastolic. The postcalibrated absolute mean difference was 7.2 (SD 5.1) for systolic and 4.3 (SD 3.3) for diastolic pressures. This is an improvement in accuracy of 33% systolic and 73% diastolic with a 48% reduction in the variability for both measures. Furthermore, the wrist cuff device demonstrated similar sensitivity in measuring high blood pressure compared with the direct intra-arterial method. The device, when calibrated to direct aortic pressures, demonstrated the potential to reduce a treatment gap in high blood pressure measurements. Conclusions The systolic pressure measurements of the wrist cuff have been iteratively calibrated using gold standard central (ascending aortic) pressure. This improves the accuracy of the indirect measures and potentially reduces the treatment gap. Devices that undergo auscultatory (indirect) calibration for licensing can be greatly improved by additional iterative calibration via intra-arterial (direct) measures of blood pressure. Further clinical trials with repeated use of the device over time are needed to assess the reliability of the device in accordance with current and evolving guidelines for informed decision making in the management of hypertension. Trial Registration ClinicalTrials.gov NCT03015363; https://clinicaltrials.gov/ct2/show/NCT03015363 (Archived by WebCite at http://www.webcitation.org/6xPZgseYS)
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Affiliation(s)
- Sarah Melville
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada.,Cardiovascular Research New Brunswick, New Brunswick Heart Centre, Saint John, NB, Canada
| | - Robert Teskey
- Cardiovascular Research New Brunswick, New Brunswick Heart Centre, Saint John, NB, Canada.,Department of Cardiology, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Shona Philip
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada.,Cardiovascular Research New Brunswick, New Brunswick Heart Centre, Saint John, NB, Canada
| | - Jeremy A Simpson
- Department of Human Health Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Sohrab Lutchmedial
- Cardiovascular Research New Brunswick, New Brunswick Heart Centre, Saint John, NB, Canada.,Department of Cardiology, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Keith R Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada.,Cardiovascular Research New Brunswick, New Brunswick Heart Centre, Saint John, NB, Canada.,Department of Cardiology, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
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Maso Talou GD, Blanco PJ, Ares GD, Guedes Bezerra C, Lemos PA, Feijóo RA. Mechanical Characterization of the Vessel Wall by Data Assimilation of Intravascular Ultrasound Studies. Front Physiol 2018; 9:292. [PMID: 29643815 PMCID: PMC5882902 DOI: 10.3389/fphys.2018.00292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/12/2018] [Indexed: 12/24/2022] Open
Abstract
Atherosclerotic plaque rupture and erosion are the most important mechanisms underlying the sudden plaque growth, responsible for acute coronary syndromes and even fatal cardiac events. Advances in the understanding of the culprit plaque structure and composition are already reported in the literature, however, there is still much work to be done toward in-vivo plaque visualization and mechanical characterization to assess plaque stability, patient risk, diagnosis and treatment prognosis. In this work, a methodology for the mechanical characterization of the vessel wall plaque and tissues is proposed based on the combination of intravascular ultrasound (IVUS) imaging processing, data assimilation and continuum mechanics models within a high performance computing (HPC) environment. Initially, the IVUS study is gated to obtain volumes of image sequences corresponding to the vessel of interest at different cardiac phases. These sequences are registered against the sequence of the end-diastolic phase to remove transversal and longitudinal rigid motions prescribed by the moving environment due to the heartbeat. Then, optical flow between the image sequences is computed to obtain the displacement fields of the vessel (each associated to a certain pressure level). The obtained displacement fields are regarded as observations within a data assimilation paradigm, which aims to estimate the material parameters of the tissues within the vessel wall. Specifically, a reduced order unscented Kalman filter is employed, endowed with a forward operator which amounts to address the solution of a hyperelastic solid mechanics model in the finite strain regime taking into account the axially stretched state of the vessel, as well as the effect of internal and external forces acting on the arterial wall. Due to the computational burden, a HPC approach is mandatory. Hence, the data assimilation and computational solid mechanics computations are parallelized at three levels: (i) a Kalman filter level; (ii) a cardiac phase level; and (iii) a mesh partitioning level. To illustrate the capabilities of this novel methodology toward the in-vivo analysis of patient-specific vessel constituents, mechanical material parameters are estimated using in-silico and in-vivo data retrieved from IVUS studies. Limitations and potentials of this approach are exposed and discussed.
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Affiliation(s)
- Gonzalo D Maso Talou
- National Laboratory for Scientific Computing, Department of Mathematical and Computational Methods, Petrópolis, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, São Paulo, Brazil
| | - Pablo J Blanco
- National Laboratory for Scientific Computing, Department of Mathematical and Computational Methods, Petrópolis, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, São Paulo, Brazil
| | - Gonzalo D Ares
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, São Paulo, Brazil.,National Scientific and Technical Research Council, Buenos Aires, Argentina.,CAE Group, National University of Mar del Plata, Mar del Plata, Argentina
| | - Cristiano Guedes Bezerra
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, São Paulo, Brazil.,Department of Interventional Cardiology, Heart Institute (Incor), São Paulo, Brazil
| | - Pedro A Lemos
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, São Paulo, Brazil.,Department of Interventional Cardiology, Heart Institute (Incor), São Paulo, Brazil
| | - Raúl A Feijóo
- National Laboratory for Scientific Computing, Department of Mathematical and Computational Methods, Petrópolis, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, São Paulo, Brazil
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Kouvas N, Tsioufis C, Vogiatzakis N, Sanidas E, Konstantinidis D, Kintis K, Dimitriadis K, Kakosaiou Z, Tsioufis P, Kouremeti M, Katsiki N, Tousoulis D. Heart Rate and Blood Pressure: "Connecting the Dots" in Epidemiology and Pathophysiology. Angiology 2017; 69:660-665. [PMID: 29232971 DOI: 10.1177/0003319717746524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is robust evidence from epidemiological and clinical studies showing that elevated heart rate (HR) constitutes a powerful predictor of morbidity and mortality in patients with hypertension, underlining the significance of HR measurement in them. Autonomous nervous system dysfunction and atherosclerosis are important features in the pathogenesis of the untoward events. However, the relationship between HR and blood pressure (BP) is complex and differs depending on the type of BP measurement which is considered. This differentiation implicates complex physiological mechanisms and is of clinical importance regarding the divergent effect of the different types of antihypertensive agents on these parameters. The aim of this review is to summarize the current evidence on the relationship between HR and BP based on epidemiological, clinical, and experimental studies.
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Affiliation(s)
- Nikos Kouvas
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Vogiatzakis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elias Sanidas
- 2 Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Dimitrios Konstantinidis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Kintis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Zoi Kakosaiou
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Mairi Kouremeti
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Niki Katsiki
- 3 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitrios Tousoulis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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30
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Iulita MF, Noriega de la Colina A, Girouard H. Arterial stiffness, cognitive impairment and dementia: confounding factor or real risk? J Neurochem 2017; 144:527-548. [PMID: 28991365 DOI: 10.1111/jnc.14235] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/18/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022]
Abstract
Large artery stiffness is a frequent condition that arises with ageing, and is accelerated by the presence of co-morbidities like hypertension, obesity and diabetes. Although epidemiological studies have indicated an association between arterial stiffness, cognitive impairment and dementia, the precise effects of stiff arteries on the brain remains obscure. This is because, in humans, arterial stiffness is often accompanied by other factors such as age, high blood pressure, atherosclerosis and inflammation, which could themselves damage the brain independently of stiffness. Therefore, the question remains: is arterial stiffness a true risk for cognitive decline? Or, is it a confounding factor? In this review, we provide an overview of arterial stiffness and its impact on brain function based on human and animal studies. We summarize the evidence linking arterial stiffness to cognitive dysfunction and dementia, and discuss the role of new animal models to better understand the mechanisms by which arterial stiffness affects the brain. We close with an overview of treatments to correct stiffness and discuss the challenges to translate them to real patient care. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- M Florencia Iulita
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, 2900, Edouard-Montpetit, Canada
| | - Adrián Noriega de la Colina
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Université de Montréal, 4545, Chemin Queen Mary, Canada
| | - Hélène Girouard
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, 2900, Edouard-Montpetit, Canada
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Bonnet B, Jourdan F, du Cailar G, Fesler P. Noninvasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension. Am J Physiol Heart Circ Physiol 2017; 313:H237-H243. [PMID: 28476921 DOI: 10.1152/ajpheart.00086.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
Abstract
End-systolic left ventricular (LV) elastance (Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection ("ejection P-V curve" method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship (r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance (Ea) was compensated by a parallel increase in Ees without change in Ea/Ees In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.NEW & NOTEWORTHY The use of real-time three-dimensional echocardiography-derived left ventricular volumes in conjunction with carotid tonometry was found to be reproducible and sensitive enough to detect expected differences in left ventricular elastance in arterial hypertension. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.
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Affiliation(s)
- Benjamin Bonnet
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.,Laboratoire de Mécanique et de Génie Civil (UMR 5508), Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules, Université de Montpellier, Montpellier, France; and
| | - Franck Jourdan
- Laboratoire de Mécanique et de Génie Civil (UMR 5508), Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules, Université de Montpellier, Montpellier, France; and
| | - Guilhem du Cailar
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France;
| | - Pierre Fesler
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, Institut National de la Santé et de la Recherche Médicale U1046, Centre National de la Recherche Scientifique, UMR 9214, Montpellier, France
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Miyashita H. The time is ripe to reevaluate the second derivative of the digital photoplethysmogram (SDPTG), originating in Japan, as an important tool for cardiovascular risk and central hemodynamic assessment. Hypertens Res 2017; 40:429-431. [DOI: 10.1038/hr.2016.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Suleman R, Padwal R, Hamilton P, Senthilselvan A, Alagiakrishnan K. Association between central blood pressure, arterial stiffness, and mild cognitive impairment. Clin Hypertens 2017; 23:2. [PMID: 28105372 PMCID: PMC5237557 DOI: 10.1186/s40885-016-0058-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/26/2016] [Indexed: 01/23/2023] Open
Abstract
Background To determine the relationship between central blood pressure (CBP) indices and mild cognitive impairment (MCI) in adults over the age of 50. Methods A cross-sectional study conducted using a non-invasive SphygmoCor XCEL device. CBP indices and brachial blood pressure were measured in 50 inpatients and outpatients. MCI was assessed using the Montreal Cognitive Assessment (MoCA) instrument and by the European Consortium Criteria (ECC). Results Seventy-six percent of subjects had hypertension, and 52% were diagnosed as having MCI using the ECC. No significant association was found between any of the measured blood pressure variables and global cognition. A significant relationship was observed between augmentation index (AI) and abnormal clock-drawing (p = 0.04) and language (p = 0.02), and between pulse pressure amplification (PPA) and language (p = 0.03). Conclusion CBP indices like AI and PPA, which are markers of vascular stiffness, are associated with poor executive function and language cognitive domain deficits.
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Affiliation(s)
- R Suleman
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - R Padwal
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - P Hamilton
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - A Senthilselvan
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | - K Alagiakrishnan
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Canada ; University of Alberta Hospital, B146, Clinical Sciences Building, 8440-112 Street, Edmonton, T6G 2G3 Canada
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Second derivative of the finger photoplethysmogram and cardiovascular mortality in middle-aged and elderly Japanese women. Hypertens Res 2016; 40:207-211. [PMID: 27682652 DOI: 10.1038/hr.2016.123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 01/12/2023]
Abstract
The second derivative of the digital photoplethysmogram (SDPTG) is an indicator of arterial stiffness. The ratio of the height of the d wave to the a wave of the SDPTG (d/a) is associated with functional peripheral vascular tension and represents aortic-blood pressure (BP) augmented by reflection waves from the periphery. This longitudinal study aimed to investigate the relationship between SDPTG and cardiovascular mortality in middle-aged and elderly Japanese women. From 1998 to 2008, we recruited 4373 women (50-79 years old at baseline) who underwent medical check-ups and SDPTG measurement. The SDPTG index (d/a) was calculated from the wave component height, and was divided into quartiles (Q) according to the d/a value. The median follow-up period was 9.0 years. The d/a value was negatively associated with age and BP, and positively associated with heart rate and body height. Using the Cox proportional hazards model, the hazard ratios for cardiovascular mortality for Q2, Q3 and Q4 were significantly higher than that of Q1. In multivariate analysis, the hazard ratio was 2.30 for Q3 (95% confidence interval (CI): 1.06-4.99, P<0.05) and 2.60 for Q4 (95% CI: 1.21-5.60, P<0.05), after adjustment for age, height, body mass index, BP levels, heart rate and other atherosclerosis-related factors. The hazard ratios of cardiovascular mortality for Q3 and Q4 were significantly higher compared with the reference (Q1). Thus, the SDPTG d/a is an independent predictor of cardiovascular mortality in middle-aged and elderly Japanese women.
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Accuracy of commercial devices and methods for noninvasive estimation of aortic systolic blood pressure a systematic review and meta-analysis of invasive validation studies. J Hypertens 2016; 34:1237-48. [DOI: 10.1097/hjh.0000000000000921] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Verberk WJ, Cheng HM, Huang LC, Lin CM, Teng YP, Chen CH. Practical Suitability of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Review of the Microlife WatchBP Office Central. Pulse (Basel) 2016; 3:205-16. [PMID: 27195242 DOI: 10.1159/000443771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Accumulating evidence indicates that central blood pressure (CBP) is a better cardiovascular risk predictor than brachial blood pressure (BP). Although more additional benefits of CBP-based treatment above usual hypertension treatment are to be demonstrated, the demand for implementing CBP assessment in general clinical practice is increasing. For this, the measurement procedure must be noninvasive, easy to perform, and cost- and time-efficient. Therefore, oscillometric devices with the possibility to assess CBP seem the best option. Recently, such an oscillometric BP monitor, the Microlife WatchBP Office Central, was developed, which demonstrated its high accuracy in a validation study against invasive BP measurement. Calibration errors of this device are limited because the procedure is automated, standardized, and performed at the same place of and within 30 s from pulse wave assessment. The transformation from the peripheral pulse wave to CBP is done by means of an individual-based pulse wave analysis according to a theory of arterial compliance and wave reflections. In addition, the device has demonstrated to enable a more reliable diagnosis of hypertension by CBP than by peripheral BP, with a lower frequency of over- and underdiagnosis. Altogether, the available clinical evidence suggests that the Microlife WatchBP Office Central fulfills the criteria for general clinical use.
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Affiliation(s)
- Willem J Verberk
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands; Department of Research and Development, Microlife Corporation, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Li-Chih Huang
- Department of Research and Development, Microlife Corporation, Taipei, Taiwan, ROC
| | - Chia-Ming Lin
- Department of Research and Development, Microlife Corporation, Taipei, Taiwan, ROC
| | - Yao-Pin Teng
- Department of Research and Development, Microlife Corporation, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
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Fan F, Qi L, Jia J, Xu X, Liu Y, Yang Y, Qin X, Li J, Li H, Zhang Y, Huo Y. Noninvasive Central Systolic Blood Pressure Is More Strongly Related to Kidney Function Decline Than Peripheral Systolic Blood Pressure in a Chinese Community-Based Population. Hypertension 2016; 67:1166-72. [PMID: 27141056 DOI: 10.1161/hypertensionaha.115.07019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
This study aimed to investigate the association of noninvasive central aortic blood pressure with kidney function decline in a Chinese community-based population with normal kidney function at baseline. A total of 3153 Chinese participants from an atherosclerosis cohort were included in our analysis. The primary outcome was renal function decline defined as a drop in estimated glomerular filtration rate (eGFR) category accompanied by a ≥25% drop in eGFR from baseline; or a sustained decline in eGFR of >5 mL/min per 1.73 m(2)/y. The secondary outcomes were rapid eGFR decline (a decline in eGFR of >3 mL/min per 1.73 m(2)/y) and new incidence of chronic kidney disease. Participants were 56.6±8.5 years old, 36.0% were males, and 48.8% had hypertension. Mean (SD) baseline eGFR was 101.2±10.6 mL/min per 1.73 m(2) After a mean 2.35-year follow-up, the incidence of renal function decline, rapid eGFR decline and chronic kidney disease were 7.3%, 19.7%, and 0.7%, respectively. In multivariate logistic-regression analyses, central and peripheral systolic blood pressure (SBP) were both independently associated with all outcomes after adjustment for various confounders. When peripheral SBP was forced into the model with central SBP simultaneously, its significant association with the 3 outcomes all disappeared; however, central SBP was still significantly related with all outcomes even after further adjusting peripheral SBP. In conclusion, central SBP is a stronger predictor compared with peripheral SBP for early kidney function decline in a Chinese community-based population with normal kidney function at baseline.
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Affiliation(s)
- Fangfang Fan
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Litong Qi
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Jia Jia
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Xin Xu
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Yan Liu
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Yang Yang
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Xianhui Qin
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Jianping Li
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Haixia Li
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Yan Zhang
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.).
| | - Yong Huo
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.).
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Townsend RR, Rosendorff C, Nichols WW, Edwards DG, Chirinos JA, Fernhall B, Cushman WC. American Society of Hypertension position paper: central blood pressure waveforms in health and disease. ACTA ACUST UNITED AC 2015; 10:22-33. [PMID: 26612106 DOI: 10.1016/j.jash.2015.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/14/2015] [Accepted: 10/28/2015] [Indexed: 01/07/2023]
Abstract
A number of devices are available which noninvasively estimate central aortic blood pressure using a variety of approaches such as tonometry or oscillometry. In this position paper, we discuss how the central pressure waveform is generated and measured, how central pressure waveforms appear in health and disease, the predictive value of central blood pressure measurements, the effects of interventions on waveforms, and areas of future need in this field of clinical and research endeavor.
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Affiliation(s)
- Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Clive Rosendorff
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Wilmer W Nichols
- Division of Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - William C Cushman
- Department of Medicine Service, Veterans Affairs Medical Center, University of Tennessee College of Medicine, Memphis, TN, USA
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Pereira T, Correia C, Cardoso J. Novel Methods for Pulse Wave Velocity Measurement. J Med Biol Eng 2015; 35:555-565. [PMID: 26500469 PMCID: PMC4609308 DOI: 10.1007/s40846-015-0086-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/14/2015] [Indexed: 12/22/2022]
Abstract
The great incidence of cardiovascular (CV) diseases in the world spurs the search for new solutions to enable an early detection of pathological processes and provides more precise diagnosis based in multi-parameters assessment. The pulse wave velocity (PWV) is considered one of the most important clinical parameters for evaluate the CV risk, vascular adaptation, and therapeutic efficacy. Several studies were dedicated to find the relationship between PWV measurement and pathological status in different diseases, and proved the relevance of this parameter. The commercial devices dedicate to PWV estimation make a regional assessment (measured between two vessels), however a local measurement is more precise evaluation of artery condition, taking into account the differences in the structure of arteries. Moreover, the current devices present some limitations due to the contact nature. Emerging trends in CV monitoring are moving away from more invasive technologies to non-invasive and non-contact solutions. The great challenge is to explore the new instrumental solutions that allow the PWV assessment with fewer approximations for an accurately evaluation and relatively inexpensive techniques in order to be used in the clinical routine.
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Affiliation(s)
- Tânia Pereira
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
| | - Carlos Correia
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
| | - João Cardoso
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
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Takahashi M, Miyai N, Nagano S, Utsumi M, Oka M, Yamamoto M, Shiba M, Uematsu Y, Nishimura Y, Takeshita T, Arita M. Orthostatic Blood Pressure Changes and Subclinical Markers of Atherosclerosis. Am J Hypertens 2015; 28:1134-40. [PMID: 25673039 DOI: 10.1093/ajh/hpu301] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/19/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Using a simple standing-up test in normotensive subjects, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP changes and subclinical markers of atherosclerosis. METHODS A total of 515 normotensive subjects aged 35-75 years (58.4±10.0 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP), serum lipids, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and urinary albumin-to-creatinine ratio. Brachial to ankle pulse wave velocity (baPWV) and carotid mean intima-media thickness (IMT) were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency. RESULTS SBP and DBP decreased when standing, with a reduction of SBP when changing position of -8.0±10.2mm Hg. Orthostatic hypotension (OH) produced a significantly higher SBP than without OH. The baPWV was significantly higher in OH than in without OH. Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, HbA1c, hs-CRP, IMT, late systolic peak of the pressure wave form (SBP2), and baPWV confirmed that baPWV, SBP2, and triglycerides were independently related to orthostatic BP changes. Multiple regression analyses showed that a decrease in SBP as well as baseline SBP, age, BMI, and fasting glucose were independent determinants of PWV. CONCLUSIONS We have shown that increased arterial stiffness was associated with OH during a standing-up test. Arterial stiffness may contribute to greater BP responses to postural changes from standing.
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Affiliation(s)
- Maasa Takahashi
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Nobuyuki Miyai
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shiori Nagano
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Miyoko Utsumi
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mayumi Oka
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mio Yamamoto
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mitsuru Shiba
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yuji Uematsu
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yoshiko Nishimura
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Tatsuya Takeshita
- Department of Public Health, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mikio Arita
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan;
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Willemet M, Chowienczyk P, Alastruey J. A database of virtual healthy subjects to assess the accuracy of foot-to-foot pulse wave velocities for estimation of aortic stiffness. Am J Physiol Heart Circ Physiol 2015; 309:H663-75. [PMID: 26055792 PMCID: PMC4537944 DOI: 10.1152/ajpheart.00175.2015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/05/2015] [Indexed: 01/09/2023]
Abstract
While central (carotid-femoral) foot-to-foot pulse wave velocity (PWV) is considered to be the gold standard for the estimation of aortic arterial stiffness, peripheral foot-to-foot PWV (brachial-ankle, femoral-ankle, and carotid-radial) are being studied as substitutes of this central measurement. We present a novel methodology to assess theoretically these computed indexes and the hemodynamics mechanisms relating them. We created a database of 3,325 virtual healthy adult subjects using a validated one-dimensional model of the arterial hemodynamics, with cardiac and arterial parameters varied within physiological healthy ranges. For each virtual subject, foot-to-foot PWV was computed from numerical pressure waveforms at the same locations where clinical measurements are commonly taken. Our numerical results confirm clinical observations: 1) carotid-femoral PWV is a good indicator of aortic stiffness and correlates well with aortic PWV; 2) brachial-ankle PWV overestimates aortic PWV and is related to the stiffness and geometry of both elastic and muscular arteries; and 3) muscular PWV (carotid-radial, femoral-ankle) does not capture the stiffening of the aorta and should therefore not be used as a surrogate for aortic stiffness. In addition, our analysis highlights that the foot-to-foot PWV algorithm is sensitive to the presence of reflected waves in late diastole, which introduce errors in the PWV estimates. In this study, we have created a database of virtual healthy subjects, which can be used to assess theoretically the efficiency of physiological indexes based on pulse wave analysis.
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Affiliation(s)
- Marie Willemet
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom; and
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Jordi Alastruey
- Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, United Kingdom; and
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Vennin S, Mayer A, Li Y, Fok H, Clapp B, Alastruey J, Chowienczyk P. Noninvasive calculation of the aortic blood pressure waveform from the flow velocity waveform: a proof of concept. Am J Physiol Heart Circ Physiol 2015; 309:H969-76. [PMID: 26163442 PMCID: PMC4591398 DOI: 10.1152/ajpheart.00152.2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/21/2015] [Indexed: 01/09/2023]
Abstract
Estimation of aortic and left ventricular (LV) pressure usually requires measurements that are difficult to acquire during the imaging required to obtain concurrent LV dimensions essential for determination of LV mechanical properties. We describe a novel method for deriving aortic pressure from the aortic flow velocity. The target pressure waveform is divided into an early systolic upstroke, determined by the water hammer equation, and a diastolic decay equal to that in the peripheral arterial tree, interposed by a late systolic portion described by a second-order polynomial constrained by conditions of continuity and conservation of mean arterial pressure. Pulse wave velocity (PWV, which can be obtained through imaging), mean arterial pressure, diastolic pressure, and diastolic decay are required inputs for the algorithm. The algorithm was tested using 1) pressure data derived theoretically from prespecified flow waveforms and properties of the arterial tree using a single-tube 1-D model of the arterial tree, and 2) experimental data acquired from a pressure/Doppler flow velocity transducer placed in the ascending aorta in 18 patients (mean ± SD: age 63 ± 11 yr, aortic BP 136 ± 23/73 ± 13 mmHg) at the time of cardiac catheterization. For experimental data, PWV was calculated from measured pressures/flows, and mean and diastolic pressures and diastolic decay were taken from measured pressure (i.e., were assumed to be known). Pressure reconstructed from measured flow agreed well with theoretical pressure: mean ± SD root mean square (RMS) error 0.7 ± 0.1 mmHg. Similarly, for experimental data, pressure reconstructed from measured flow agreed well with measured pressure (mean RMS error 2.4 ± 1.0 mmHg). First systolic shoulder and systolic peak pressures were also accurately rendered (mean ± SD difference 1.4 ± 2.0 mmHg for peak systolic pressure). This is the first noninvasive derivation of aortic pressure based on fluid dynamics (flow and wave speed) in the aorta itself.
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Affiliation(s)
- Samuel Vennin
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, St. Thomas' Hospital, London, United Kingdom; Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Alexia Mayer
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, St. Thomas' Hospital, London, United Kingdom
| | - Ye Li
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, St. Thomas' Hospital, London, United Kingdom
| | - Henry Fok
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, St. Thomas' Hospital, London, United Kingdom
| | - Brian Clapp
- Department of Cardiology, Guy's and St. Thomas' Foundation Trust, London, United Kingdom
| | - Jordi Alastruey
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Phil Chowienczyk
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, St. Thomas' Hospital, London, United Kingdom;
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 938] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Metoki H, Obara T, Asayama K, Satoh M, Hosaka M, Elnagar N, Miyawaki Y, Kojima I, Ohkubo T, Imai Y. Differential effects of angiotensin II receptor blocker and losartan/hydrochlorothiazide combination on central blood pressure and augmentation index. Clin Exp Hypertens 2014; 37:294-302. [DOI: 10.3109/10641963.2014.960972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pereira T, Santos I, Oliveira T, Vaz P, Pereira T, Santos H, Pereira H, Correia C, Cardoso J. Pulse pressure waveform estimation using distension profiling with contactless optical probe. Med Eng Phys 2014; 36:1515-20. [PMID: 25169470 DOI: 10.1016/j.medengphy.2014.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/04/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Abstract
The pulse pressure waveform has, for long, been known as a fundamental biomedical signal and its analysis is recognized as a non-invasive, simple, and resourceful technique for the assessment of arterial vessels condition observed in several diseases. In the current paper, waveforms from non-invasive optical probe that measures carotid artery distension profiles are compared with the waveforms of the pulse pressure acquired by intra-arterial catheter invasive measurement in the ascending aorta. Measurements were performed in a study population of 16 patients who had undergone cardiac catheterization. The hemodynamic parameters: area under the curve (AUC), the area during systole (AS) and the area during diastole (AD), their ratio (AD/AS) and the ejection time index (ETI), from invasive and non-invasive measurements were compared. The results show that the pressure waveforms obtained by the two methods are similar, with 13% of mean value of the root mean square error (RMSE). Moreover, the correlation coefficient demonstrates the strong correlation. The comparison between the AUCs allows the assessment of the differences between the phases of the cardiac cycle. In the systolic period the waveforms are almost equal, evidencing greatest clinical relevance during this period. Slight differences are found in diastole, probably due to the structural arterial differences. The optical probe has lower variability than the invasive system (13% vs 16%). This study validates the capability of acquiring the arterial pulse waveform with a non-invasive method, using a non-contact optical probe at the carotid site with residual differences from the aortic invasive measurements.
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Affiliation(s)
- Tânia Pereira
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal.
| | - Inês Santos
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal
| | - Tatiana Oliveira
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal
| | - Pedro Vaz
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal
| | - Telmo Pereira
- Coimbra College of Health Technology, Coimbra, Portugal
| | - Helder Santos
- Coimbra College of Health Technology, Coimbra, Portugal
| | - Helena Pereira
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal; ISA-Intelligent Sensing Anywhere, Coimbra, Portugal
| | - Carlos Correia
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal
| | - João Cardoso
- Instrumentation Center, Physics Department, University of Coimbra, Coimbra, Portugal
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Herbert A, Cruickshank JK, Laurent S, Boutouyrie P. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J 2014; 35:3122-33. [PMID: 25112663 DOI: 10.1093/eurheartj/ehu293] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Estimated central systolic blood pressure (cSBP) and amplification (Brachial SBP-cSBP) are non-invasive measures potentially prognostic of cardiovascular (CV) disease. No worldwide, multiple-device reference values are available. We aimed to establish reference values for a worldwide general population standardizing between the different available methods of measurement. How these values were significantly altered by cardiovascular risk factors (CVRFs) was then investigated. METHODS AND RESULTS Existing data from population surveys and clinical trials were combined, whether published or not. Reference values of cSBP and amplification were calculated as percentiles for 'Normal' (no CVRFs) and 'Reference' (any CVRFs) populations. We included 45,436 subjects out of 82,930 that were gathered from 77 studies of 53 centres. Included subjects were apparently healthy, not treated for hypertension or dyslipidaemia, and free from overt CV disease and diabetes. Values of cSBP and amplification were stratified by brachial blood pressure categories and age decade in turn, both being stratified by sex. Amplification decreased with age and more so in males than in females. Sex was the most powerful factor associated with amplification with 6.6 mmHg (5.8-7.4) higher amplification in males than in females. Amplification was marginally but significantly influenced by CVRFs, with smoking and dyslipidaemia decreasing amplification, but increased with increasing levels of blood glucose. CONCLUSION Typical values of cSBP and amplification in a healthy population and a population free of traditional CVRFs are now available according to age, sex, and brachial BP, providing values included from different devices with a wide geographical representation. Amplification is significantly influenced by CVRFs, but differently in men and women.
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Affiliation(s)
- Annie Herbert
- Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France Research & Development Department, Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, UK
| | - John Kennedy Cruickshank
- Diabetes, Cardiovascular Medicine & Nutrition, King's College University of London & King's Health Partners, London, UK
| | - Stéphane Laurent
- Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France
| | - Pierre Boutouyrie
- Department of Pharmacology and INSERM U970, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 56 rue Leblanc, Paris 75015, France
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Validation of the pulse decomposition analysis algorithm using central arterial blood pressure. Biomed Eng Online 2014; 13:96. [PMID: 25005686 PMCID: PMC4105793 DOI: 10.1186/1475-925x-13-96] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/24/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is a significant need for continuous noninvasive blood pressure (cNIBP) monitoring, especially for anesthetized surgery and ICU recovery. cNIBP systems could lower costs and expand the use of continuous blood pressure monitoring, lowering risk and improving outcomes.The test system examined here is the CareTaker® and a pulse contour analysis algorithm, Pulse Decomposition Analysis (PDA). PDA's premise is that the peripheral arterial pressure pulse is a superposition of five individual component pressure pulses that are due to the left ventricular ejection and reflections and re-reflections from only two reflection sites within the central arteries.The hypothesis examined here is that the model's principal parameters P2P1 and T13 can be correlated with, respectively, systolic and pulse pressures. METHODS Central arterial blood pressures of patients (38 m/25 f, mean age: 62.7 y, SD: 11.5 y, mean height: 172.3 cm, SD: 9.7 cm, mean weight: 86.8 kg, SD: 20.1 kg) undergoing cardiac catheterization were monitored using central line catheters while the PDA parameters were extracted from the arterial pulse signal obtained non-invasively using CareTaker system. RESULTS Qualitative validation of the model was achieved with the direct observation of the five component pressure pulses in the central arteries using central line catheters. Statistically significant correlations between P2P1 and systole and T13 and pulse pressure were established (systole: R square: 0.92 (p < 0.0001), diastole: R square: 0.78 (p < 0.0001). Bland-Altman comparisons between blood pressures obtained through the conversion of PDA parameters to blood pressures of non-invasively obtained pulse signatures with catheter-obtained blood pressures fell within the trend guidelines of the Association for the Advancement of Medical Instrumentation SP-10 standard (standard deviation: 8 mmHg(systole: 5.87 mmHg, diastole: 5.69 mmHg)). CONCLUSIONS The results indicate that arterial blood pressure can be accurately measured and tracked noninvasively and continuously using the CareTaker system and the PDA algorithm. The results further support the physical model that all of the features of the pressure pulse envelope, whether in the central arteries or in the arterial periphery, can be explained by the interaction of the left ventricular ejection pressure pulse with two centrally located reflection sites.
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Effect of weight loss on central systolic blood pressure in elderly community-dwelling persons. Hypertens Res 2014; 37:933-8. [PMID: 24965169 DOI: 10.1038/hr.2014.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 11/09/2022]
Abstract
Central blood pressure (BP) has been shown to strongly associate with cardiovascular disease and outcome. Recent studies have demonstrated a relationship between changes in body size by exercise training and peripheral BP; however, the effect on changes in central BP is unknown. The aim of this study was to assess whether changes in body size are independently related to changes in central BP in the elderly. The subjects were 11 men (mean age, 68±6 years) and 84 women (68±7 years) from a rural village. Before and at the end of the 12-week training program, metabolic variables, and first peak radial systolic BP (SBP1) and second peak radial SBP (SBP2) as estimates of central SBP, were obtained. Radial augmentation index (AI) was calculated as follows: ((SBP2-diastolic BP (DBP))/(SBP1-DBP)) × 100 (%) and we used AI corrected at heart rate 75 per min (AI@75). After the 12-week training program, weight loss correlated strongly with reduction in brachial mean arterial pressure (MAP), radial SBP1, SBP2 and AI@75. After adjusting for confounding factors, weight loss was significantly and independently associated with each reduction in brachial MAP (β=0.34, P=0.001), radial SBP1 (β=0.31, P=0.002), SBP2 (β=0.37, P<0.001) and AI@75 (β=0.36, P=0.001). These findings suggest that weight loss by a 12-week training program may be an effective strategy to improve central BP parameters among Japanese elderly persons.
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Chulkov VS, Vereina NK, Sinitsyn SP, Dolgushina VF. [Estimation of central blood pressure and arterial stiffness in pregnant women with different forms of hypertension]. TERAPEVT ARKH 2014; 86:15-9. [PMID: 25804034 DOI: 10.17116/terarkh2014861215-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To estimate central (aortic) blood pressure (BP) and arterial stiffness and their prognostic value in the development of preeclampsia (PE) in pregnant women with different forms of hypertension. SUBJECTS AND METHODS The study included 106 patients with chronic hypertension, 21 with the latter concurrent with PE, 63 with gestational hypertension, 10 with PE, and 100 without hypertension. All the women underwent 24-hour BP monitoring by an oscillometric method to estimatecentral (aortic) BP and arterial stiffness at 16-22 weeks' gestation. RESULTS The highest average daily central systolic and diastolic BP was in the pregnant women with PE. ROC analysis showed that the average daily aortic systolic BP greater than 115 mm Hg was most significant for the prediction of PE. The highest values of arterial stiffness (augmentation index, stiffness, maximum rate of blood pressure rise) were detected in the pregnant women with PE in the presence of chronic hypertension. CONCLUSION 24-four BP monitoring inpregnant women can provide additional characteristics that reflect the stiffness of the aorta and peripheral arteries, which may be used to predict PE.
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Determination of central blood pressure by a noninvasive method (brachial blood pressure and QKD interval). J Hypertens 2013; 31:1847-52. [DOI: 10.1097/hjh.0b013e328362bab9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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